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SHB > 10.17.16 Orbit I > Flashcards

10.17.16 Orbit I Flashcards

1
Q

What three bones make up the outer rim of the orbit?

A
  1. Frontal bone
  2. Zygomatic
  3. Maxilla
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2
Q

What four bones make up the inside of the orbit?

A
  1. Lacrimal bone
  2. Ethmoid bone
  3. Sphenoid bone
  4. Palatine bone
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3
Q

The lacrimal bone has a fossa for the ___.

A

Lacrimal sac

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4
Q

The superior orbital fissure lies between what two structures?

A

The lesser and greater wings of the sphenoid bone

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5
Q

The inferior orbital fissure lies between what two structures?

A

Greater wing of the sphenoid and the maxilla

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6
Q

The orbit is ___ in shape and has a base, four walls, and an apex.

A

Pyramidal

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7
Q

What forms the base and apex of the orbit?

A

Base: orbital margin
Apex: optic canal

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8
Q

What forms the four walls of the orbit?

A

Superior (roof): frontal bone, lesser wing of sphenoid
Inferior (floor): maxilla, zygomatic, palatine
Lateral: Zygomatic, sphenoid, little bit of frontal
Medial: ethmoid, lacrimal, little bit of maxillary, frontal, and sphenoid

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9
Q

“Blow-out” fractures due to a sharp blow to the eye can result in what?

A

The eye falling into the maxillary sinus below the floor of the orbit

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10
Q

What is the strongest wall of the orbit?

A

Lateral wall

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11
Q

What are palpebrae?

A

Eyelids

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12
Q

What do the palpebrae do?

A

Protect and aid in the lubrication of the eye

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13
Q

What are the layers of the palpebrae?

A
  1. Skin
  2. Subcutaneous connective tissue
  3. Muscular layer
  4. Submuscular layer
  5. Tarsal plate
  6. Tarsal glands
  7. Palpebral conjunctiva
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14
Q

What is the space between the upper and lower lids, bounded by the upper and lower palpebral margins?

A

Palpebral fissure

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15
Q

The skin of the of palpebrae contain what two types of glands?

A

Sweat glands (glands of Moll) and sebaceous/ciliary glands (glands of Zinn)

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16
Q

The eyelashes are contained in the layer of the skin at the anterior border of the ___ junction.

A

Mucocutaneous

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17
Q

Obstruction of the ciliary glands results in a ___.

A

Stye

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18
Q

What does the subcutaneous connective tissue of the palpebrae allow?

A

Free movement of the overlying skin

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19
Q

What does the muscular layer of the palpebrae contain?

A

The palpebral portion of orbicularis oculi

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20
Q

What does the submuscular layer contain?

A

The nerves which supply the eyelid

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21
Q

What gives form to the upper and lower eyelids?

A

Tarsal plate

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22
Q

What muscle attaches to the superior aspect of the tarsal plate of the upper lid?

A

Levator palpebrae superioris

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23
Q

What do secretions from the tarsal glands do?

A

Prevent the eyelids from sticking together, help form a seal between the lids when they are closed

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24
Q

What condition occurs when the ducts of the tarsal glands become blocked?

A

Chalazion

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25
Q

What is the mucus membrane that helps moisten the eye itself?

A

Palpebral conjunctiva

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26
Q

The palpebral conjunctiva is continuous with the ___, which covers the sclera of the eye.

A

Orbital conjunctiva

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27
Q

What is the junction of the palpebral and orbital conjunctiva?

A

Fornix

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28
Q

What causes Horner’s syndrome?

A

Lesion to the superior cervical sympathetic ganglion, which paralyzes the tarsal muscle on the affected side

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29
Q

What is the clinical manifestation of Horner’s syndrome?

A
  1. Ptosis (dropping eyelid)
  2. Meiosis (small pupil)
  3. Anhydrosis (lack of sweating and reddening of the skin on the affected side)
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30
Q

What are the medial and lateral acute angles of the eye?

A

Medial canthus and lateral

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31
Q

What is the space between the upper and lower lids known as?

A

Palpebral fissure

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32
Q

The larger medial angle of the eye is known as the ___.

A

Lacrimal lake

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33
Q

What is the fleshy elevation seen in the medial angle of the eye within the lacrimal lake?

A

Lacrimal caruncle

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34
Q

What is the connective tissue band found lateral to the lacrimal caruncle?

A

Plica semilunaris

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35
Q

Where is the lacrimal gland located?

