Conjunctiva

• Conjunctiva


  Mucous membrane that lines the inner surface of the eyelids and covers the front of the eye
• Conjunctiva

  • Lines body cavity open to exterior
  • Continuous with skin at mucocutaneous junction on lid margin
  • Continuous with corneal epithelium at limbus
  • Volume ~ 7ml
• Histological structure of conjunctiva

  1. Conjunctival sac

  2. Palpebral conjunctiva

  3. Forniceal conjunctiva

  4. Bulbar conjunctiva
• Palpebral conjunctiva


  Inner surface of eyelid (upper and lower)<|>Tightly bound to tarsal plate<|>Uneven surface helps move tears over corneal surface<|>Continuous with lining of nasal cavity via lacrimal puncta
• Forniceal conjunctiva


  Loose<|>Prevents stretching when eye moves<|>Continuous cul-de-sac<|>Loosely attached to fascial sheaths of levator palpebrae superioris and rectus muscles
• Bulbar conjunctiva


  Covers anterior sclera<|>Loosely attached to underlying Tenon's capsule<|>Firmly attached to corneal limbus<|>Contains palisades of Vogt and radial ridges
• Conjunctival epithelium

  Non-keratinised (not dry)<|>Moist surface<|>Secretion of mucus<|>Stratified<|>Cell types: squamous, columnar, cuboidal
• Conjunctival stroma

  Lamina propria (connective tissue)<|>Loose connective tissue<|>Contains nerves, blood vessels, lymphocytes & glands<|>Thickness varies: thickest in forniceal, thinnest in palpebral
• Conjunctival glands

  • Goblet cells in epithelium
  • Crypts of Henle in palpebral conjunctiva
  • Glands of Manz at corneal limbus
  • Glands of Krause in superior fornix
  • Glands of Wolfring in superior palpebral conjunctiva
• Appearance of bulbar conjunctiva & limbus

  • Normal
  • Bulbar redness (sign of superficial inflammation)
  • Limbal redness (sign of keratitis, uveitis, closed-angle glaucoma)
• Appearance of palpebral conjunctiva

  • Normal: upper lid everted, normal papillae, lid redness
  • Abnormal: papillae form, lid roughness
• Clinical signs of conjunctival disorders

  • Discharge: watery, mucoid, mucopurulent
  • Redness
  • Papillae
  • Follicles
  • Oedema (chemosis)
  • Subconjunctival haemorrhage
  • Lymphadenopathy
  • Pinguecula
  • Pterygium
  • Complexion associated melanosis
  • Primary acquired melanosis
• Optometrists routinely examine the conjunctiva and are expected to recognise and grade conjunctival disorders
• Understanding of conjunctival disorders is facilitated by studying the structure from histological specimens and the superficial structure as seen clinically