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FRCOphth part 1 Anatomy of the Ocular appendages > Conjunctiva > Flashcards

Conjunctiva Flashcards

1
Q

What is the conjunctiva?

A

A thin mucous membrane that lines the eyelids and reflects onto the anterior surface of the eyeball

The conjunctiva forms a potential space, the conjunctival sac, which is open at the palpebral fissure.

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2
Q

What are the three regions of the conjunctiva?

A
  • Palpebral conjunctiva
  • Conjunctival fornices
  • Bulbar conjunctiva
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3
Q

Where is the palpebral conjunctiva located?

A

It lines the eyelids and is firmly attached to the posterior surfaces of the tarsal plates

It has been previously described in detail.

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4
Q

What is the function of the conjunctival fornices?

A

It forms transitional regions between the palpebral and bulbar conjunctivae

It is loosely attached to the underlying fascial expansions of the sheaths of the levator and recti muscles.

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5
Q

How far is the superior fornix situated from the limbus?

A

About 10 mm

The inferior fornix is about 8 mm from the limbus.

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6
Q

What structures replace the fornices medially?

A

The caruncle and the plica semilunaris

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7
Q

What is the bulbar (ocular) conjunctiva?

A

The portion that lies in contact with the eyeball and is thin and translucent

The underlying white sclera is clearly visible through it.

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8
Q

What happens about 3 mm from the cornea in the bulbar conjunctiva?

A

It becomes more closely attached to the sclera and the fascia bulbi.

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9
Q

What is the conjunctival limbus?

A

The line along which fusion of the conjunctiva to the cornea occurs

It is situated about 1 mm anterior to the edge or limbus of the cornea.

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10
Q

True or False: The conjunctiva is continuous with the epidermis of the skin at the lid margin.

A

True

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11
Q

Fill in the blank: The ducts of the lacrimal gland open into the lateral part of the _______.

A

superior fornix

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12
Q

What is a significant characteristic of the conjunctival fornices?

A

They permit accumulation of edema fluids due to the looseness of the underlying connective tissue.

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13
Q

What is the junction between the cornea and the sclera called?

A

The bulbar sheath fuses with the sclera about 1.5 mm posterior to the corneal limbus.

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14
Q

What type of cells make up the epithelial covering of the conjunctiva?

A

Stratified columnar cells consisting of two to five layers.

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15
Q

What type of epithelium is found at the limbus of the conjunctiva?

A

Stratified squamous nonkeratinized epithelium.

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16
Q

What does the lamina propria form at the limbus of the conjunctiva?

A

Papillae.

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17
Q

What type of epithelium is continuous with the conjunctiva at the posterior edge of the lid margin?

A

Keratinized stratified squamous epithelium of the epidermis.

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18
Q

The conjunctiva joins the skin at which location?

A

Along the posterior margin of the openings of the tarsal glands.

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19
Q

Fill in the blank: The conjunctiva has an epithelial covering of _______ cells.

A

[stratified columnar]

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20
Q

True or False: The lamina propria of the conjunctiva is made of dense connective tissue.

A

False.

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21
Q

How many layers of cells are typically found in the epithelial covering of the conjunctiva?

A

Two to five layers.

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22
Q

Where are goblet cells most numerous in the conjunctiva?

A

Inferonasally

Goblet cells are more prevalent in children and young adults.

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23
Q

What is the primary function of goblet cells in the conjunctiva?

A

Contributing stability to the tear film

Their secretions play a crucial role in maintaining tear film integrity.

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24
Q

How many accessory lacrimal glands can be found in the conjunctiva?

A

As many as 50

These glands are scattered throughout the conjunctival sac.

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25
Q

What is the structural composition of the conjunctival submucosa?

A

Fine, delicate connective tissue

It ends at the edges of the cornea.

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26
Q

Where is the highest concentration of lymphocytes found in the conjunctival submucosa?

A

In the fornices

Lymphocytes are absent in the marginal conjunctiva.

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27
Q

What does the deeper part of the conjunctival submucosa contain?

A

Denser fibrous tissue, blood vessels, nerves, smooth muscle, and accessory lacrimal glands

This layer provides structural support and vascularization.

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28
Q

What do conjunctival papillae form from?

