Lacrimalis UMS

8/18/2019 Lacrimalis UMS

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ANATOMY &

PHYSIOLOGY OFLACRIMAL

SECRETION &OUTFLOW

Dr.Nurcahya AB,SpM


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LACRIMAL APPARATUS It is concerned with the tear formation &

transport.

Lacrimal passage includes :

Lacr!a"#"a$%

C$'u$c()a" *ac

Lacr!a"pu$c(a

Lacr!a"ca$a"cu

"

Lacr!a"*ac

Na*"acr!a" %uc(


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The following components of thelacrimal apparatus are discussed :

Embryology

Osteology

Secretory system

Excretory system

hysiology


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EMBRYOLOGY Ectodermal origin

Solid epithelial buds!"rst # months$

Superolateral con%unctial fornix.


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Lacrimal sac and nasolacrimal duct :ectoderm of the naso'optic furrow ornasolacrimal furrow

The ectoderm of the furrow buries andforms a solid cord .

(anali)ation : begins at * months andmay continue after birth.


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OSTEOLOGY The lacrimal sac fossa is a depression in

the inferomedial orbital rim+

,axillary and lacrimal bones.

-ordered by the anterior lacrimal crest!maxillary bone$ & posterior lacrimal

crest !lacrimal bone$.

The fossa is approximately /'mm high+*' to 0'mm wide+ and #'mm deep.


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The medial orbital wall : 1rontal process

of maxilla+ lacrimal + ethmoid + lesserwing of sphenoid bone.

The frontoethmoidal suture is important

in lacrimal surgery

It mar2s the roof of the ethmoid sinus.-ony dissection superior to this suturemay expose the dura of the cranialcaity.


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The nasolacrimal canal originates atbase of lacrimal fossa.

1ormed by the maxillary bone laterallyand the lacrimal and inferior turbinate

bones medially.

The width of superior opening is *3/ mm.

The duct courses posteriorly andlaterally in the bone for # mm to draininto the inferior meatus of the nasalcaity.


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SECRETORY SYSTEM It includes lacrimal gland+ accessory

glands

Lacrimal gland is aboe & anterolateralto globe.

Secretes tears into superior fornix.

Tears moisten & lubricates the : cornea +

con%unctia.

It contributes *45 of 675 of refractie


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LACRIMAL

GLAND

It consists of

Large Orbital Part

Smaller Palpebral Part

Lateral expansion of leator separatesthe parts


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ACCESSORY GLANDS

8re small+ compound+ branched+ tubularglands

Located in the middle of lid !9olfringglands$ or superior & inferior fornices!rause glands$.

Ectopic portions of lacrimal gland tissue.


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It is with connectie tissue coat and

excretory duct.

The excretory duct splits & formintralobular ducts+ connected tosecretory glandular epithelia.

Secretory epithelia hae elongated

tubules.

True acini are absent.


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BLOOD SUPPLY

8rtery supply : Lacrimal artery + branchof ophthalmic artery.

;enous drainages : Ophthalmic ;ein.

Lymphatic drainage :


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NER+E SUPPLY

Sensory nere supply : lacrimal nere+ branch of ophthalmic diision of ;th

nere

Sympathetic nere supply : carotidplexus

Secretomotor "bers : superiorsaliary nucleus


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ECRETORY SYSTEM THE PUNCTA 8 small+ round or oal ori"ce on the

eleation+ the papilla lacrimalis.

8t medial end of lid margin at the %unctionof its ciliated and non'ciliated parts.

=pper punctum medial to lower+ from the

medial canthus being / and /.6 mm.

The upper punctum opens inferoposteriorly+the lower superoposteriorly.


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PHYSIOLOGY

The tear "lm oerlays corneal andcon%unctial epithelia.

Tears produced by the ocular surfaceepithelia and adnexa.

Thic2ness of up to *7 >m+

;olume of tears coering the ocularsurface range from #.?* ± #.7 µL to 7 µL

TEAR FILM


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1or mucous and a@ueous layers+ secretion isregulated by neural reAexes.

1or the lipid layer+ the blin2 itself regulatesrelease of pre'secreted meibomian gland .

Tear secretion is balanced by drainage andeaporation.

5rainage is regulated by neural reAexes +causingasodilation and asoconstriction of blood sinus.

Eaporation depends blin2 rate and temperature+humidity+ and wind speed.


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THE ROLES OF THEPRECORNEAL TEAR FILM To protect the cornea from dryingB

To maintain the refractie power of thecorneaB

To defend against eye infectionB

To allow gas to moe between the air and theaascular corneaB

To support corneal dehydration !assisted bythe tear "lm hyperosmolality$.


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(onsists of four layers

Clycocalyx

,ucous layer

8@ueous layer.

Lipid layers


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GLYCOCALYStructure

The glycocalyx is a networ2 of polysaccharides that pro%ectfrom cellular surfaces.

