Superior palpebral Levator muscle

- Superior palpebral levator muscle = retractor of the upper eyelid = located within the orbit
above the globe.
- O = lesser wing of sphenoid bone, and in front of the optic foramen
- As levator approaches the eye from its posterior origin at the orbital apex, a ligament – the
superior transverse ligament (Whitnall’s ligament) may act as a fulcrum.
Whitnall’s ligament:
- Whitnall’s ligament is a fibrous band that spans the anterior superior orbit from the trochlea
to the lacrimal gland fascia.
- Provides support for upper lid and orbital structures and fulcrum
- Ligament is located at the point where levator muscle fibers end and the aponeurosis begins
Levator Aponeurosis
- As it enters the eyelid, the levator becomes a fan-shaped tendinous expansion, the levator
aponeurosis
- Unlike a typical tendon, the aponeurosis spreads out into an extensive sheet posterior to the
orbital septum and extends into the upper lid, fanning out across the entire width
- Tendinous fibres pass through the submuscular connective tissue
- Its posterior fibres insert into the lower anterior surface of tarsal plate, and the anterior
fibers run between the muscles bundles of the orbicularis to insert primarily into the skin of
the eyelid.
- The fibers from levator aponeurosis anchors the skin to the underlying tissues in the pre-
tarsal area of the eyelid, and creates the PALPEBRAL SULCUS.
o The eastern Asian descent, the orbital septum attaches to the tarsal plate more
inferiorly and the aponeurotic fibres do NOT ATTACH as extensively to the
cutaneous tissue
- The 2 side extensions of the aponeurosis are referred to as horns
o Lateral horn = helps to support lacrimal gland by holding it against the orbital roof,
dividing the gland into orbital and palpebral lobes
o The lateral horn then attatches to the lateral palpebral ligament and lateral orbital
tubercle
o The medial horn is attached to the medial palpebral ligament and medial orbital rim
Tarsal muscle (of Muller)
Superior tarsal muscle (of muller) is composed of smooth muscles
- O = posterioinferior aspect of levator muscle
- Begin to appear within the striated muscle at where the muscle becomes aponeurotic
- I = on the superior edge of tarsal plate
- Contraction of Muller’s muscles can provide 2mm of additional lid elevation
The inferior tarsal muscle is found at lower eyelid
- O = inferior rectuc muscle sheath
- I = lower conjunctiva and lower border of tarsal plate
Both nervers are innervated by the sympathetic fibers that widen the palpebral fissure when
activated
Glands of the lids
Meibomian glands (tarsal glands): Modified holocrine sebaceous glands
- Holocrine glands = their secretion is produced by the decompostion of the entire cell. As
each cell degenerates, the nucleus diminishes in size and the cell membrane disintegrates
- No of glands
 Upper lid = 30-40 rows
 Lower lid = 20-30 rows
- Structure: multilobed and arranged vertically with openings to lid margins;
 They occupy the length of tarsal plates
 On eyelid eversion, the vertical rows of Meibomian glands can be seen as
yellow streaks through the palpebral conjunctiva
- Function: produce the outer lipid layer of the tear film in the eye
 The lipid layer protects the eye’s natural moisture or aqueous and allows
eyelid to glide safely over the eye
 Cells on the inner wall of the Meibomian gland accessbue PRODUCE OIL
 When you blink in a normal eye, the lids touch and apply pressure
Meibomian glands causing them to expressing small amount of eyelid. The
upper lid
 When gland is blocked, there is NOT enough oil to coat the tear film =
aqueous evaporates
- Cells in varying stages of decomposition pack each saccule. Decomposed cell move down the
duct towards the opening. The pressure exerted by a blind releases the secreation into the
tear film, at which point the secretion (lipid droplets and cell debris) forms the outmost lipid
layer of tear film.
- The predominant innervation of Meibomian glands is PARASYMPATHETIC
- Secretion of Meibomian glands = meibum.
Single Meibomian gland morphology:
- Multiple holocrine secretory ACINI in tarsal plate
- Arranged circularly around a long central duct and
connected via short, lateral, connecting ductile
- Terminal part of the central duct is lined by an
ingrowth of epidermis (ep) that covers the free lid
margin; forms a SHORT EXCRETORY DUCT that
opens at the posterior part of the lid margin, just
anterior to the MUCOCUTANEOUS JUNCTION (mcj)
near the inner lid border.
- Oily secretion (meibum) is synthesized within the
secretory acini and transported (yellow arrows) in a
distal direction toward the orifice.
 degree of loss of Meibomian
glands