A

Superolateral aspect of the orbital

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36
Q

The ducts of the lacrimal gland drain into the ___.

A

Superior palpebral fornix

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37
Q

From where do tears flow?

A

Lacrimal gland

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38
Q

Where do tears drain?

A

Puncta lacrimali (at medial canthus of the eye)

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39
Q

What connects the lacrimal puncta with the lacrimal sac?

A

Lacrimal canaliculus

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40
Q

Are the motor fibers to the lacrimal gland sympathetic or parasympathetic in nature?

A

Parasympathetic

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41
Q

The specific branch of CN VII that contains the secretomotor parasympathetic fibers to the lacrimal gland is the ___.

A

Greater petrosal nerve

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42
Q

The greater petrosal nerve continues across the foramen lacerum, where it is met by the ___ nerve.

A

Deep petrosal nerve

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43
Q

Does the deep petrosal nerve contain sympathetic or parasympathetic fibers?

A

Sympathetic

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44
Q

What nerve do the greater and deep petrosal nerves form?

A

Nerve of the pterygoid canal

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45
Q

The nerve of the pterygoid canal runs through the ___. Then, it courses into the pterygopalatine fossa to the ___ ganglion.

A

Pterygoid canal; pterygopalatine

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46
Q

What synapses in the pterygopalatine ganglion?

A

ONLY the parasympathetic fibers of the nerve of the pterygoid

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47
Q

The postganglionic fibers of the nerve of the pterygoid canal join the ___ nerve and follow its zygomaticotemporal branch anteriorly.

A

Maxillary nerve (CN V2)

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48
Q

After joining CN V2, these fibers join the ___ and follow it to the lacrimal gland.

A

Lacrimal branch of CN V1

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49
Q

Parasympathetic stimulation of the lacrimal gland leads to ___. Sympathetic stimulation results in ___.

A

Increased lacrimal secretion (tearing); vasoconstriction and decreased tear production

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50
Q

What are the 7 extraocular muscles?

A
  1. Superior oblique
  2. Levator palpebrae superioris
  3. Superior rectus
  4. Medial rectus
  5. Lateral rectus
  6. Inferior rectus
  7. Inferior oblique
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51
Q

From where do the recti muscles originate?

A

Anulus tendineus

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52
Q

What is the anulus tendineus?

A

Fibrous ring which encircles the junction of the superior and inferior orbital fissures and optic canal

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53
Q

What is the origin of inferior rectus?

A

Anulus tendineus

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54
Q

What is the origin of lateral rectus?

A

Anulus tendineus

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55
Q

What is the origin of medial rectus?

A

Anulus tendineus

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56
Q

What is the origin of superior rectus?

A

Anulus tendineus

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57
Q

What is the insertion of inferior rectus?

A

Inferior aspect of eyeball, posterior to corneoscleral junction

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58
Q

What is the insertion of lateral rectus?

A

Lateral aspect of eyeball, posterior to corneoscleral junction

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59
Q

What is the insertion of medial rectus?

A

Medial aspect of eyeball, posterior to corneoscleral junction

60
Q

What is the insertion of superior rectus?

A

Superior aspect of eyeball, posterior to corneoscleral junction

61
Q

What innervates inferior rectus?

A

Oculomotor nerve (CN III), inferior division

62
Q

What innervates lateral rectus?

A

Abducent nerve (CN VI)

63
Q

What innervates medial rectus?

A

Oculomotor nerve (CN III), inferior division

64
Q

What innervates superior rectus?

A

Oculomotor nerve (CN III), superior division

65
Q

What supplies inferior rectus?

A

Ophthalmic artery

66
Q

What supplies lateral rectus?

A

Ophthalmic artery

67
Q

What supplies medial rectus?

A

Ophthalmic artery

68
Q

What supplies superior rectus?

A

Ophthalmic artery

69
Q

What is the function of inferior rectus?

A

Depresses, adducts, laterally rotates eyeball

70
Q

What is the function of lateral rectus?

A

Abducts eyeball

71
Q

What is the function of medial rectus?

A

Adducts eyeball

72
Q

What is the function of superior rectus?

A

Elevates, adducts, and medially rotates eyeball

73
Q

What are the extraocular muscles that do not originate from the anulus tendineus?

A
  1. Superior oblique
  2. Inferior oblique
  3. Levator palpebrae superioris
74
Q

What is the origin of superior oblique?

A

Body of sphenoid (above optic foramen), medial to origin of superior rectus

75
Q

What is the insertion of superior oblique?

