1 - Zill - Orbit Flashcards

1
Q

Bones of the Orbit

A
  1. Roof - Frontal
  2. Floor - Maxillary
  3. Medial Wall - Maxillary, Lacrimal, Ethmoid, Frontal, Sphenoid Bones
  4. Lateral Wall - Zygomatic, Sphenoid
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2
Q

What does the orbit serve as a highways for?

A

Nerves and Vessels to Face, Scalp, and Nasal Cavity

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3
Q

Optic Canal

A

In base of Lesser Wing of Sphenoid

Contents:

Optic Nerve (CN II)

Opthalmic Artery

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4
Q

Superior Orbital Fissure

A

Between Greater and Lesser Wings of Sphenoid

Contents:

Cranial Nerves III, IV, V1, VI (3, 4, 5.1, 6)

Ophthalmic Veins

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5
Q

Supraorbital Notch (Foramen)

A

In frontal bone

Contents:

Supraorbital Nerve (From V1)

Supraorbital Artery (From Ophthalmic A.)

Supraorbital Vein (From Opthalmic V.)

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6
Q

Infraorbital Foramen

A

In maxillary bone

Contents:

Infraorbital Nerve (From V2)

Infraorbita Artery (From Maxillary Artery)

Infraorbita Vein

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7
Q

Anterior and Posterior Ethmoidal Foramina

A

Between Ethmoid and frontal bones (back of the eye)

Connect Orbit and Nasal Cavities

Contains:

Anterior and Posterior Ethmoidal Nerves (branch of V1)

Anterior and Posterior Ethmoidal Arteries (branch of Ophthalmic)

Anterior and Posterior Ethmoidal Veins (branch of Ophthalmic)

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8
Q

Opening of Nasolacrimal Duct

A

In Maxillary, Lacrimal, and Inf. Nasal Concha

Contains:

Membraneous Nasolacrimal Duct

Tears

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9
Q

Stye (Horde’olum)

A

Obstruction or Infection of Sebaceous Gland in subcutaneous layer

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10
Q

Eyelids (Palpebrae)

Layers

A

Layers:

Skin - Contains eyelashes, openings of sebaceous, sweat glands

Subcutaneous Layer - Connective tissue, contains sebaceous glands (Stye here)

Tarsal Plate - Fibrous CT skeleton of eyelid (Chalazion here)

Orbital Septum - CT layer continuous with periosteum of orbit

Conjuctiva - Clear membrane covering inside of lide, fuses to sclera (Conjuctiva or “Pinkeye”)

Muscles:

Orbicularis Oculi (palpebral part) - Closes eye, Cranial Nerve 7

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11
Q

What can occur if Orbicularis Oculi is paralyzed?

What nerve innervates this?

A

Cornea can become damaged, as the eyelid does not function

Cranial Nerve VII

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12
Q

Chalazion

A

Obstruction of Tarsal (meibomian) Gland in eyelid

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13
Q

Levator Palpebrae Superioris

Action?

Innervation?

Clinical?

A

Action: Lift upper eyelid

Innervation:

Skeletal muscle part - CN III

Smooth Muscle Part - Sympathetics

Clinical: Eyelid Droop, damage to CN III or Sympathetics

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14
Q

Conjuctivitis (Pinkeye)

A

Inflammation of Conjunctiva

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15
Q

Lacrimal Gland

Action?

**Innervation?**

A

Action: Superolateral orbit, opens by ducts through conjunctiva to superior fornix, constantly produces tears

**Innervation: Cranial Nerve VII**

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16
Q

Facial Nerve and Lacrimal Duct:

Block VII?

Pressure/Irritate VII?

A

Block - Decrease tears

Pressure/Irritate - Excessive Tears

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17
Q

Human Development - Obstructed Nasolacrimal Duct

A

Failure of duct to canalize, tears drain over lower eyelid to face

Opened surgically for tears to drain to nasal cavity

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18
Q

Medial and Lateral Check Ligaments

A

Prevent Excessive Rotation of eye

19
Q

Three Structural Layers of Eye

A
  1. Fibrous Layer: Sclera, Cornea
  2. Vascular Layer: Iris, Ciliary Body, Choroid
  3. Retina
20
Q

Sclera

A

Tough, smooth white connective layer

Muscles attach here, fuses with dura posteriorly and cornea anteriorly

21
Q

Cornea

A

Avascular, aids in focusing light

Irregularities: Astigmatism

22
Q

Blood Supply to Orbit

A

Ophthalmic Artery

Major Branches:

Posterior Ciliary Arteries (Long and Short)

Central Artery of Retina

23
Q

Blood Supply to Eye

A
  1. Posterior Ciliary Arteries - pierce sclera, blood to choroid, photoreceptors
  2. Central Artery of Retina - pierce Optic Nerve, blood to neural retina; end artery (no anastomoses)
24
Q