Zeis Glands
- Modified sebaceous HOLOCRINE glands at base of eyelash follicle
- Zeis glands are very similar to Meibomian glands. However, the zeis glands are COMPOSED
OF JUST ONE OR TWO AINI and are associated with the eyelash follicles
- Generally, 2 Zeis glands are present per follicle.
- Function
o To release sebum (oil secretion) into the follicle and thereby PREVENT CILIA FROM
BECOMING DRY AND BRITTLE
Glands of Moll
- Location: near eyelash follicle;
o Myoepithelial cells surround these cells
- Moll glands = specialised APOCRINE glands/ modified sweat glands, empty into lash follicle
o Apolocrine gland = gland’s secretion is composed not of the whole cell but PARTS OF
CELLULAR CYTOPLASM.
 - The large lumen often appears empty and is surrounded by a layer of cuboidal to columnar
secretory cells
- Consist of a spiral that beings as a large cavity, and then forms a duct. The duct might emply
into the duct of Zeis gland, or it might open directly onto the lid margin between cilia.
- Recent studies: immune defence to protect lash shaft and ocular surface?

Accessory lacrimal glands

- Groups of secretory cells with truncated-pyramid shape arranged in an oval pattern around a
central lumen. The acini are surrounded, sometimes incompletely, by a row of myoepithelial
cells
- Ducts of wolfring glands have a tortuous course and open onto the palpebral conjunctiva
- Densely innervated;
Krause & Wolfring:
- Accessory lacrimal glands (aqueous) structure – lacrimal gland
- Location
o Krause – in stroma of conjunctival fornix
 o Wolfring – along orbital border of tarsal plate

Conjunctiva
Parts
- Bulbar  merges with corneal epithelium at limbus
- Palpebral/Tarsal  adheres tightly to tarsus of superior lid, less tightly to inferior lid
- Fonices: loosely attached to conjunctiva
o Accessory lacrimal glands of Krause (@ fornices) & wolfring
o High concentration of goblet cells; lymphocytes (CALT)

1. Limbus
2. Bulbar
3. Fornices
4. Inferior lid
[Link] margin
Function
- Mucous membrane that facilitates movement
- Promote tear film stability
- Protective (e.g. innate immunity)
- “nourishing” (e.g. blood vessels to provide nutrients
Structure
1. Epithelium:
- 5 layers, non-keratinised
- Interspersed with goblet cells (mucin 5AC), Langerhans cells (immune cells),
melanocytes
2. Stroma (substantia propria, submucosa)
- Loose connective tissue, blood vessels
- Accessory lacrimal gland
- Lymphatic vessels, nerves, immune cells (lymphoctyes & mast cells), Lymphoid
follicles (fornices)
Palpebral conjunctiva
The palpebral conjunctiva has 2 layers
1. Epithelium = A stratified epithelial layer
- The epithelial layer of the conjunctiva is continuous with the skin epithelium at the
mucocutaneous junction of the lid margin
- As conjunctiva lines the lid, squamous cells cuboidal and columnar cells = forms a
stratified columnar mucoepithelial layer,
- = the granular and keratinized layers have been discontinued.
- At the mucocutaneous junction, the epithelial layer is approx. 5 cells thick and may be a
location for stem cells that repopulate the palpebral conjunctival epithelium
 2-3 cells thick at upper lid conjunctival epithelium.
 3-4 cells thick for lower lid
  This stratified columnar epithelium continuous throughout the
fornices into the bulbar conjunctiva – where it changes to a
stratified squamous layer near the limbus, becoming continuous
with the corneal epithelium
The surface of superficial conjunctival cell
- Melanin granules are found in the cytoplasm of conjunctival epithelial cells, especially near
the limbus; = give pigmented skin
- Goblet cells = produce mucous component of tear film are found in epithelium
- Subsurface vesicles, found below the outer membrane of the superficial conjunctival cell
2. Stroma = a connective tissue stromal layer, the submucosa.
- The submucosa (stroma, substantia propria) of the palpebral conjunctiva is VERY THIN in the
tarsal portion of the eyelid
- From eye to orbital portion: thickness of stroma increases!
- Is composed of loose, vascularized connective tissue that can be subdivided into the outer
lymphoid layer and a deep fibrous layer
o The lymphoid layer contains macrophages, mast cells, polymorphonuclear
leukocytes and occasional Langerhans cells ( = makes the conjunctiva an
immunologically active tissue);
 More lymphoid tissue is found in palpebral conjunctiva than in bulbar
conjunctive