A

Passes through trochlea, attaches to superior sclera between superior and lateral recti

76
Q

What innervates superior oblique?

A

Trochlear nerve (CN IV)

77
Q

What supplies superior oblique?

A

Ophthalmic artery

78
Q

What is the function of superior oblique?

A

Abducts, depresses, and medially rotates eyeball

79
Q

What is the origin of inferior oblique?

A

Anterior floor of orbit lateral to nasolacrimal canal

80
Q

What is the insertion of inferior oblique?

A

Lateral sclera deep to lateral rectus

81
Q

What innervates inferior oblique?

A

Oculomotor nerve (CN III), inferior division

82
Q

What supplies inferior oblique?

A

Ophthalmic artery

83
Q

What is the function of inferior oblique?

A

Abducts, elevates, and laterally rotates eyeball

84
Q

What is the origin of levator palpebrae superioris?

A

Lesser wing of sphenoid, anterior to optic canal

85
Q

What is the insertion of levator palpebrae superioris?

A

Superior tarsal plate

86
Q

What innervates levator palpebrae superioris?

A

Oculomotor nerve (CN III), superior division

87
Q

What supplies levator palpebrae superioris?

A

Ophthalmic artery

88
Q

What is the function of levator palpebrae superioris?

A

Raises upper eyelid

89
Q

Which of the 6 eye muscles elevates the eye?

A

Superior rectus and inferior oblique

90
Q

Which of the 6 eye muscles depresses the eye?

A

Inferior rectus and superior oblique

91
Q

Which of the 6 eye muscles adducts the eye?

A

Superior rectus, inferior rectus, medial rectus

92
Q

Which of the 6 eye muscles abducts the eye?

A

Superior oblique, inferior oblique, lateral rectus

93
Q

Which of the 6 eye muscles rotates the eye medially?

A

Superior rectus and superior oblique

94
Q

Which of the 6 eye muscles rotates the eye laterally?

A

Inferior rectus and inferior oblique

95
Q

What three nerves innervate the extraocular muscles?

A
  1. Oculomotor nerve (CN III)
  2. Trochlear nerve (CN IV)
  3. Abudcent nerve (CN VI)
96
Q

Through what foramen or fissure do the nerves that innervate the extraocular muscles enter?

A

Superior orbital fissure

97
Q

What nerves innervate which extraocular muscles?

A
  1. Lateral rectus - CN VI
  2. Superior oblique - CN IV
  3. All others - CN III

LR6, SO4, AO3

98
Q

The optic nerve (CN II) enters the orbit via the ___ canal with the ___ artery.

A

Optic; ophthalmic

99
Q

What does the optic nerve do in the eye?

A

Conveys sensory information (vision) from the retina to the CNS

100
Q

What is the largest nerve in the orbit?

A

Optic nerve (CN II)

101
Q

What supplies sensory innervation to the orbit and external eye?

A

Ophthalmic division of the trigeminal nerve (V1)

102
Q

The ophthalmic division of the trigeminal nerve (CN V1 enters the orbit through the ___.

A

Superior orbital fissure

103
Q

What are the three primary branches of the ophthalmic nerve (CN V1)?

A
  1. Lacrimal nerve
  2. Frontal nerve
  3. Nasociliary nerve
104
Q

What does the lacrimal nerve do?

A

Provides sensory innervation to the lacrimal gland and the lateral aspect of the eye and upper and lower palpebrae

105
Q

The postganglionic parasympathetics that run to the lacrimal gland join the ___ nerve after running with the zygomaticotemporal branch of CN V2.

A

Lacrimal

106
Q

What nerve runs on top of levator palpebrae superioris?

A

Frontal nerve

107
Q

What are the 2 divisions of the frontal nerve?

A
  1. Supratrochlear nerve

2. Supraorbital nerve

108
Q

Which division of the frontal nerve is more medial? More lateral?

A

Medial: supratrochlear
Lateral: supraorbital

109
Q

What does the supratrochlear nerve do?

A

Supplies sensory innervation to the skin above the medial canthus and a portion of the scalp

110
Q

What does the supraorbital nerve do?

A

Supplies the superior palpebra and the scalp above

111
Q

The ___ nerve is the direct continuation of the frontal nerve and exits the orbit via the ___.

A

Supraorbital; supraorbital foramen (notch)

112
Q

What are the 5 branches of the nasociliary nerve?

