Dr.

Nurcahya AB,SpM
 It is
concerned with the tear formation &
transport.
Lacrimal passage includes :

Lacrimal Conjunctival Lacrimal

gland sac puncta

Nasolacrimal Lacrimal Lacrimal

duct sac canaliculi
 The following components of the lacrimal
apparatus are discussed :
Embryology

Osteology

Secretory system

Excretory system

Physiology
 Ectodermal origin

Solid epithelial buds(first 2 months)

Superolateral conjunctival fornix.

 Lacrimal sac and nasolacrimal duct : ectoderm
of the naso-optic furrow or nasolacrimal furrow

The ectoderm of the furrow buries and forms a

solid cord .

Canalization: begins at 4 months and may

continue after birth.
 The lacrimal sac fossa is a depression in the
inferomedial orbital rim,

Maxillary and lacrimal bones.

Bordered by the anterior lacrimal crest

(maxillary bone) & posterior lacrimal crest
(lacrimal bone).

The fossa is approximately 16-mm high, 4- to 9-

mm wide, and 2-mm deep.
 The medial orbital wall :Frontal process of
maxilla, lacrimal , ethmoid , lesser wing of
sphenoid bone.

The frontoethmoidal suture is important in

lacrimal surgery

It marks the roof of the ethmoid sinus.Bony

dissection superior to this suture may expose
the dura of the cranial cavity.
 The nasolacrimal canal originates at base of
lacrimal fossa.

Formed by the maxillary bone laterally and the

lacrimal and inferior turbinate bones medially.

The width of superior opening is 46 mm.

The duct courses posteriorly and laterally in

the bone for 12 mm to drain into the inferior
meatus of the nasal cavity.
 It includes lacrimal gland, accessory glands

Lacrimal gland is above & anterolateral to globe.

Secretes tears into superior fornix.

Tears moisten & lubricates the : cornea ,

conjunctiva.

It contributes 43D of 50D of refractive power of

eye .
 It consists of

Large Orbital Part

Smaller Palpebral Part

Lateral expansion of levator separates the parts

 Are small, compound, branched, tubular glands

Locatedin the middle of lid (Wolfring glands)

or superior & inferior fornices (Krause glands).

Ectopic portions of lacrimal gland tissue.

 It is
with connective tissue coat and excretory
duct.

The excretory duct splits & form intralobular

ducts, connected to secretory glandular
epithelia.

Secretory epithelia have elongated tubules.

True acini are absent.

 Artery supply :
Lacrimal artery , branch of
ophthalmic artery.

Venous drainages : Ophthalmic Vein.

Lymphatic drainage : Joins that of conjunctiva &

drain into the preauricular lymph nodes.
 Sensorynerve supply : lacrimal nerve ,
branch of ophthalmic division of Vth nerve

Sympathetic nerve supply : carotid plexus

Secretomotor fibers : superior salivary

nucleus
A small, round or oval orifice on the elevation,
the papilla lacrimalis.

At medial end of lid margin at the junction of its

ciliated and non-ciliated parts.

Upper punctum medial to lower, from the

medial canthus being 6 and 6.5 mm.

The upper punctum opens inferoposteriorly, the

lower superoposteriorly.
 The tear film overlays corneal and conjunctival
epithelia.

Tears produced by the ocular surface epithelia

and adnexa.

Thickness of up to 40 m,

Volume of tears covering the ocular surface

range from 2.74 2.0L to 7 L
 For mucous and aqueous layers, secretion is
regulated by neural reflexes.

For the lipid layer, the blink itself regulates

release of pre-secreted meibomian gland .

Tearsecretion is balanced by drainage and

evaporation.

Drainage is regulated by neural reflexes ,causing

vasodilation and vasoconstriction of blood sinus.

Evaporation depends blink rate and temperature,

humidity, and wind speed.
 To protect the cornea from drying;

To maintain the refractive power of the cornea;

To defend against eye infection;

To allow gas
to move between the air and the
avascular cornea;

To support corneal dehydration (assisted by the

tear film hyperosmolality).
 Consists of four layers

Glycocalyx

Mucous layer

Aqueous layer.

Lipid layers
Structure

The glycocalyx is a network of polysaccharides that project

from cellular surfaces.