o The deep fibrous layer connects the conjunctiva to the underlying structures and
contains a random network of collagen fibrils, and numerous fibroblasts, blood
vessels, nerves and accessory lacrimal glands.
 This fibrous layer merges and is continuous with the dense connective tissue
of the tarsal plate
 Lots of blood vessels; a pale palpebral conjunctiva may be a clinical sign of
anemia
o
Cells
Goblet cells
- Secreted gel-forming mucin 5AC
- Mucins are glycoproteins that can be secreted. It can be
o Globular, or
o Membrane bound

-
- Density varies in different locations in human conjunctiva; species variation
 - Distribution: clusters vs homogenous
- Conjunctiva Epithelium: mucin 4.
- In humans, we have more goblet cells on the NASAL LOWER PART OF THE CONJUNCTIVA.

Goblet cells:
- Function = produce, store and secrete the innermost mucous layer of the tear film
o A goblet cell produces mucin droplets that accumulate, causing the cell to swell and
become goblet shaped.
o Parasympathetic and sympathetic nerves.
o Invaginations of conjunctival epithelium, often located near the fornix = are called
the crypts of Henle.
o Goblet cells RELEASE THEIR MUCUS into the cavity formed by these invaginations
and the mucus may become trapped if the opening to the crypt is NARROW.
- Location: scattered through the stratified columnar conjunctival epithelium;
o They are numerous in the inferior nasal aspect of the tarsal conjunctiva
- Increase age = decrease goblet cells
- Increase in inflammatory conditions = decrease goblet cells
opening
of Meibomian glands. Clear
iquid sits in front of the
lipid; grey line – where
riolan muscle is around the
mybomian glands

Caruncle: vascular. Hairy

conjunctiva !
- Mucosal
- Not keratinised
- Immune function
Plica semilunaris: half
moon shaped

Just above anterior lid

margin, there is a tear lake

Plica semilunaris (10): 8-10

layers of epithelium, goblet
cells & blood vessels

Caruncle (11): hair follicles

(12), sebaceous glands
(13), emanating from the
surface, may show focal
surface keratinizationz (14)
and adipose tissue (15)

Bottom: cross section of

the caruncle with palpebral
conjunctiva on both sides
Immune tissue in the (palpebral) conjunctival- associated lymphoid tissue (CALT)

Conjunctival-associated Lymphoid Tissue (CALT)

Mucosa-associated lymphoid tissue (MALT) = part of the immune system located at the mucosal
surfaces

Lymphoid tissue = mainly palpebral conjunctiva, more in upper> lower lid.

1. Diffuse lymphoid layer (lymphocytes and plasma cells, formed a thin layer in the stroma)
2. Follicular accumulations (B lymphocytes)
3. Can be associated with the conjunctival crypts
Lymphoid tissue is found in all mucous membrane that we find within the body, but this is eye-
related. This is a layer of immune cells. This is a local immune monitoring tissue within the
conjunctiva!

There is also lymphoid tissue in the lacrimal drainage of tissue  CALT and LDALT
- Lymphoid tissue with similar characteristics also observed in the lacrimal drainage system =
LDALT
- LDALT = Lacrimal Drainage-Associated Lymphoid Tissue
o (Or EALT = Eye-associated Lymphoid Tissue)

Tears coming across, lymphoid tissue in

palpebral conjunctiva, upper>lower lid.
Little in fornix.

Tears drains to the duct, where there is

immune tissue there, called LDALT
(lacrimal drainage-associated Lymphoid
tissue). This lacrimal immune tissue tries to
pick up some problem e.g. bacteria or virus
that causes response in body.

This feeds back via the lymphatic system to

the lymphocyte recirculation into lymph
nodes = get more immune cells coming
back via the blood system to help with
those areas.

