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FRCOphth part 1 Anatomy of the Ocular appendages > Lacrimal apparatus > Flashcards

Lacrimal apparatus Flashcards

1
Q

What are the components of the lacrimal apparatus?

A

The lacrimal gland, lacrimal lake, lacrimal canaliculi, lacrimal sac, nasolacrimal duct

The nasolacrimal duct carries tears into the nasal cavity.

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2
Q

What are the two parts of the lacrimal gland?

A

Orbital part, palpebral part

The palpebral part is about one-third the size of the orbital part.

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3
Q

Where is the lacrimal gland located?

A

In the lacrimal fossa on the anterior and lateral part of the roof of the orbit

It lies just within the margin of the orbit.

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4
Q

What shape is the larger orbital part of the lacrimal gland?

A

Almond-shaped

The superior surface of the orbital part is convex and related to bone.

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5
Q

What is the function of the lacrimal gland?

A

Secretes tears

Tears are essential for keeping the eye moist and for protection.

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6
Q

What is the relationship of the inferior surface of the lacrimal gland?

A

Lies above the aponeurosis of the levator palpebrae superioris

It also lies above the upper margin of the lateral rectus muscle.

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7
Q

How many ducts does the lacrimal gland approximately have?

A

About 12 ducts

These ducts pass from the orbital part through the palpebral part to open into the superior conjunctival fornix.

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8
Q

What type of structure is the lacrimal gland?

A

Lobulated tubulo-acinar structure

The lobules are separated from one another by loose connective tissue.

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9
Q

What is the size comparison between the orbital part and the palpebral part of the lacrimal gland?

A

The palpebral part is about one-third the size of the orbital part

This indicates a significant difference in their respective sizes.

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10
Q

What is the significance of accessory lacrimal glands?

A

They keep the cornea moist if the main gland is nonfunctional

These smaller glands are scattered around the conjunctival sac.

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11
Q

Fill in the blank: The lacrimal gland has no definite _______.

A

capsule

The periorbita is believed to split and enclose the gland.

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12
Q

True or False: The lacrimal gland is enclosed by a definite capsule.

A

False

The gland is believed to be enclosed by the split of the periorbita.

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13
Q

What type of cells line the acini of the lacrimal gland?

A

Columnar cells

The acini appear as round or tube-shaped masses with central lumens.

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14
Q

What is the anterior border of the lacrimal gland related to?

A

Related to the orbital septum

The posterior border is in contact with orbital fat.

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15
Q

What is the primary function of the lacrimal gland?

A

To produce tears and keep the eye moist.

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16
Q

Which nerve innervates the lacrimal gland?

A

Facial nerve.

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17
Q

What is the role of the superior cervical sympathetic ganglion in lacrimal gland function?

A

Provides sympathetic innervation.

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18
Q

Fill in the blank: The lacrimal gland receives parasympathetic innervation from the _______.

A

Pterygopalatine ganglion.

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19
Q

What type of cells line the lacrimal gland?

A

Columnar or cuboidal epithelial cells.

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20
Q

What is the structure that surrounds the secretory cells of the acini in the lacrimal gland?

A

Myoepithelial cells.

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21
Q

True or False: The larger intralobular ducts of the lacrimal gland have a single-layered epithelial lining.

A

False.

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22
Q

What shape are the secretory cells of the acini in the lacrimal gland?

A

Truncated-conical.

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23
Q

Which ganglion is associated with the lacrimal gland’s innervation?

A

Pterygopalatine ganglion.

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24
Q

What type of nerve is the greater petrosal nerve?

A

Parasympathetic nerve.

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25
Q

What is the role of the nerve of the pterygoid canal in relation to the lacrimal gland?

A

Transmits parasympathetic fibers to the gland.

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26
Q

Fill in the blank: The lacrimal nerve is a branch of the _______.

A

Maxillary nerve.

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27
Q

What is the appearance of the epithelial secretory cells of the lacrimal gland under an electron microscope?

A

Surrounded by a discontinuous layer of myoepithelial cells.

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28
Q

What structure provides the basal support for the secretory cells in the lacrimal gland?

A

Basal lamina.

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29
Q

What type of surface features do the secretory cells have that aid in secretion?

A

Microvilli on their apical or luminal surface.

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30
Q

Which part of the nervous system provides sympathetic innervation to the lacrimal gland?

