Embryology and Anatomy of

Eye Lids And Conjunctiva

Dr. Meghna Roy
JR-1, Deptt. Of Ophthalmology
Embryology Of Eye Lids and Conjunctiva :

• The major development of the eye takes place between week 3

and week 10 and involves ectoderm, neural crest cells, and
mesenchyme.

• The neural tube ectoderm gives rise to the retina, the iris and
ciliary body epithelia, the optic nerve, the smooth muscles of the
iris, and some of the vitreous humor.

• Surface ectoderm gives rise to the lens, the conjunctival and

corneal epithelia, the eyelids, and the lacrimal apparatus.

• The remaining ocular structures form from mesenchyme.

• The eyelids begin to form in the sixth week from neural
crest cells as well as surface ectoderm just anterior to the c
ornea.

• They begin as two folds of skin that meet over the cornea
and they are attached to one another until about the
27th week when they separate.

• While they are adherent to one another there is a

conjunctival sac between the eyelids and the cornea .

• The orbicularis oculi, which is found within the eyelids,forms

from the second branchial arch along with the other
muscles of facial expression and will be innervated with SVE
fibers.
• Formation of eyelids takes place by reduplication of surface ectoderm
above and below the cornea

• Ectodermal folds contain mesoderm which gives rise to the muscle a

nd tarsal plates

• Folds enlarge and they approach each other and their margins fuse

• Conjunctival sac is thus formed

• The conjunctiva is of ectodermal origin

• The lids remain fused till 7th month of intrauterine life

Congenital Malformations Of Eyelids:

TELECANTHUS

BLEPHAROPHIMOSIS PTOSIS
 EPIBLEPHARON

A.UPPER LID COLOBOMA B.LOWER LID COLOBOMA

CONGENITAL LOWER LID ENTROPION
EURYBLEPHARON

MICROBLEPHARON CRYPTOPTHLAMOS A.COMPLETE

 CONGENITAL UPPER LID EVERSION

A. ABLEPHARON
B.FOLLOWING RECONSTRUCTION
ANKYLOBLEPHARON
Anatomy Of Eyelid

• Mobile tissue curtain infront of eyeballs

• Two lids : Upper and lower
• Two canthi :
Medial - seperated from globe by tear lake
- caruncle and plica semilunaris present
Lateral – lie in contact with globe

• Position (In primary position of gaze) –

Upper lid – covers 1/6 th of cornea
Lower Lid – Just touches the limbus
Lid Margin :
• 2mm in width

• Two portions ( Divided by Lacrimal Papilla)

1. Lacrimal Portion- Devoid of lashes or gland
2. Ciliary Portion – Two borders
Anterior – Rounded
Posterior - sharp
- An Inter-marginal strip
Grey Line divides it into
Anterior Strip – Lashes
Posterior Strip - Meibomian Gland
Opening
• Eyelashes - arranged in 2-3 rows
- lash follicles are obliquely arranged and lack errectores
- Gland Of Zeis and Moll empty into infundibulum of
piliary canal
Surface Anatomy Of Eyelid :
Lid Folds :
• Two lid folds : Superior and Inferior

• Superior lid fold :

- formed by fibrous slip from tendon of levator.

- divides upper lid into orbital and tarsal part

• Inferior lid fold – less distinct

- formed by fascia surrounding inferior rectus

• Naso jugal fold or Sulcus medially

• Malar fold or Sulcus laterally

Layers Of Eyelid
1. Skin
2. Subcutaneous areolar tissue
3. Layer of straited muscle
4. Submuscular areolar tissue
5. Fibrous layer
6. Layer of non straited muscle (Muller’s fibre)
7. Conjunctiva
1. Skin –
Thinnest in body
Epidermis – stratified squamous epithelium
- Stratum germinatum
Unicellular sebaceous gland
Typical eccrine sweat gland

2. Subcutaneous areolar tissue

- contains no fat
- non existent – near ciliary margin
- lid folds
- medial and lateral angle

3. Layers of stiriaited Muscle :

- Orbicularis Occuli
- Levator palpabrae superioris
Levator Palpabrae Superiosis
Orbicularis oculi :
4. Submuscular Areolar Tissue
• Splits the eyelid into anterior and posterior
lamina
• Easily approached through grey line

• Nerves and vessels of lid lie in this layer

It superiorly communicates with sub

aponeurotic stratum of scalp (dangerous area
of scalp) ;
Hence pus and blood can make its way to
upper eyelid from this layer
5. Fibrous Layer
• Consists of – Tarsal Plate- central thick part
Septum orbitale- peripheral thin part
Medial palpebral ligament
Lateral palpebral ligament
Tarsal Plate :
• Firm plate of dense connective tissue.