Blood vessels: help to deliver immune cells

into tissue that has a problem
There is a passage way for immune cells to
travel = circulating immune cells !!

Circulating immune cells sneak into the

tissue-based immune cells. Lymphocytes in
tissue.

Monocytes transformed into

macrophages!!
Function of eyelid
- Protect the eye from injury (both lashes and lids)
- Eyebrow shields eyes from bright light coming from directly above;
o Effective barrier to liquids running from the forehead into the eye
- Blink = refresh and maintain tear film; lid ‘components; contribute to tear film
- Aid in tear drainage (Lacrimal drainage; tear pumping)
- Conjunctiva source of corneal nutrition during eye closure
- Aesthetics (appearance); eyebrows can be elevate, depressed, or drawn together (facial
expression)
- Large hairs of eyebrow – abundant sensory innervation and very sensitive to tactile
stimulation
- Stimulation of ‘cilia’ reflex blinking of both eyelids (sensory nerve reflex)

Function
1. Protect eye from injury and shied things away from the cornea (eyelashes curving outward;
eyelids to blink and block)
2. Eyebrows limit light shone to the back of the eye. It stops sweat (liquids) from running from
the forehead to the eye = protect eye surface = help vision
3. Eyelids BLINK = refresh and maintain tear film;
a. Otherwise the tears will eventually thin and vision would be crappy  and surface
will be irregular, tears dries out.
b. Tear film is the first thing to begin! To check vision.
c. lid ‘components’ contribute to tear film
4. Eyelids BLINK = aids in tear drainage. Through the nasal-lacrimal system tears goes into
the punctum and down the nose.
a. Blink = refresh and move the tear along
5. Conjunctiva blood vessels provide nutrients and oxygen to cornea when eyelids are closed
(e.g. when you sleep, eyelid provides O2 to cornea.)
6. Appearance & facial expression
7. Eyebrows and eyelashes = v. sensory.
a. Sends a message to the brain when the eye is close to a foreign object = like cat
whiskers
b. Abundant sensory innervation and very sensitive to tactile stimulation
c. Stimulation of ‘cilia’  reflex blinking of both eyelids ( sensory nerve reflex)
If any of these factors are changed = affects vision!
(Conditions that affect eyelid structure & function (including lashes = compromise ocular surface
integrity and vision.)

Can eyelids go wrong?

- Misdirected, mislocated in the wrong place
o e.g. rolled out, rolled in
- too loose
- too tight
What’s affected?
- Comfort & appearance
- Ocular surface integrity
- Tears: normal tear flow, composition
- Lid margins, conjunctival integrity
- Vision
Tear Film
The tear film covers the ANTERIOR surface of the globe.
Tear film overlays the ocular surface
- Provides an interface between epithelium and the external environment
- Essential for health (homeostasis) & protection of the ocular surface and for good vision
- Basal vs reflex tears
Precorneal tear film thickness = 3-40 μm thick
- This thickness is measured by various techniques e.g. reflectance spectra ~3.4 +/- 2.6
μm
Normal volume (unstimulated) = 7μl
- Tube capillary tube to suck the tears from patient’s tear film
- Certain proteins diagnose diseases.

PART 1: Components of tear film and where they come from

The tear film has 3 main components/layers
1. Lipid phase: Meibomian glands
2. Aqueous phase: Lacrimal gland (& accessory
lacrimal glands)
3. Mucin Phase: secreted by globet cells and
conjunctiva/cornea epithelium
1. Lipid layer
- Lipid layer = outermost layer
- Secreted by: Meibomian glands
Function:
- Reduce evaporation
- Reduce lid ‘spillover’,
- Allow lipid/aqueous phase to mix
- Provides lubrication for smooth eyelid
movement
Composition:
- Contains waxy esters, cholesterol and free
fatty acids (NON-POLAR substances)
- And polar lipids that interact with water:
phospholipids, sphingolipids.
There is a polar and a non-polar lipid layer:
- Outer layer = non-polar = limit aqueous
evaporation from surface
- Inner layer = polar phospholipids = facilitate
interaction with aqueous layer
2. Aqueous layer
- Aqueous layer = middle layer
- Secreted by: main and accessory lacrimal glands
(lacrimal gland and accessory gland); some secretion
from ocular surface cells (e.g. growth hormones,
proteins) & serum from conjunctival blood vessels
Function:
- Keeps eye hydrated
- Repels bacteria Water molecules compete for
- Protects cornea from damage polar mucin attractions =
Composition: prevents adherence of mucins in
- Contains water, electrolytes (inorganic salts), tear film to other tear mucins
- Growth factors &Hormones (estrogen and and underlying glycocalyx.
testosterone)
- Antimicrobial proteins (kill bacteria!= normal ocular Conjunctival goblet cells secrete
surface defence ), Cytokines (pro-inflammatory and mucins and mix with aqueous
anti-inflammatory) layer of the tears.
- Vitamins, glycoproteins There are also membrane bound
- (POLAR substances)  SOLUBLE MUCINS mucins.