A

Autonomic nervous system.

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31
Q

What is the role of the zygomaticotemporal nerve in relation to the lacrimal gland?

A

Provides sensory innervation.

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32
Q

What are junctional complexes and desmosomes?

A

Structures that attach adjacent secretory cells

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33
Q

What are canaliculi?

A

Narrow extensions of the acinar lumen between adjacent secretory cells

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34
Q

Where is the nucleus located in a secretory cell?

A

Basally located

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35
Q

What organelles are well-developed in the cytoplasm of secretory cells?

A
  • Rough-surfaced endoplasmic reticulum
  • Golgi complex
  • Moderate numbers of mitochondria
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36
Q

What types of cellular structures are found in the cytoplasm of secretory cells?

A
  • Free ribosomes
  • Lipid droplets
  • Vacuoles
  • Secretory granules
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37
Q

What characterizes the secretory granules in secretory cells?

A

They are round or ovoid and membrane-bound

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38
Q

What variations exist among secretory granules?

A
  • Homogeneous or finely granular
  • Vary in electron density
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39
Q

What do researchers believe about the differences in secretory granules?

A

They may represent different stages in secretory activity or distinct cell types

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40
Q

What type of secretory cell predominance is suggested by the dense granules?

A

Serous type

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41
Q

What does positive staining of secretory granules for acid mucopolysaccharides indicate?

A

Mucus is also produced

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42
Q

What is the arterial supply to the lacrimal gland?

A
  • Lacrimal artery (branch of ophthalmic artery)
  • Infraorbital artery (sometimes supplies the gland)
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43
Q

Where does venous drainage of the lacrimal gland occur?

A

Into the ophthalmic vein

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44
Q

Where does the lymphatic drainage of the lacrimal gland pass?

A

To the superficial parotid lymph nodes

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45
Q

What type of nerve fibers does the lacrimal gland receive?

A

Both autonomic and sensory nerve fibers

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46
Q

Where is the parasympathetic secretomotor nerve supply for the lacrimal gland derived from?

A

The lacrimatory nucleus of the facial nerve

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47
Q

Through which structures do the preganglionic fibers reach the pterygopalatine ganglion?

A

Nervus intermedius, great petrosal branch, nerve of the pterygoid canal

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48
Q

How do postganglionic fibers reach the lacrimal gland?

A

Join the maxillary nerve, pass into its zygomatic branch and zygomaticotemporal nerve, then reach the lacrimal gland via the lacrimal nerve

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49
Q

From where do the sympathetic postganglionic fibers arise?

A

Superior cervical sympathetic ganglion

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50
Q

What is the pathway of sympathetic postganglionic fibers to the lacrimal gland?

A

Travel in the plexus around the internal carotid artery, join deep petrosal nerve, nerve of the pterygoid canal, maxillary nerve, zygomatic nerve, zygomaticotemporal nerve, and lacrimal nerve

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51
Q

Which nerve carries sensory fibers to the lacrimal gland?

A

Lacrimal nerve, a branch of the ophthalmic division of the trigeminal nerve

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52
Q

What is believed to provide afferent fibers to the parasympathetic lacrimatory nucleus?

A

Hypothalamus through descending autonomic pathways in the reticular formation

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53
Q

What emotional response may lead to excessive tear production?

A

Crying

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54
Q

What type of stimuli can cause excessive tear production through the olfactory system?

A

Certain olfactory stimuli

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55
Q

What triggers reflex lacrimation?

A

Irritation of the cornea or conjunctiva through afferent nervous stimuli

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56
Q

How are the sensory nuclei of the trigeminal nerve connected to the lacrimatory nucleus?

A

By internuncial neurons

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57
Q

What do acinar cells produce that passes into the duct system?

A

Secretion

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58
Q

What components are found in the final watery secretion (tears)?

A
  • Lysozyme (antibacterial enzyme)
  • IgA (immunoglobulin)
  • Beta-lysin (bactericidal protein)
59
Q

What is the main function of tears?

A

Keep the corneal epithelium moist

60
Q

What is a secondary function of tears?

A

Lubricate the front of the eyeball

61
Q

Which glands also contribute to lubrication of the eye?

A

Meibomian glands

62
Q

Fill in the blank: The lacrimal gland secretes substances that affect the ocular surface by regulating _______.