,ucins are classi"ed into secreted and membrane'spanningmucin.

Secreted mucins are either gel'forming or small soluble

1unction

The membrane'spanning mucins function to hydrate theocular surface and sere as a barrier to pathogens.

,embrane'spanning mucins appear to be altered in dry eye


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MUCOUS LAYERStructure

The mucous layer bac2bone is the gel'formingmucin + synthesi)ed and secreted by

con%unctial goblet cells.

1unction

To resistance of the eye to infection byproiding protection against microorganisms.

,ucins sere as wetting agents that 2eep theapical epithelia hydrated.


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A-UEOUS LAYER

Lacrimal gland produce a@ueous layer.

Other ocular surface epithelia also contributeto the a@ueous layer+ eg. con%unctia+accessory lacrimal glands

?>m thic2.

9ithout the lubrication + the shearing forcesproduced on blin2ing will cause accumulatieocular surface damage.


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(omposed of water+ with many solutes+including dissoled mucins+ electrolyte sand

proteins.

The osmotic pressure : concentrations ofsodium+ potassium and chloride ions.

The tear "lmDs osmotic pressure is importantin the control of cornea3tear "lm water Aux.

-icarbonate and carbonate : p buFering+maintaining the p at ?.43?./ when the

eyes open & /.G eyes closed.


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8@ueous layer function

8@ueous de"ciency dry eye.

rotection from bacterial infection

HeAex secretion washes away noxioussubstances.

rotects against changes in p.


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LIPID LAYER

,eibomian glands+ modi"ed sebaceousglands+ that line the upper and lowereyelids.

,eibomian gland lipids are stored inesicles.

The secretory product contains a complexmixture of lipids and proteins and is termedmeibum.

,eibum is released on to the ocular surfacein small amounts with each blin2.


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1unction

ydrophobic barrier to preent tearoerAow.

The meibom forms a water'tight seal of

the apposed lid margins during sleep.

Heduce tear eaporation .

Lipids enhance the stability of the tear"lm and proide a smooth optical.


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DISTRIBUTION OF THETEARS (on%unctial fornices+ preocular tear

"lm+ and marginal tear strips.

,arginal tear strips are wedge shaped

tear menisci+ borders of upper and lowerlids.

8pposed lacrimal puncta dip intomarginal strip of tears

8nterior limit of the marginal strip is themucocutaneous %unction of the lid+


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CONDUCTION OF THETEARS

Tears are lost from the con%unctia sacby absorption+ eaporation+ and

nasolacrimal system.

This is related to the si)e of thepalpebral aperture+ the blin2 rate+

ambient temperature and humidity.


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Tears Aow the upper and lower marginal strips J upper

and lower canaliculi !capillarityKsuction$

Eyes closeretarsal orbicularis oculi compresses the

ampullaeK shortens and compressescanaliculiKpuncta medially.

Lacrimal part of the orbicularis oculi+contracts J compresses the sac+!positiepressure$ tears J nasolacrimal duct Jnose.

Eyes open,uscles relax J canaliculi and sac

expand!negatie pressure$Kcapillaritytears into sac.


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DA/RIOADENITIS -isa uniMbilateral

Etiologi etiologi radang

CM radang

ThM2ompres hangat'''antibioti2a-ila abses '''Ninsisi


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DA/RIOSISTITIS eradangan sa2us la2rimalis Sering pada ana2Morang dewasaN *7

th terutama wanita Ce%ala :

' mata berair terutama bila 2enaangin

'bila 2antung dite2an 2eluar se2retdg nanah

'2elopa2 mata mele2at Terapi :

'urut'antibioti2a K tetes mata


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DA/RIOSISTITIS


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INSUFISIENLA/RIMAL0MATA /ERING Tida2 dapat diobati

Sering pada usia lan%ut

erawatan dengan :

'air mata buatan ! 7.6 metilsellulose+ +* poliinil al2ohol dll$

'salep mata biasa tu malam hari

'pengobatan terhadap radang ter2ait


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,ata 2ering pada artritis reumatoid diwarnai dg tetesmata rose bengal


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•HIPERSE/RESI /ELEN1AR LA/RIMAL0AIR MATA NROCOS

rodu2si berlebihan

,alposisi pungtum la2rimalis o2malposisi 2elopa2 mata

Stenosis pungtum Sumbatan pd 2antung la2rimalis atau

pd ductus nasola2rimalis

Terapi :'tergantung penyebab

'penenang'''bila gawat operasi


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Sumbatan pd sistimnasola2rimal 2iri+pdana2#

,ata nrocos 2arenae2tropion pungtumla2rimal


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5a2riolit : pengendapan 2apur

didalam 2antung la2rimal a2ibatgangguan 2eseimbangan airmataatau peradangan sa2us la2rimalis ygbiasanya disebab2an oleh %amur


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THAN/ YOU

Lacrimalis UMS

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