Mucins help wet the surface of

the cornea. = polar interface.
3. Mucous layer
- Mucous layer = innermost layer
- Secreted by = conjunctival goblet cells & ocular surface (conjunctival epithelium) cells
Function:
- An interface that facilitates ADHESION of aqueous layer of tears to the OCULAR SURFACE
- Mucins can bind and entrap bacteria and viruses; block binding sites on microbes and
prevent them from penetrating the ocular surface
Composition
- Family 21 mucin genes identified = transmembrane or secretory
- Secretory mucins: produced by goblet & ocular surface cells
  E.g. MUC5AC (goblet cells), MUC2
- Transmembrane mucins: across cells membrane
 E.g. MUC1, MUC4, MUC16
- Inorganic salt, water, large glycoproteins, glycocalyx secretion

- Function 1 = an interface that facilitates ADHESION of aqueous layer of tears to the

OCULAR SURFACE.
- Composition = glycocalyx secretion from the surface epithelia and mucin – both are
produced and secreted by the CONJUCTIVAL GOBLET CELLS.
- Secreted by: conjunctival goblet cells
- Function 2 = mucins can bind and entrap bacteria and viruses; block binding sites on
microbes and prevent them from penetrating the ocular surface
Mucous layer = mucins + inorganic salts + water; large glycoproteins.
There is a family 21 mucin genes identified = transmembrane or secretory
Secretory mucins: produced by goblet & ocular surface cells
- E.g. MUC5AC (goblet cells), MUC2
Transmembrane mucins: across cells membrane
- E.g. MUC1, MUC4, MUC16
 Mucin synthesis in conjunctival
goblet cells
- Synthesis in ER, modified
in Golgi, stored in
secretory granules in
apical portion of the cell
- Stimulation: secretory
granules fuse and
release stored mucin
from apical portion of
cell
- Entire population of
granules are released at
once
- Goblet cell body
resynthesizes mucins to
secrete again.
Electron-microscopy:
Shows the surface epithelium
with the mucinous layer of tear
film (glycocalyx + membrane-
bound mucins)
- mutinous layer = keeps
tear film attached

Corneal epithelial cells (i.e.

surface squamous cells) is NOT
flat. But has microvilli and
microplicae, (i.e. projections) =
folds to INCREASE SA.

Glycocalyx
- The plasma membrane of surface epithelial cells secrets a glycocalyx component (from
its apical end) that adjoins the mucin layer of tear film.
- Glycocalyx = covering of macromolecules (e.g. mucins and glycoproteins)
 Includes transmembrane mucins (e.g. MUC1, MUC4 and MUC16)
 Negatively charged (polyanionic) molecules (e.g. proteoglycans and
glycosaminoglycan)
- Corneal epithelial cells (i.e. surface squamous cells) is NOT flat. But has many projections
@apical surface = folds to INCREASE SA = enhance stability of tear film.
 Microvilli = fingerlike projections
 Microplicae = ridgelike projections
Functions of Glycocalyx
- Binds mucins to hydrophobic ocular surface
- Glycocalyx = CHARGED SURFACE = can bind to molecules e.g. fibrinogen and albumin,
enzymes, cytokines, growth factors
- Glycocalyx =CHARGE-SELECTIVE BARRIER; certain molecules can’t cross epithelial plasma
membrane

Other major tear proteins & ‘components’