Mucins are classified into secreted and membrane-spanning

mucin.

Secreted mucins are either gel-forming or small soluble

Function

The membrane-spanning mucins function to hydrate the

ocular surface and serve as a barrier to pathogens.

Membrane-spanning mucins appear to be altered in dry eye

Structure

The mucous layer backbone is the gel-forming

mucin , synthesized and secreted by conjunctival
goblet cells.

Function

To resistance of the eye to infection by providing

protection against microorganisms.
Mucins serve as wetting agents that keep the apical
epithelia hydrated.
 Lacrimal gland produce aqueous layer.

Other ocular surface epithelia also contribute to the

aqueous layer, eg. conjunctiva, accessory lacrimal
glands

7m thick.

Without the lubrication , the shearing forces

produced on blinking will cause accumulative
ocular surface damage.
 Composed of water, with many solutes, including
dissolved mucins, electrolyte sand proteins.

The osmotic pressure :

concentrations of sodium,
potassium and chloride ions.

The tear films osmotic pressure is important in

the control of corneatear film water flux.

Bicarbonate and carbonate : pH buffering,

maintaining the pH at 7.37.6 when the eyes open
& 6.8 eyes closed.
Aqueous layer function
Aqueous deficiency dry eye.
Protection from bacterial infection
Reflex secretion washes away noxious
substances.
Protects against changes in pH.
 Meibomian glands, modified sebaceous glands, that
line the upper and lower eyelids.

Meibomian gland lipids are stored in vesicles.

The secretory product contains a complex mixture

of lipids and proteins and is termed meibum.

Meibum is released on to the ocular surface in small

amounts with each blink.
0.1m in thickness
Function
Hydrophobic barrier to prevent tear overflow.

The meibom forms a water-tight seal of the

apposed lid margins during sleep.

Reduce tear evaporation .

Lipidsenhance the stability of the tear

film and provide a smooth optical.
 Conjunctival fornices, preocular tear film, and
marginal tear strips.
Marginal tear strips are wedge shaped tear
menisci, borders of upper and lower lids.
Apposed lacrimal puncta dip into marginal
strip of tears
Anterior limit of the marginal strip is the
mucocutaneous junction of the lid,
 Tears arelost from the conjunctiva sac by
absorption, evaporation, and nasolacrimal
system.

This is
related to the size of the palpebral
aperture, the blink rate, ambient temperature
and humidity.
 Tears flow
the upper and lower marginal strips upper and
lower canaliculi (capillarity+suction)
Eyes close
Pretarsal orbicularis oculi compresses the
ampullae+ shortens and compresses
canaliculi+puncta medially.
Lacrimal part of the orbicularis oculi, contracts
compresses the sac,(positive pressure) tears
nasolacrimal duct nose.
Eyes open
Muscles relax canaliculi and sac expand(negative
pressure)+capillarity= tears into sac.
 Bisa uni/bilateral
Etiologi =etiologi radang
G/ = radang
Th/kompres hangat---antibiotika
Bila abses --->insisi
 Peradangan sakus lakrimalis
Sering pada anak/orang dewasa> 40 th
terutama wanita
Gejala :
- mata berair terutama bila kena angin
-bila kantung ditekan keluar sekret dg
nanah
-kelopak mata melekat
Terapi :
-urut
-antibiotika + tetes mata
 Tidak dapat diobati
Sering pada usia lanjut
Perawatan dengan :
-air mata buatan ( 0.5% metil sellulose,
1,4 % polivinil alkohol dll)
-salep mata biasa tu malam hari
-pengobatan terhadap radang terkait
Mata kering pada artritis reumatoid diwarnai dg tetes mata rose
bengal
 Produksi berlebihan
Malposisi pungtum lakrimalis ok malposisi
kelopak mata
Stenosis pungtum
Sumbatan pd kantung lakrimalis atau pd
ductus nasolakrimalis
Terapi :
-tergantung penyebab
-penenang---bila gawat operasi
 Sumbatan pd sistim
Mata nrocos karena ektropion
nasolakrimal kiri,pd anak2
pungtum lakrimal
 Dakriolit
: pengendapan kapur didalam
kantung lakrimal akibat gangguan
keseimbangan airmata atau peradangan
sakus lakrimalis yg biasanya disebabkan
oleh jamur