A

The submucosa projecting toward the surface epithelium at the limbus and lid margins

These structures contribute to the overall anatomy of the conjunctiva.

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29
Q

True or False: Accessory lacrimal glands have ducts that open to the free surface of the conjunctiva.

A

True

This feature is similar to that of the primary lacrimal glands.

30
Q

Fill in the blank: Goblet cells are commonly found lining _______ in the conjunctiva.

A

Crypts

This arrangement aids in their functionality.

31
Q

What is the source of the arterial supply of the conjunctiva?

A

The two palpebral arches in each eyelid and the anterior ciliary arteries.

The palpebral arches consist of the large marginal and smaller peripheral arches.

32
Q

Where does the large marginal arch run in relation to the eyelid?

A

3 mm from the free border of the eyelid between the tarsal plate and the orbicularis oculi muscle.

This arch is responsible for supplying the palpebral conjunctiva.

33
Q

What do small branches from the palpebral arches do?

A

They connect the two arches in front and behind the tarsal plates.

This connection aids in the vascular supply to the conjunctiva.

34
Q

Which branches supply the superior and inferior conjunctival fornices?

A

Branches from the peripheral arch.

These branches also contribute to the blood supply under the bulbar conjunctiva.

35
Q

What are the posterior conjunctival arteries responsible for?

A

Supplying the bulbar conjunctiva and proceeding toward the cornea.

They anastomose with the anterior conjunctival arteries at the limbus.

36
Q

What do the anterior ciliary arteries arise from?

A

Muscular branches of the ophthalmic artery to the rectus muscles.

These arteries play a role in the conjunctival blood supply.

37
Q

What happens in some individuals regarding the peripheral arterial arch in the lower lid?

A

They may have no peripheral arterial arch, with the marginal arch supplying the conjunctiva.

This variation affects the blood supply to the lower conjunctiva.

38
Q

How do conjunctival veins compare to conjunctival arteries?

A

Conjunctival veins are more numerous than the arteries.

They accompany the arteries and drain into the palpebral veins or directly into the superior and inferior ophthalmic veins.

39
Q

What is the arrangement of conjunctival lymph vessels?

A

They are arranged as a superficial and a deep plexus in the submucosa.

This arrangement facilitates effective lymph drainage from the conjunctiva.

40
Q

Where do lymph vessels from the lateral side of the conjunctiva drain?

A

Into the superficial parotid nodes.

This drainage pathway is important for the immune response.

41
Q

Where do lymph vessels from the medial side of the conjunctiva drain?

A

Into the submandibular nodes.

This pathway is part of the lymphatic drainage system of the eye.

42
Q

What is the source of sensory innervation for the bulbar conjunctiva?

A

Long ciliary nerves, which are branches of the nasociliary nerve

The nasociliary nerve is a branch of the ophthalmic division of the trigeminal nerve.

43
Q

Which nerves innervate the superior palpebral conjunctiva?

A

Frontal and lacrimal branches of the ophthalmic division of the trigeminal nerve

These branches provide sensory innervation to the upper eyelid area.

44
Q

How is the inferior palpebral conjunctiva innervated?

A

Laterally by the lacrimal branch and medially by the infraorbital nerve

The lacrimal branch is from the ophthalmic division, while the infraorbital nerve is from the maxillary division of the trigeminal nerve.

45
Q

What is the lacrimal caruncle?

A

A small, pinkish ovoid body situated in the lacus lacrimalis at the medial angle of the eye

It lies on the medial side of the plica semilunaris.

46
Q

What type of epithelium does the lacrimal caruncle contain?

A

Non-keratinized stratified squamous epithelium

This differs from typical skin, which has keratinized epithelium.

47
Q

What is the arterial supply of the lacrimal caruncle?

A

Superior medial palpebral arteries

These arteries supply blood to the medial parts of the eyelids.

48
Q

What is the function of the plica semilunaris?

A

It allows the eyeball to move fully laterally

It may represent the nictitating membrane of lower vertebrates.

49
Q

Describe the plica semilunaris.

A

A halfmoon-shaped fold of conjunctiva lying lateral to and partly under the caruncle

It has a free and concave lateral margin.

50
Q

What is the appearance of the palpebral conjunctiva?