• Size – Length – 29 mm
Width – 1mm
Height- 10-11mm (upper); 4-5mm (lower)

• Borders – Free border – straight

Attached border- convex
Upper border of upper tarsus – septum orbitale
- Muller muscle
Lower border of lower tarsus- orbital septum
- capsulopalpebral fascia
- inferior palpebral muscle

• Surface – Anterior – Convex – attachment of LPS Aponeurosis

Posterior – Concave – lined by cunjunctiva
Tarsal Plate Of Eyelid :
 Extremities :

• Extremities –
Lateral end – attached to Whitnall’s tubercle
by lateral palpebral ligament

Medial end - attached to anterior lacrimal crest and

frontal process of maxilla by medial palpebral ligament
Septum Orbital

• Thin floating membrane of connective tissue

• Comparatively thick and strong on lateral side and upper eyelid

• Attachments -
Centrally – continuous with convex border of tarsi
Peripherally – attached to orbital margin as arcus marginale.
Structures piercing through Septum :
Medial palpebral Ligament
Can be divided into two parts

• Anterior part - Resembles letter ‘Y’

- The two limbs of Y
correspond with lacrimal portion of lid
margin ; contain lacrimal canaliculi

• Posterior part – Passes behind lacrimal

sac
Lateral palpebral Ligament
• Comparatively thin

• Attachment – lateral- Whitnall’s tubercle

medial- lateral end of tarsal plate
superiorly- merges with lateral expansion of LPS
aponeurosis
inferiorly- merges with lateral expansion of inferior
oblique and inferior rectus muscle

• Surface –
Anterior – related to lateral palpebral raphe
Posterior- related to check ligament of lateral rectus
6. Non straited muscle fibre layer (Muller’s Muscle)

• Origin :
Upper Lid- LPS inferior terminal striated fibers
Lower Lid – Expansion of inferior rectus

• Insertion : Orbital margin of Tarsal plate

• Nerve supply : Sympathetic nerve fiber

• Applied Anatomy :
Sympathetic irritation – Retraction of lid
Sympathetic paralysis - Horner’s syndrome
Applied Aspects
1. Anomaly in position of lid margin

• Entropion

• Ectropion

• Symblepharon

• Ankyloblepharon

• Blepharophimosis

• Lagophthalmos

• Lid retraction

• Ptosis
Blepharophimosis Ptosis
Cicatrial ectropion
Disorders Of Eyelashes

• Trichiasis

• Pseudotrichiaisis

• Distichiasis

• Madarosis
Glands Of Eyelids

1. Tarsal or Meibomian Gland

2. Glands of Zeis

3. Gland of Moll

4. Accessory lacrimal gland of Wolfring

Meibomian Gland

• Modified sweat gland

• Present in stroma of tarsal plate
• Arranged in single row; vertically; parallel to each other; 20-30 in each lid

Structure
• Central duct – perpendicular to lid margin
- recieves 10-15 acini
• Acini – lined by glandular epithilium
• Central ducts open in a single row on lid margin
• Opening lies between grey line and posterior border of lid

Secretions
• Oily in nature
• Oily marginal tear strip – prevent overflow of tear across lid margin
• Prevent evaporation of tear film
• Allows smooth movement of eyelid over globe
• Ensures air-tight closure of eyelids
Gland Of Zeis
• Modified sebaceous gland

• Single cul-de-sac or two to three lobules attached to

eyelash follicle.

• Lining of Acini – Cuboidal epithelium

• Secretions – sebum

• Functions- Oily layer of tear film

- Prevent eyelid from becoming dry
and brittle
3. Glands Of Moll
• Modified sweat gland

• More numerous in lower lid than upper

• Unbranched spiral shaped

• Duct passes through dermis and epidermis

• Duct may terminate between the lashes; between lash and its epithelium
; or into the duct of zeis gland.

Epithelial Lining

• Secretory portion- cells with secretory and fatty granules.

• Myoepithelial cells present
4. Accesory Lacrimal
Gland Of Wolfring

• Present along upper and lower border of

superior and inferior tarsi respectively
• Upper lid – 2-5 in number
• Lower lid – 2-3 in number
Applied Aspect

1.Disorder of Meibomian gland :

Acute meibomitis
Internal holdeorum
Chalazion

2. Disorder of gland of zeis and moll :

Stye or external holdeorum
Arterial supply of eyelid

• Medial palpebral artery – branch of dorsal nasal artery

• Lateral palpebral artery – branch of lacrimal artery

• Marginal arterial arcade – 2-3 mm away from lid margin

• Superior or peripheral arterial arcade – along upper border

of superior tarsal plate

• Anastomosing twigs from – Superficial temporal artery

- Transverse facial artery
- infra orbital artery

• Branches – Forward – supply orbicularis and skin

- Backward - supply tarsal gland and conjunctiva
Venous drainage of lid
• Two sets of venous plexus
1. Pre tarsal
2. Post tarsal

1. Pre tarsal venous plexus

• Drains structures superficial to tarsus
• Medial Side : Angular vein, internal jugular vein
• Lateral side : Superficial temporal and lacrimal
vein external jugular vein

