ANATOMY &

PHYSIOLOGY OF
LACRIMAL
SECRETION &
OUTFLOW
Dr.Nurcahya AB,SpM

LACRIMAL APPARATUS

It is concerned with the tear formation &

transport.
Lacrimal passage includes :

Lacrimal
gland

Nasolacrim
al duct

Conjunctiv
al sac

Lacrimal
puncta

Lacrimal
sac

Lacrimal
canalicu
li

The following components of the

lacrimal apparatus are discussed :
Embryology

Osteology

Secretory system

Excretory system

Physiology

EMBRYOLOGY

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.

OSTEOLOGY

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.

SECRETORY SYSTEM

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

LACRIMAL
GLAND

It consists of
Large

Orbital Part

Smaller

Palpebral Part

Lateral expansion of levator separates

the parts

ACCESSORY GLANDS

Are small, compound, branched, tubular

glands

Located in 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.

BLOOD SUPPLY

Artery supply : Lacrimal artery , branch

of ophthalmic artery.

Venous drainages : Ophthalmic Vein.

Lymphatic drainage : Joins that of

conjunctiva & drain into the preauricular
lymph nodes.

NERVE SUPPLY

Sensory nerve supply : lacrimal nerve

, branch of ophthalmic division of Vth
nerve

Sympathetic nerve supply : carotid

plexus

Secretomotor fibers : superior

salivary nucleus

EXCRETORY SYSTEM
THE PUNCTA

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.

PHYSIOLOGY
TEAR FILM

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 .

Tear secretion 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.

THE ROLES OF THE

PRECORNEAL TEAR FILM

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
Lipid

layer.

layers

GLYCOCALYX
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

MUCOUS LAYER
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.

AQUEOUS LAYER

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.

LIPID LAYER

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.

Function
Hydrophobic barrier to prevent tear
overflow.

The meibom forms a water-tight seal of

the apposed lid margins during sleep.

Reduce tear evaporation .

Lipids enhance the stability of the tear

film and provide a smooth optical.

DISTRIBUTION OF THE
TEARS

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,

CONDUCTION OF THE
TEARS

Tears are lost 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.

* DAKRIOADENITIS

Bisa uni/bilateral
Etiologi =etiologi radang
G/ = radang
Th/kompres hangat---antibiotika
Bila abses --->insisi

*DAKRIOSISTITIS

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

DAKRIOSISTITIS

* INSUFISIEN
LAKRIMAL/MATA KERING

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

 HIPERSEKRESI KELENJAR LAKRIMAL/

AIR MATA NROCOS

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

Mata nrocos karena

ektropion pungtum
lakrimal

Sumbatan pd sistim
nasolakrimal kiri,pd
anak2

Dakriolit : pengendapan kapur

didalam kantung lakrimal akibat
gangguan keseimbangan airmata
atau peradangan sakus lakrimalis yg
biasanya disebabkan oleh jamur

THANK YOU