Choroid

A

Highly vascular, pigmented, provides O2, nutrients to photoreceptors

25
Vascular Layer of Eye (Uveal Tract [Uvea])
Choroid, Ciliary Body, Iris
26
Retina Blood Supply? Clinical?
Contains **Rods** and **Cones** Blood: **Ce****ntral Artery of Retina (**br. of Ophthalmic A.); no anastomoses Clinical: **Occlusion can result in blindness**
27
CRAO (Central Retinal Artery Occlusion) What can slightly prevent this?
Most common cause is **Carotid Artery atherosclerosis;** if complete blockage = **blind in one eye** - - - Ciliary Arteries can supply retina in 20% of people
28
Subarachnoid Space and CSF Papilledema
Dura and Subarachnoid space extends to back of eyeball **around Optic Nerve;** Increase in **CSF Pressure can affect vision** - Slow onset, headaches - Papilledema = Swelling of Optic Disc
29
Ciliary Body Muscle Attachment? Contracted vs Relaxed? Control?
Ciliary Muscles - smooth muscles that attach **suspensory ligaments** of **lens; controls thickness of lens** **- - -** **Far Sight:** Muscles Relaxed - Tight Ligaments - Flat Lens **Near Sight:** Muscles Contracted - Loose Ligaments - Thick Lens - - - Lens is thickened (more power) for viewing objects close up, under **Parasympathetic Control - III (Short Ciliary Nerves)**
30
Iris \*\*\*Pupil Dillation Control?\*\*\*
Iris - Pigmented contractile layer with smooth muscles surrounding pupil - - - **Constrictor Pupil -** Circular smooth muscle - **Parasympathetics (CN III)** **Dilator Pupil -** Radial smooth muscle - **Sympathetics** **IF ONE IS BLOCKED, OTHER WINS!** **"ParaConstrictor - **_C_**ranial Nerve III"**
31
Extraocular Muscles: Superior / Inferior Rectus Lateral / Medial Rectus Superior / Inferior Oblique
Superior / Inferior Rectus - Up / Down Lateral / Medial Rectus - Lateral / Medial (will be opposite for eyes for coordinated L/R movements) Superior / Inferior Oblique - Superior act through trochlea, Inferior to floor of orbit (rotate eyes)
32
Voluntary Eye Movements
Adduct - Move medially Abduct - Move laterally Raise - Move superiorly Lower - Move inferiorly
33
Involuntary Eye Movements
Rotation Involuntary **when tilt head** Medial Rotate - Intorsion Lateral Rotate - Extorsion
34
Origins of Extraocular Muscles?
All but **Inferior Oblique** take origin from **Tendinous Ring** Inferior Oblique takes origin from **Floor of Orbit**
35
Medial and Lateral Rectus Action? Innervation?
Lateral Rectus Action: Abduct Eye Innervation: **Cranial Nerve VI** **- - -** Medial Rectus Action: Adduct Eye Innervation: **Craial Nerve III**
36
Superior and Inferior Rectus Action? Innervation?
Superior Rectus Action: Raise, Adduct, Medial Rotate Innervation: **Cranial Nerve III** **- - -** Inferior Rectus Action: Lower, Adduct, Lateral Rotate Innervation: **Cranial Nerve III**
37
Superior and Inferior Oblique Action? Innervation?
Superior Oblique Action: Lower, Abduct, Medial Rotate Innervation: **Cranial Nerve IV** **"Like muscle on nose"** - - - Inferior Oblique Action: Raise, Abduct, Lateral Rotate Innervation: **Cranial Nerve III** **"Like muscle on ear"**
38
Draw the eye movements diagram.
39
Clinical: Damage to Abducens Nerve (CN VI)
At Rest: Medial Strabismus (cross-eyed) due to damage/paralyze **Lateral Rectus** ## Footnote *Nothing is "pulling" the eye lateral, so it will be pulled medial by resting eye tonus*
40
Clinical: Damage to Trochlear (CN IV) Nerve
Symptoms: Inability to turn eye **down and out** **Head Tilt (to counter eye lateral rotation at rest)** Difficulty walking down stairs
41
Clinical: Oculomotor (CN III) Nerve Damage
At Rest: 1 - Lateral Strabismus (wall-eyed) - due to **paralyzed medial rectus** 2. Ptosis - Drooping eyelid, **paralyze Lev. Palpebrae Superioris** 3. Dilated Pupil (**mydriasis**) - **Paralyze Pupillary Constrictor`**
42
Ciliary Ganglion - Parasympathetics of what? Travel with? Innervate? Clinical Damage?
Parasympathetics of **Oculomotor (CN III)** Travel in **Short Ciliary Nerves** Innervate **Ciliary Muscles, Constrictor Pupillae** Clinical Damage to Short Ciliary Nerves: **Dilated "Blown" Pupil = Mydriasis**
43
Trigeminal Nerve Types?
V1 - Somatic Sensory V2 - Somatic Sensory V3 - Somatic Sensory and Branchiomotor
44