A

[epithelial cell turnover]

63
Q

True or False: Hormones, particularly androgens, suppress lacrimal secretion.

A

False

64
Q

What is the punctum lacrimale?

A

A small round or oval orifice at the summit of the papilla lacrimalis

Located at the medial end of the lid margin, in line with the openings of the tarsal glands

65
Q

Where is the punctum lacrimale located in relation to the tarsal glands?

A

In line with the openings of the tarsal glands

The conjunctiva surrounding the punctum appears pale red due to being somewhat avascular

66
Q

How does the upper punctum differ from the lower punctum in orientation?

A

The upper punctum looks downward and backward; the lower punctum looks upward and backward

The upper punctum is slightly medial to that of the lower lid

67
Q

What is the length of each lacrimal canaliculus?

A

About 10 mm long

Each canaliculus consists of a vertical and a horizontal portion

68
Q

Describe the path of the lacrimal canaliculi.

A

They begin at the puncta, pass vertically from the lid margin, then turn sharply medially

The upper canaliculus runs medially and downward; the lower one runs medially and upward

69
Q

What forms at the junction of the vertical and horizontal portions of the canaliculi?

A

An ampulla

The canaliculi are slightly dilated at this junction

70
Q

Where do the canaliculi enter the lacrimal sac?

A

At the lateral surface of the sac about 2.5 mm below its apex

They may be separate or united to form a common stem at the point of entrance

71
Q

What is the sinus of Maier?

A

A small diverticulum of the lacrimal sac

Situated at the site of entry of the canaliculi into the sac

72
Q

What anatomical structure do the canaliculi lie behind?

A

The medial palpebral ligament

They are surrounded by fibers of the pars lacrimalis of the orbicularis oculi muscle

73
Q

What type of epithelium lines the walls of the canaliculi?

A

Stratified squamous epithelium

The walls are thin and elastic

74
Q

True or False: During blinking, the canaliculi are pulled laterally and lengthened.

A

False

The canaliculi are pulled medially, shortened, and compressed by the lacrimal part of the orbicularis oculi

75
Q

Fill in the blank: The pumping action during blinking assists in the _______ of the lacrimal sac.

A

dilatation

This action is caused by the lacrimal part of the orbicularis oculi

76
Q

What is the length of the lacrimal sac?

A

About 12 mm long

77
Q

Where is the lacrimal sac located?

A

In the anterior part of the medial wall of the orbit

78
Q

What forms the lacrimal fossa?

A

The lacrimal bone and the frontal process of the maxilla

79
Q

What does the lacrimal sac receive on its lateral side?

A

The openings of the lacrimal canaliculi

80
Q

What encloses the lacrimal sac?

A

The lacrimal fascia

81
Q

What is the relationship of the lacrimal fascia to the lacrimal bone and maxilla?

A

Attached behind to the posterior lacrimal crest of the lacrimal bone and in front to the anterior lacrimal crest of the maxilla

82
Q

What type of tissue forms the wall of the lacrimal sac?

A

Fibroelastic tissue

83
Q

What type of cells line the lacrimal sac?

A

Two layers of columnar cells, including goblet cells

84
Q

What is the length of the nasolacrimal duct?

A

About 18 mm long

85
Q

Where does the nasolacrimal duct connect?

A

The lower end of the lacrimal sac with the inferior meatus of the nose

86
Q

What is the direction of the nasolacrimal duct?

A

Downward, backward, and lateral

87
Q

What forms the bony nasolacrimal canal?

A

The maxilla, the lacrimal bone, and the inferior nasal concha

88
Q

What is the relationship between the nasolacrimal duct and the periosteum?

A

The wall of the duct is closely attached to the periosteum lining the canal

89
Q

What type of epithelium lines the nasolacrimal duct?

A

Two layers of columnar epithelium, some of which are ciliated

90
Q

What guards the opening of the nasolacrimal duct?

A

A flap of mucous membrane called the plica lacrimalis

91
Q

What is the function of the plica lacrimalis?

A

Prevents air from entering the lacrimal sac when blowing the nose

92
Q

True or False: The nasolacrimal duct opens above into the anterior part of the inferior meatus of the nose.

A

False

93
Q

What is related medially to the upper half of the lacrimal sac?

A

The anterior ethmoidal sinuses

94
Q

What is related medially to the lower half of the lacrimal sac?