2. Post tarsal venous plexus

• Drains structure posterior to tarsal plate
• Drains into ophthalmic vein
Anatomy Of Conjunctiva
Anatomy Of Conjunctiva

• Ethymology:
The name “conjunctiva” has
originated from the term “conjoin” which
means “to join”
Parts Of Conjuctiva

1. Palpebral conjunctiva:
marginal; tarsal; orbital

2. Bulbar conjunctiva: scleral; limbal

3. Conjunctival fornix:
superior; inferior; medial and lateral
1. Palpebral Conjunctiva
1. Marginal conjunctiva

Transition zone from skin to conjunctiva proper

Extend from lid to sulcus subtarsalis

Sulcus subtarsalis –
• shallow groove 2mm from margin
• Perforating vessels pass through tarsus to supply conjunctiva
• Common site for lodgement of conjunctical foreign body

2. Tarsal conjunctiva
Thin, transparent, highly vascular
Firmly adherent to tarsal plate
upper lid – whole width
lower lid – half width
Tarsal glands can be seen as yellow streaks
Common site for follicular and papillary reaction

3. Orbital part
Loose palpebral conjunctiva between tarsal plate and fornix
In upper lid, lies over muller’s muscle
2. Bulbar conjunctiva
• Lies loose over underlying structure

• Seperated from anterior sclera by :

episcleral tissue and tenon’s capsule

• Limbal conjunctiva :
3mm ridge of bulbar conjunctiva around cornea

• Limbus : Conjunctiva, tenon’s capsule , episcleral tissue fuse.

Become firmly adherent to corneoscleral junction
Preferred site for obtaining a firm hold of eyeball
Epithilium of conjunctiva becomes continuous with
cornea

• Subconjunctival vessel and anterior ciliary artery forming peri corneal ple
xus can be seen
3. Conjunctival fornix
Joins bulbar conjunctiva with palpebral conjunctiva

1. Superior fornix
Located at level of superior orbital margin
At a distance of 10mm from limbus
Upper part –
attachment of fascial sheeth of LPS and superior
rectus
Maintains the recess of superior fornix in
movement of upper lid

Subconjunctival tissue –
contains Gland of krause and Muller’s muscle

Foreign body – can be seen after double eversion of lid

2. Inferior fornix
Located near inferior orbital margin
Upto 8 mm from lower limbus.

Fascial sheath of inferior rectus and inferior oblique attached; helps in ma

intaining recess

Subconjunctival tissue – Glands of Krause

3. Lateral fornix
14mm from lateral limbus; 5 mm from lateral canthus

4. Medial fornix
Shallow cul-de-sac

Plica semilunaris and caruncle are present

Histology :

Three layers:
1. Epithelium
2. Adenoid layer
3. Fibrous layer
Conjunctival Glands
Two types
• Mucin secreting: goblet cells; crypts of henle; glands of manz
• Accessory lacrimal gland: glads of Krause and Gland of wolfring
1. Goblet cell:
Density of goblet cell: more on nasal side , in bulbar conjunctiva and inferior
fornix
Mucin secreted- lubricates and protects epithelial cell
- tear film stability
2. Henle’s gland:
Not true gland
Tubular structure containing goblet cell
3. Gland of manz:
Existence in humans is controversial

Applied: Destruction of goblet cells in Vit A deficiency – epithelial xerosis

Blood Supply of conjunctiva
1. Marginal arterial arcade

2. Peripheral arterial arcade

3. Anterior ciliary artery

Branches of muscular artery
2 from each rectus

Therefore ,Palpebral conjunctiva and fornices:

Branches from peripheral and marginal arcades

Bulbar conjunctiva : posterior and anterior conjunctival arteries

Blood Supply of conjunctiva
Venus Drainage
• Drain into venous plexus of eyelid
• Circumcorneal zone (5-6mm) –
Drains into anterior ciliary vein
Nerve supply

• Circumcorneal zone :
Long ciliary nerve

• Rest of conjunctiva:
Branches from lacrimal
nerve,infra trochlear, supra trochlear, supra
orbital and frontal nerves
Applied Aspect :

1. Inflammatory conditions

• Infective conjunctivitis
• Allergic conjunctivitis
• Cicatricial conjunctivitis
• Toxic conjunctivitis
Applied Aspect :

2. Degenerative conditions

• Pingicula
• Pterygium
• Concretion
 PTERYGIUM
PINGICULA
Applied Aspect :
3. Other symptomatic conditions

• Hyperemia
• Chemosis
• Ecchymosis
• Xerosis
• Discolouration
HYPERAEMIA CHEMOSIS
Some interesting Facts About Eye :
• We blink more when we talk.

• All babies are colour blind at birth.

• It’s possible to blink five times in a single second.

• Everyone has one eye that is slightly stronger than other.

• While a fingerprint has 40 unique characteristics, an iris has

256. This is why retina scans are increasingly being used for
security purposes.
Source : https://www.lenstore.co.uk/eyecare/101-amazing-eye-facts
Thank you…