Ординатура / Офтальмология / Английские материалы / Atlas of Confocal Laser Scanning In-vivo Microscopy in Opthalmology - Principles and Applications in Diagnostic and Therapeutic Ophtalmology_Guthoff, Baudouin, Stave_2006

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Fig. 5.133 Amyloidosis. a–e Under normally structured conjunctiva (a) and in the subconjunctival space (b) between blood vessels (right arrow), a lobular tissue pattern (left arrow) is visible (c, d), which shows a high degree of consistency with histology after invasive biopsy

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Fig. 5.135 Conjunctival and limbal tumors. a Slitlamp photograph of a 55-year-old woman with a lim-

bal tumor. b–d Numerous cellular abnormalities: nuclear abnormalities, polymorphism

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Fig. 5.137 Conjunctival and limbal tumors, carcinoma in situ. a, b Numerous cellular abnormalities: polymorphism, abnormal and irregular reflectivity. c Histology

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5.10 Conjunctiva

The different areas of the conjunctival epithelium display varying morphology.

The tarsal conjunctiva consists of two or three layers of cylindrical epithelium and contains individual goblet cells and lymph vessels. Deep to the epithelium is located the loosely meshed, highly vascular fiber lattice of the lamina propria with its papillary structure; this contains free cells (lymphocytes, plasma cells)

and occasional lymph follicles, which are present in vastly increased numbers in inflammatory conditions, as well as smaller glandular packages. The lamina propria is continuous with the deeper-lying subconjunctival lamina, which is denser and is tightly fused with the tarsal plate.

The bulbar conjunctiva, in contrast, is characterized by several layers of squamous epithelium with numerous goblet cells. Deep to the epithelium is a very loosely meshed, highly mobile connective tissue with a pronounced capillary network.

Fig. 5.139 Tarsal conjunctiva. a Slit-lamp photograph of the healthy tarsal conjunctiva of the upper lid. b Conjunctival epithelium with some highly reflective cells, possibly goblet cells (black arrow); under the basal membrane (white arrow) the lamina propria of the underlying connective tissue is seen with numerous small blood vessels and some highly

reflective round cells, possibly lymphocytes (dashedline arrows). c Subconjunctival connective tissue with blood vessels and highly reflective cells (lymphocytes, plasma cells). d Lymphatic follicle of the conjunctiva in a healthy person. e Epithelium (black arrow), lamina propria with blood vessels (dashed-line arrow)

Fig. 5.140 Bulbar conjunctiva. a Superficial conjunctival epithelium (z=3 mm). Tthe epithelial structure is not as well organized as in the cornea; the cell borders are brighter than the cytoplasm, and in some cells a bright nucleus is visible. b Deeper conjunctival epithelium (z=10 mm). c–e Lamina propria with high-

ly reflective latticelike connective tissue and some highly reflective cells (black arrows) and blood vessels (dashed-line arrows). f, g Oblique sections: epithelium (black arrow), underlying connective tissue (dashed-line arrow), blood vessels (white arrow)