Lactoferrin
- Binds free iron in tears
- Binds to negative bacterial cell wall, and then kill them = prevents bacteria binding to
epithelium surface
- Inhibits viral binding to epithelial cells
- Facilitates phagocytosis (via opsonisation) = cell-eating = rid of cells that we don’t want =
HELP IMMUNE FUNCTION
- Protects from oxidative stress
- Helps with wound healing (of damaged epithelium)
Lysozyme
- Help bacteria and viruses and fungi attaching to epithelium !!
- Enzyme that cleaves bonds in peptidoglycan layer in Gram + bacteria cell walls
- Affects bacteria effectively = potential ‘bacterior killer’ (bacteriocidal) when combined
with lactoferrin or SlgA
Lipocalin-1 = large family of proteins
- Secreted from lacrimal gland, may be bacteriostatic (stop bacterial dividing), involved in
lipid transport
- Soak up lipid in the ocular surface = ‘master lipid sponge’ of ocular surface! = maintain
equilibrium of lipids
- Carrier for lipid soluble vitamins and steroid hormones
- A key endonuclease (= cleave nucleui material)
Lacritin
- Pro-secretory mitogen = promotes basal tearing when applied topically good in wound
healing = good for dry eye patients!
- Highly expressed in human lacrimal glands (secretory granules) and Meibomian glands
- Recently found in the gland of Wolfing;
 Also found in primate (non-human) conjunctiva and corneal epithelium
Immunoglobulins = immune-related molecules
- immunoglobulin (ig) = antibodies, glycoprotein molecules produced by plasma cells (white
 blood cells); critical part of the immune response by specifically recognise and bind
antigens, e.g. bacteria or viruses destruction;
 various Ig isotypes differ in biological features, structures, target specificity and
distribution
 isotypes = various antibodies produced by plasma cell are classificed by isotypes
that differ in function and antigen responses – 5 major isotypes idenfitied in
humans = igA, igD, igE, igG, igM
- slgA: main immunoglobulin (protein) in tears
 Prevents bacterial adherence (stick) to epithelium
 Neutralises toxin (produced by bacteria)
 DECREASE ANTIGEN uptake
 Synergise with lysozyme
- igE: important in parasitic infections and responsible for symptoms of atopic allergy
(increased worms in stomach = increase igE in bloodstream)
(increased allergy = increase igE)
- igG: activates classical complement pathway
- igM: activates classical complement pathway
Serum proteins (from blood supply)
- Leak passively into tears from CONJUNCTIVAL BLOOD VESSELS
- increased concentration with sleep (eyes closed); - because closed eye (sleep) = more SA
of eye is covered with eyelid = more SA covered with palpebral conjunctival blood vessels
= more serum proteins; important for binding bacteria; infection
- adhesion bind bacteria, opsonins (aid cell phagocytosis), inflammatory roles
- NEATROPHILS ALSO LEAD FROM CONJUNCTIVAL BLOOD VESSELS
main (immune) cells in tears: neutrophils & macrophages
- activated by complement components, metabolites, various cytokines & chemokines
- involved in killing and ‘eating’ (phagocytosis) of bacteria etc.
- neutrophils increases during sleep. Wake up = decrease neutrophils again.

TedxTalk
Basal tears
Forms 3 layers,
Function = keeps dirt and debris away
Mucus layer keeps everything fastened to her
Aqueous V
Lipid  oily. Keeps ocular surface smooth so that the eye can see; keeps the aqueous layer from
evaporating

Reflex tears
Function = wash away harmful substances
- Hence released in larger amounts
- Contains antibodies to stop microorganism that are trying to get in
Emotional tears
- To Stabilise the mood asap
- Contains higher levels of stress hormones e.g. ACTH, enkephalin

Function of tear film:

1. Keep ocular surface moist and serves as a lubricant between the globe and eyelids
(interface)
a.
 2. Traps & remove cell debris (sloughed off epithelial cells, immune cells = 1st line OCULAR
DEFENCE
3. Provides atmospheric oxygen for the cornea (esp. open eyes)
4. Provides a smooth refractive optical surface = necessary for optimum optical function
5. Contains antibacterial substances (lysozyme, beta-lysin, lactoferrin, immunoglobulins) to
help protect against infection = OCULAR DEFENCE
6. Helps to maintain corneal hydration by changes in tonicity that occur with evaporation
Contain various growth factors, peptides, cytokines (pro and anti-inflammatory) that can regulate
ocular surface normal growth (epithelial turnover) & wound repair
Ocular surface and tear film homeostasis
- Tear secretion involves all ocular adnexa and ocular surface epithelia – and must be
coordinated to maintain ocular homeostasis
- For mucin and aqueous layer, secretion is regulated by neural reflexes.
- Lacrimal gland and goblet cells: sensory nerves in cornea and conjunctiva are activated by
mechanical, chemical and thermal stimuli
 Activate efferent autonomic (parasympathetic and sympathetic nerves) innerve
lacrimal gland and conjunctival goblet cells mucous and fluid secretion
- Lipid layer: blinking regulate release of pre-secreted lipids stored in the Meibomian gland
duct
 When eyelids retract, a thin film of lipid covers underlying aqueous and mucous
layer
Tear secretion = balance of drainage and evaporation
‘lacrimal functional unit’ = an integrated system comprising the lacrimal glands, ocular surface
(cornea, conjunctiva, Meibomian glads, goblet cells and lids), and the sensory and motor nerves
that connect them

Maintaining tear film and ocular surface homeostasis = combination of factors

Conjunctival goblet cells are
surrounded by parasympathetic
and sympathetic nerves

Cornea is innervated with

sensory nerves, which can
activate a neural reflex to
stimulate conjunctival goblet cell
secretion via parasympathetic
nerve releasing ACh and VIP.
Lacrimal secretory system
The secretory system includes:
- Main lacrimal gland
- Accessory lacrimal gland
- Meibomian gland
- Conjunctival goblet cells
The main lacrimal gland is located in a FOSSA on the TEMPORAL side of the orbital plate of the
frontal bone, just posterior to the superior orbital margin.
Lacrimal gland structure
- The lacrimal gland is divided into 2 portions, palpebral (closer to lids) and orbital, by
the aponeurosis levator muscle (located superior-temporal
 The superior surface lies against the periorbita of the lacrimal fossa, the inferior
surface rests against the aponeurosis; the medial edge lies AGAINST the levator;
the lateral edge LIES ON THE LATERAL RECTUS MUSCLE
- The palpebral lobe is 1/3 to size of the orbital lobe and is subdivided into 2-3
sections
- If the upper lid is everted, the lacrimal gland CAN be seen above the edge of the
upper tarsal plate.

- Ducts from both portions of the gland exit through the palpebral lobe
The lacrimal gland consists of lobules made of numerous ACINI.
- Each ACINUS = is an irregular arrangement of secretory cells around a central lumen
surrounded by an incomplete layer of myoepithelial cells
Lacrimal gland tubule-acinar structures in lobules; columnar secretory cells surrounding a central
lumen
- cells secrete aqueous component of tears via secretory granules
- both lacrimal and accessory glands are responsible for BASAL (normal tearing, keep
eye moist) and REFLEX (respond to foreign object & emotions) tear secretion
 (Histologically, the main lacrimal gland = identical to accessory lacrimal gland)
 The accessory glands are located in the subconjunctival tissue, from the fornix
area to the near tarsal plate
- Lacrimal sac & nasolacrimal duct: linked with columnar epithelium and goblet cells
(=mucin production)

- A network of ducts connects the acini and drains into one of the main excretory
ducts
- There are approx. 12 ducts, which empty into the conjunctival sac in the superior
fornix.
- The secretion is composed of: water, electrolytes, and antibacterial agents including
lysozyme, lactoferrin, and immunoglobins
-
Stained dissection lacrimal gland
(for nuclei and surrounding tissues)
Blue = nuclei of cells
The lumens are surrounded by epithelial cells
which are secreting vesicles that produce
aqueous components of the tear film.
Autoimmune cells are here too (i.e. the
plasma cells lymphocytes) !!!