A
  1. Communicating branch to the ciliary ganglion/short ciliary nerve
  2. Long ciliary nerves
  3. Posterior ethmoidal nerve
  4. Anterior ethmoidal nerve
  5. Infratrochlear nerve
113
Q

What does the communicating branch to the ciliary ganglion do?

A

Contributes sensory fibers to the inferior portion of the ey

114
Q

Does the communicating branch of the ciliary ganglion synapse in the ganglion?

A

No

115
Q

How does the communicating branch to the ciliary ganglion reach the eye?

A

Running through the short ciliary nerves

116
Q

What do the long ciliary nerves do?

A

Provide sensory innervation to the eye

117
Q

What does the posterior ethmoidal nerve do?

A

Runs to the posterior and middle ethmoidal air cells on the medial wall of the orbit

118
Q

What does the anterior ethmoidal nerve do?

A

Runs to the middle and anterior ethmoidal air cells

119
Q

What does the anterior ethmoidal nerve end as?

A

External nasal nerve

120
Q

What does the infratrochlear nerve do?

A

Supplies the medial canthus, lower eyelid, and surrounding region of the orbit

121
Q

What are the only fibers which synapse in the ciliary ganglion?

A

Parasympathetic fibers from the oculomotor nerve (CN III)

122
Q

What connects the ciliary ganglion to the posterior aspect of the eye?

A

Short ciliary nerves

123
Q

Where is the ciliary ganglion located?

A

Between the optic nerve and the lateral rectus muscle

124
Q

What do the parasympathetic fibers of the eye do?

A

Cause constriction of the pupil (sphincter pupillae muscle) and allow the eye to focus on near objects (contraction of the ciliary muscle)

125
Q

What is the path of the parasympathetic fibers to the eye?

A

Parasympathetic fibers of the oculomotor nerve (CN III) travel to the inferior division of CN III (specifically the branch to the inferior oblique muscles). They then run to the ciliary ganglion where they synapse. The postganglionics then course to the eye through the short ciliary nerves.

126
Q

Contraction of the ciliary muscle changes the shape of the ___.

A

Lens

127
Q

Contraction of the sphincter pupillae muscle constricts the ___.

A

Pupil

128
Q

What is accommodation and what does it allow?

A

Combination of constriction of the pupil, changing the shape of the lens, and ocular convergence; allows one to focus on a near object after looking at a distant one

129
Q

What is the path of sympathetic fibers to the eye?

A

Postganglionic sympathetic fibers originate in the superior cervical ganglion. They participate in the internal carotid plexus and then “hitch a ride” with the ophthalmic division of trigeminal (CN V1). These fibers pass through the ciliary ganglion (WITHOUT synapsing) and enter the eye via the short ciliary nerves. The fibers also reach the eye via long ciliary nerves.

130
Q

What do the sympathetic fibers to the eye innervate?

A

Dilator pupillae muscle

131
Q

What does the dilator pupillae muscle do?

A

Widens (enlarges) the pupil

132
Q

The long ciliary nerves provide both ___ and ___ innervation to the eye.

A

Sensory; sympathetic

133
Q

How does the ophthalmic artery enter the orbit?

A

Optic canal

134
Q

What are the branches of the ophthalmic artery?

A
  1. Meningeal
  2. Lacrimal
  3. Central retinal
  4. Long and short ciliary (choroidal)
  5. Supraorbital
  6. Anterior ethmoidal
  7. Posterior ethmoidal
  8. Supratrochlear
  9. Medial and lateral palpebral
  10. Dorsal nasal
135
Q

What do the meningeal branches of the ophthalmic artery supply

A

Anterior meninges

136
Q

What does the lacrimal artery supply?

A

Lacrimal gland

137
Q

What does the central retinal artery supply?

A

Internal retina

138
Q

What do the long and short ciliary arteries supply?

A

Choroid layer of the eye

139
Q

What does the supraorbital artery supply?

A

Forehead

140
Q

What do the anterior and posterior ethmoidal arteries supply?

A

Paranasal sinus

141
Q

What does the supratrochlear artery supply?

A

Superiomedial forehead

142
Q

What do the medial and lateral palpebral arteries supply?

A

Eyelids

143
Q

What does the dorsal nasal artery supply?

A

Bridge of nose

144
Q

Venous drainage o the orbit occurs through which veins?

A

Superior and inferior ophthalmic veins

145
Q

The superior and inferior ophthalmic veins pass through the ___ fissure and enter the ___.

A

Superior orbital; cavernous sinus

146
Q

The eye itself is drained by the ___.

A

Central vein of the retina

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