A

Thin, translucent, firmly attached, and very vascular

Its thinness allows for visualization of underlying structures during examination.

51
Q

What can be seen when the palpebral conjunctiva is examined?

A

Yellowish tarsal glands and many blood vessels

This examination is commonly used clinically in the diagnosis of anemia.

52
Q

True or False: The firm attachment of the palpebral conjunctiva to the tarsal plates makes surgical separation easy.

A

False

Surgical separation is extremely difficult, especially in the upper lid.

53
Q

Fill in the blank: The connective tissue of the plica semilunaris is highly _______.

A

vascular

This vascularity supports the function of the conjunctival fold.

54
Q

What supplies the peripheral bulbar conjunctiva?

A

The posterior conjunctival branches of the peripheral arterial arch

These branches extend forward to within 4 mm of the corneoscleral limbus.

55
Q

What happens to the conjunctival vessels in acute conjunctivitis?

A

They dilate and appear bright red

This is due to their superficial location.

56
Q

What effect does topical epinephrine have on conjunctival vessels?

A

It can constrict the vessels

This is possible because the vessels are situated in the connective tissue of the conjunctiva.

57
Q

What supplies the central bulbar conjunctiva?

A

The anterior conjunctival branches of the anterior ciliary arteries

These arteries form a superficial conjunctival plexus and a deep episcleral plexus.

58
Q

What happens to the superficial conjunctival pericorneal plexus in inflammatory disease of the cornea?

A

It becomes dilated and vessels appear bright red

The vessels are superficial and move with the conjunctiva.

59
Q

What occurs in inflammatory disease of the iris or ciliary body?

A

The deep episcleral pericorneal plexus becomes dilated

The vessels appear dull red and do not move with the conjunctiva.

60
Q

What is the characteristic of the redness in deep episcleral plexus dilation?

A

Redness disappears on pressure

This indicates that they cannot be constricted with topical epinephrine.

61
Q

What happens in very severe inflammatory disease of the bulbar conjunctiva?

A

All the arteries supplying the bulbar conjunctiva become dilated

This occurs due to their profuse anastomotic connections.

62
Q

What causes difficulty in grasping the palpebral conjunctiva with surgical forceps?

A

Firm tethering of the membrane to the tarsal plates

This has been noted previously.

63
Q

Where is the conjunctiva at the superior tornix loosely attached?

A

By fascia to the fascia of the levator palpebrae superioris and the superior rectus muscles

There is a similar connection at the inferior fornix.

64
Q

Where can the bulbar conjunctiva be easily grasped with surgical forceps?

A

Where the conjunctiva of the fornices is reflected onto the eyeball

This is also where bulbar conjunctiva is incised for tenotomy of the recti muscles.

65
Q

How far from the corneoscleral limbus do the conjunctiva, bulba fascia, and sclera become firmly united?

A

About 3 mm

At this site, a firm grip can be obtained with forceps.

66
Q

What is Tenon’s capsule?

A

Bulba fascia

It is closely associated with the conjunctiva and sclera.

67
Q

True or False: The deep episcleral plexus moves with the conjunctiva.

A

False

The deep episcleral plexus vessels do not move with the conjunctiva.

68
Q

What is the common surgical site for piercing the eyeball in the treatment of glaucoma?

A

The region between the bulbar limbus about 1.5 mm posterior to the corneoscleral limbus and the conjunctival limbus about 1 mm anterior to the corneoscleral limbus.

This area is significant for surgical procedures related to glaucoma treatment.

69
Q

What is the bulbar limbus?

A

Attachment of the bulbar sheath to the sclera.

The bulbar limbus plays a role in the anatomical structure of the eye relevant to surgical interventions.

70
Q

What is the conjunctival limbus?

A

Attachment of the conjunctiva to the cornea.

Understanding the conjunctival limbus is crucial for eye surgeries and procedures.

71
Q

How far is the bulbar limbus located from the corneoscleral limbus?

A

About 1.5 mm posterior.

This measurement is important for surgical precision in glaucoma treatments.

72
Q

How far is the conjunctival limbus located from the corneoscleral limbus?

A

About 1 mm anterior.

This distance is relevant for understanding the surgical approach in eye procedures.

FRCOphth part 1 Anatomy of the Ocular appendages (3 decks)

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