Acini = 2 layers of cells placed on a thin

hyaline basement membrane, surrounding a
1=Lumens, some are filled with secreted protein central lumen. Basal cells are myoepithelial;
2=Secretory vesicles/granules acinar cells are columnar, secrete aqueous
3 = Plasma cells lymphocytes component of tears into ducts. Produce
reflex and basal tears.
Blood vessel connection: The lacrimal gland is supplied by the lacrimal artery, a branch of the
ophthalmic artery
Sensory innervations: is through the lacrimal nerve, (CNV1) [ trigeminal nerve ophthalmic
division nasociliary branch]
- The gland receives vasomotor sympathetic innervation and secretomotor
 parasympathetic innervation
- Autonomic innervation:
 Parasympathetic = increases tear flow
 Sympathetic = decreases tear flow
- Parasympathetic fibres (autonomic nerves) hitchhike via CNVII (motor nerves) 
Pterygopalatime (or sphenopalatine) ganglion  Zygomaticotemporal nerve
lacrimal nerve innervate lacrimal gland  increase tear production
- Sympathetic pathway carotid plexus superior cervical ganglion (no synapses)
innervate lacrimal gland decrease tear production

- Reflex tearing occurs with stimulation of branches of the ophthalmic nerve or in

response to external stimuli (e.g. intense light)
 The afferent pathway is through the trigeminal nerve
 The parasympathetic pathway is through the facial nerve

Parasympathetic system

Nasolacrimal Drainage system

Some tear fluid is lost by EVAPORATION and some by REABSORPTION through CONJUNCTIVAL
TISSUE. However ~75% passes tear liquid is passed through the nasolacrimal drainage system
The nasolacrimal drainage system consists of
- Puncta
- Canaliculi
- Lacrimal sac
- Nasolacrimal duct

Ampulla is between punctum and canaliculi

Functions
1. Both upper and lower lids have a punctum. The puncta is turned towards the globe.
2. Lacrimal puncta: open into upper & lower canaliculi (like tubes), and then join to form the
common canaliculus
3. Canaliculus: opens laterally into the lacrimal sac (lacrimal fossa) into the anterior medial
wall of the orbit
 - The walls of the canaliculi contain elastic tissue, and are surrounded by fibres
from the lacrimal portion of the orbicularis muscle (Horner’s muscle).
- The lacrimal sac lies within a fossa in the anterior portion of the medial orbital
wall. This fossa is formed by the frontal process of the maxillary bone, and the
lacrimal bone.
4. The lacrimal sac joins inferiorly with nasolacrimal duct that empties into nasal cavity
- The duct terminates in the inferior meatus of the nose @ the valve of Hasner.
- The Valve of Hasner is a fold of mucosal tissue that prevents backflowing of
tears/fluid from to nasal cavity/secretion back to the eye (via the duct).
Orbicularis oculi allows us blink  pumping action of muscle allows tears to drain

Tear film distribution

- the lacrimal gland fluid is secreted into the lateral part of the upper fornix and descends
across the anterior surface of the globe
- Orbicularis contracts = forces meibum out of the pores = lid motion spreads the thin lipid
layer across the surface
- Each blink reforms the tear film, spreading it over the ocular surface
- At the posterior edge of both upper and lower eyelid margin, there is a meniscus of tear
fluid.
 The lower lid tear meniscus is seen more easily
 The upper tear meniscus is continuous with the lower meniscus at the lateral
canthus.
 At the medial canthus, the tear meniscus LEAD directly TO PUNTA and DRAINS
into them.
 The lacrimal lake, a tear reservoir, is located in the medial canthus
Tear drainage:
- Close eyelids – eyelids first meet at temporal canthus, then moves towards the medial
canthus = tears pool in the lacrimal lake.
- Hence blink & gravity push tears to the lid margin [Meibomian (lipid) secretion prevents
spillage/evaporation] lacrimal lake forms = lacrimal lake expands  The tear menisci
are pushed towards the lacrimal puncta where they drain into lacrimal sac via canaliculi
 nasolacrimal duct  nasal cavity
- ‘valve’ of Hasner (flap of membrane), at the distal end, prevents tear movement back the
other way
How tears drain
- Nasolacrimal obstructions (e.g. canaliculitis
-
Fluorescein disappearance test

Top:
Fluorescein is instilled in both eyes. The
yellow liquid goes through the puncta of the
eye, to the lacrimal sac via the canalicula and
into nasal cavity, and out the nose.

This test is to test whether the puncta is open

or blocked (or how open it is). We want them
to be OPEN.
The left nostril of the baby doesn’t have
fluroscin flowing out = left puncta is blocked!
(often in babies punctum doesn’t open
properly)
We can also check for anything that may
cause progressive constriction of the puncta
e.g. large hordeolum or chalazion

Bottom: baby under blue light