
<ul>
  <li>Thin mucous membrane</li>
  <li>Embryology: derived from surface ectoderm</li>
  <li>Continuous with the skin at the lids and with the corneal epithelium</li>
  <li>Goblet cells throughout especially in the fornices and plica semilunaris&nbsp;</li>
  <ul>
    <li>Concentration declines with age</li>
  </ul>
  <li>Accessory lacrimal glands (of Krause and Wolfring) throughout lamina propria</li>
  <ul>
    <li>Identical to lacrimal gland in histology</li>
    <li>Gland of Krause in the superior fornix</li>
    <li>Gland of Wolfring at superior tarsal border</li>
    <li>These accessory glands provide basal tear production&nbsp;</li>
  </ul>
  <li>Contains network of dendritic (Langerhans) cells</li>
  <li>Conjunctival sac has 25-30 microlitre capacity</li>
  <li>Tight junctions between cells prevent travel of electrolytes from tears&nbsp;</li>
  <li>Conjunctival epithelium and goblet cells rely on vitamin A and retinoids&nbsp;</li>
  <ul>
    <li>Abnormal in vitamin A deficiency leading to severe dry eye disease</li>
  </ul>
</ul>

## Conjunctival layers
<ul>
  <li>Epithelium:</li>
  <ul>
    <li>2-7 layers</li>
    <li>Non-keratinised stratified&nbsp;</li>
    <li>Squamous over palpebral and limbal surfaces</li>
    <li>Columnar over bulbar surface</li>
    <li>Goblet cells, melanocytes, dendritic cells, lymphocytes</li>
    <li>Microvilli on the apical surface harbour glycoproteins that stabilise the tear film</li>
  </ul>
  <li>Epithelial basement membrane: type IV collagen, anchoring fibrils and hemidesmosomes</li>
  <li>Stroma:</li>
  <ul>
    <li>Loose connective tissue</li>
    <li>Superficial lymphoid layer: attached to epithelium via the BM</li>
    <li>
      Deep collagenous fibrous layer: attached to Tenon&rsquo;s capsule over bulbar surface and
      posterior lamellae over palpebral surface
    </li>
  </ul>
</ul>

## Arterial supply
<ul>
  <li>Palpebral arches supply most of the conjunctiva</li>
  <li>Anterior ciliary arteries (from the muscular branches) also supply the limbal conjunctiva</li>
</ul>

## Venous drainage
<ul>
  <li>Match the arteries and drain into superior and inferior ophthalmic veins</li>
</ul>

## Lymph
<ul>
  <li>Laterally to the superficial parotid nodes</li>
  <li>Medially to the submandibular nodes</li>
</ul>

## Nerve supply
<ul>
  <li>
    Superior palpebral and forniceal conjunctiva: frontal and lacrimal branches of ophthalmic nerve
    (CNV1)
  </li>
  <li>
    Inferior palpebral and fornical: lacrimal branches (ophthalmic) supplies laterally and the
    infraorbital nerve (CNV2) supplies medially
  </li>
  <li>Bulbar: long ciliary nerves (branches of nasociliary from ophthalmic)</li>
</ul>

## Palpebral (tarsal) conjunctiva
<ul>
  <li>Firmly attached to tarsal plates</li>
  <li>Stratified squamous epithelium</li>
  <li>Continuous with keratinised epithelium of the skin just posterior to the tarsal glands</li>
</ul>

## Forniceal conjunctiva
<ul>
  <li>
    Attached to fascia of the extraocular muscles, therefore the conjunctiva moves as the globe
    moves
  </li>
  <li>Lacrimal ducts of the palpebral lobe of the lacrimal gland open into superior fornix</li>
  <li>Lateral fornix extends 14mm from the limbus to the equator</li>
  <li>Contains accessory lacrimal glands of Krause and Wolfring</li>
  <li>The superior fornix extends further from the limbus (ie. is deeper) than the inferior</li>
</ul>

## Bulbar conjunctiva
<ul>
  <li>Loosely attached to sclera</li>
  <li>Columnar squamous epithelium but converts back to squamous at the limbus</li>
  <li>Conjunctival limbus is situated 1mm anterior to the corneoscleral limbus</li>
  <li>Fused with Tenon&rsquo;s capsule 3mm from the limbus&nbsp;</li>
  <li>
    Note: Tenon&rsquo;s capsule fuses with the sclera a bit further forward, 1.5mm from limbus
  </li>
</ul>


Anterior segment - ocular surface

Conjunctiva

Intro

FRCOphth Part 2 Study Notes

Tumours, masses and neoplasia

Tumours overview

Uveitis

Uveitis background

Anterior uveitis

Intermediate uveitis

Uveitis in JIA

Uveitis with JIA

Retinal vasculitis

Sarcoidosis

Behcet's disease

Toxoplasmosis

Strabismus

Overview

Viral uveitis

Esotropia

Fungal uveitis

Mycobacterial uveitis

Adnexal masses

Exotropia

Spirochaetal uveitis (including Syphilis)

Melanoma

Nematode uveitis

Retinoblastoma

Retinoblastoma (for Part 2)

Incomitent

Voyt-Koyanagi-Harada syndrome

Conjunctival intraepithelial neoplasia

Vertical deviations

Orbit and ocular adnexae

Orbit

Sympathetic ophthalmia

AV Malformations and hamartomas

Arteriovenous malformations and hamartomas

Restriction syndromes

Paediatrics

Leucocoria

Congenital Cataract

Paediatric Glaucoma

Retinopathy of prematurity

Retinopathy of Prematurity

ROP-like disorders

Congenital nasolacrimal duct obstruction

White dot syndromes

Aniridia: Short Arm 11 Deletion (11p13)

Choristomas

Management Of Amblyopia

Alphabet patterns

Iris Nodules

Scleritis

Meningioma

Strabismus surgery

Optic nerve glioma

Lymphoma

Extraocular Muscles

Rhabdomyosarcoma

Idiopathic orbital inflammation

Orbital neuroblastoma

Anterior Persistent Foetal Vasculature

Lacrimal system

Metastatic lesions

Surgical Retina

Retinal Detachment

Vitreoretinal Interface And Macular Hole

Epiretinal Membrane

Medical Retina

Diabetic Eye Disease

Orbital Blood Vessels

Retinal Vascular Disease

Macular Degeneration

Central Serous Chorioretinopathy (CSCR)

Sickle Cell Retinopathy

Retinitis Pigmentosa

Albinism

Retinal Telangiectasias

Miscellaneous Retinopathies

Atropine And Myopia Progression

Pharmacology

Side Effects Of Systemic Drugs

Foetal Alcohol Syndrome

Neuro-ophthalmology

Optic Neuropathy

Papilloedema

Idiopathic Intracranial Hypertension

Chiasmal Disorders

Retrochiasmal Disorders

Migraine

Paranasal Sinuses

Supranuclear Motility Disorders

Third Nerve Palsies

Fourth Nerve Palsies

Sixth Nerve Palsies

Seventh Nerve Palsies

Anisocoria

Myasthenia Gravis

Myopathies

Blepharospasm

Functional Visual Loss

Lacrimal Glands

Phakomatoses

Developmental diseases

Tear Film

Eyelids

Blinking

Lid Malpositions

Conjunctivitis

Sclera

Pigmented Conjunctival Lesions

Squamous Cell Carcinoma Of The Conjunctiva

Ocular Cicatricial Pemphigoid

Cornea

Corneal Structure And Development