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Principles of the Conjunctiva

The conjunctiva is a thin transparent membrane that lines the surface of the sclera and the underside of the eyelid. It can be thought of as a modified layer of skin.

Schematic diagram of the eye National Eye Institute, CC BY 2.0


Anatomy

Anatomy of the conjunctiva.


Conjunctival Segments

The conjunctiva is anatomically divided into 3 sections

  • Palpebral conjunctiva - lines the posterior surface of the eyelids
  • Bulbar conjunctiva - lines the anterior surface of the sclera
  • Forniceal conjunctiva - a folded layer between the palpebral and bulbar conjunctiva. It allows movement of the eyelids.

The conjunctiva does not cover the cornea. It fuses with the sclera at the limbus


Innervation

  • Main - CNV1 (ophthalmic division of the trigeminal nerve)
  • Inferior conjunctiva - infraorbital nerve
  • Limbus - long ciliary nerve (branch of the nasociliary nerve)

Lymphatics

  • Medial conjunctiva - submandibular nodes
  • Lateral conjunctiva - preauricular nodes

Signs of Conjunctival Disease

Sign

Description

Hyperaemia (conjunctival injection)

Enlargement of conjunctival vessels

Chemosis (conjunctival oedema)

Transparent swelling of the conjunctiva

Conjunctival membranes

Exudative adherences of the conjunctiva

Cicatrization

Scarring of the conjunctiva

Follicles

Discrete lesions which appear like transparent grains of rice. No vessels inside the lesion

Papillae

Lesions confined to the palpebral conjunctiva with a vascular center.


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