A

The anterior part of the middle meatus of the nose

95
Q

What vein crosses the anterior surface of the medial palpebral ligament?

A

The angular vein

96
Q

What forms the angular vein?

A

The union of the supratrochlear and supraorbital veins

97
Q

What does the angular vein later become?

A

The facial vein

98
Q

What are the sources of arterial supply to the lacrimal sac and the nasolacrimal duct?

A

Branches of the medial palpebral of the ophthalmic, facial, infraorbital from the maxillary, and sphenopalatine arteries of the maxillary.

These arteries provide the necessary blood supply to the lacrimal structures.

99
Q

Which nerves supply the lacrimal sac and nasolacrimal duct?

A

Infratrochlear branch of the ophthalmic division of the trigeminal nerve and the anterior superior alveolar nerve.

These nerves are responsible for sensory innervation to the lacrimal apparatus.

100
Q

What is the primary function of tear production?

A

To keep the eye moist.

Normal tear formation is essential for eye health and comfort.

101
Q

Where does normal tear formation occur?

A

Accessory lacrimal glands scattered throughout the conjunctival sac.

These glands secrete tears continuously to maintain moisture.

102
Q

What triggers excessive tear production, such as during crying?

A

Reflex nervous stimulation of the main lacrimal gland.

This stimulation can be a response to emotional or physical stimuli.

103
Q

What happens to the tears produced under normal conditions?

A

They just exceed that lost by evaporation and the remainder passes down the nasolacrimal duct.

This balance is crucial for maintaining tear volume.

104
Q

Where does tear fluid accumulate in the conjunctival sac?

A

In the conjunctival fornices and the lacus lacrimalis.

These areas are important for tear distribution and drainage.

105
Q

How does the superior marginal strip of tear fluid behave?

A

It overlaps the cornea for about 1 mm as a straight line.

This strip is influenced by eye movements and eyelid positioning.

106
Q

What occurs when the upper lid is gently raised away from the eyeball?

A

The tear fluid rises into the superior fornix.

This action demonstrates the fluid dynamics in the conjunctival sac.

107
Q

How does the inferior marginal strip of tear fluid behave?

A

It rises up over the cornea for about 1 mm due to surface tension.

This strip also plays a role in tear distribution.

108
Q

What happens when the lower lid is pulled down from the eyeball?

A

The level of the tear fluid sinks into the inferior fornix.

This illustrates the effect of eyelid movement on tear fluid distribution.

109
Q

What is the capacity of the conjunctival sac?

A

About 25 to 30 mL.

Understanding this capacity is important for diagnosing conditions related to tear production.

110
Q

What occurs when the volume of tears secreted exceeds the conjunctival sac’s capacity?

A

Clinical tearing results.

This can be a sign of underlying issues with tear production or drainage.

111
Q

What are the main sources of tear production?

A

Lacrimal gland and accessory lacrimal glands

These glands produce the fluid that enters the conjunctival sac.

112
Q

How does tear fluid travel across the conjunctival sac?

A

Capillarity and blinking movements of the eyelids

These physical influences help move the tear fluid across the sac.

113
Q

What prevents tears from pouring over the cornea under normal conditions?

A

The physical structure of the eye and blinking

Tears are wiped across the cornea to prevent desiccation.

114
Q

What role do the tarsal glands play in tear drainage?

A

They produce an oily secretion that prevents overflow of tears

This secretion helps maintain the tear film and prevents excessive tear flow.

115
Q

What happens to tears during exaggerated tear production, such as crying?

A

Tears flow across the cornea and escape down the cheek

This interferes with the cornea’s function as an efficient lens.

116
Q

What occurs to the conjunctival sac during sleep?

A

The conjunctival sac is closed

The lid margins are in apposition, preventing tear loss.

117
Q

How are tears drained from the lacus lacrimalis?

A

Through the canaliculi

The puncta of the canaliculi maintain contact with the lacus lacrimalis.

118
Q

What mechanism aids the entry of tear fluid into the canaliculi?

A

Capillarity

The tone of the orbicularis oculi helps maintain the position for drainage.

119
Q

What is referred to as the pumping action of the orbicularis oculi?

A

The contraction of the lacrimal part that compresses the canaliculi

This action causes dilatation of the lacrimal sac, sucking tears into it.

120
Q

How do tears pass down the nasolacrimal duct?

A

Gravity and evaporation of fluid

Air movement during breathing also assists in this process.

121
Q

What are the three layers of the precorneal tear film?

A

1) Oily layer 2) Watery layer 3) Mucin layer

Each layer has distinct properties and functions in maintaining eye health.

122
Q

What is the thickness range of the oily layer of the tear film?

A

0.9 to 0.2 micrometers

This layer is primarily produced by the tarsal glands.

123
Q

What is the primary function of the watery layer of the tear film?

A

Defense against invading organisms

It contains lysozyme, immunoglobulin, and beta-lysin.

124
Q

What does the mucin layer do in the tear film?

A

Wets the microvilli of the corneal epithelium

This layer is secreted by conjunctival goblet cells.

125
Q

What is the primary function of the lacrimal gland?

A

Production of tears

The lacrimal gland has ducts that transport tears to the conjunctival sac.

126
Q

How many ducts are typically associated with the lacrimal gland?

A

About 12 ducts

These ducts originate mostly in the orbital part of the gland.

127
Q

What happens if the palpebral part of the lacrimal gland is surgically removed?

A

Destroys the drainage of the whole gland

The palpebral part is crucial for tear drainage.

128
Q

What conditions can obstruct the openings of the lacrimal ducts?

A

Scarring from erythema multiforme, ocular cicatricial pemphigoid, trachoma, and chemical burns

These conditions can lead to blockage of tear drainage.

129
Q

What type of tumors are most commonly associated with the lacrimal gland?

A

Benign tumors

Examples include mixed cell tumors and benign lymphoid hyperplasia.

130
Q

What symptoms are associated with malignant tumors of the lacrimal gland?

A

Early erosion of the lacrimal fossa and severe pain

Malignant tumors are less common but more aggressive.

131
Q

What causes dry eyes related to the lacrimal gland?

A

Deficiency of the watery component of tears or mucin component

Conditions include disease of the main and accessory lacrimal glands and goblet cell dysfunction.

132
Q

How can the outflow of tears in dry eyes be restricted?

A

By reducing the size of the punctum lacrimale

Techniques include using plugs, cautery, or laser.

133
Q

What is lacrimation?

A

Excessive production of tears

Can be caused reflexly from conditions like photophobia or inflammation.

134
Q

What is a key anatomical feature of the lacrimal canaliculi?

A

Each canaliculus passes vertically for about 2 mm before bending medially

This bending is important for understanding probing techniques.

135
Q

Where is the lacrimal sac located?

A

In the lacrimal fossa in the anterior part of the medial wall of the orbit

The sac is covered by the medial palpebral ligament.

136
Q

What occurs if the lacrimal sac is distended with inflammatory exudate?

A

Causes visible swelling below the lower border of the medial palpebral ligament

This can indicate an abscess or fistula in the region.

137
Q

What must be avoided when making an incision close to the medial canthus of the eye?

A

The angular vein

The angular vein is the upper part of the facial vein and is formed by the union of the supratrochlear and supraorbital veins.

138
Q

Where is the angular vein located in relation to the medial canthus?

A

About 8 mm medial to the medial canthus

It descends across the anterior surface of the medial palpebral ligament lateral to the facial artery.

139
Q

What may need to be divided to fully expose the lacrimal sac?

A

The medial palpebral ligament

This division may be necessary to avoid complications during surgery.

140
Q

What is a potential complication when approaching the lacrimal sac?

A

Bleeding from the venous plexus around the lacrimal sac

This bleeding may be troublesome during surgical procedures.

141
Q

How can the lacrimal sac be approached besides the anterior incision?

A

Via endoscopy through the nasal cavity

This method provides an alternative route for accessing the sac.

142
Q

What is the orientation of the nasolacrimal duct when passing a probe?

A

Downward, backward, and laterally

The duct is approximately 18 mm long.

143
Q

Where does the nasolacrimal duct open?

A

Into the anterior part of the inferior meatus of the nose

This opening is crucial for drainage.

144
Q

What is the correct technique for inserting a probe into the nasolacrimal duct?

A

Insert into the punctum of the upper lid, direct vertically, then medially into the lacrimal sac, and turn downward at right angles

The end of the probe should be visible within the nose after correct insertion.

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

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