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Ophthalmology > 1.4: Orbital Autonomics > Flashcards

1.4: Orbital Autonomics Flashcards

1
Q

What holds the eyes in their vertical position?

A

The suspensory ligament

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2
Q

Where does the suspensory ligament attach?

A

Laterally, it attaches to the zygoma

Medially, it attaches to the maxilla

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3
Q

Describe what can happen during ocular trauma when the zygoma is damaged?

A

Zygoma is damaged

Suspensory ligament lowers the eye on one side

Can lead to diplopia

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4
Q

What is diplopia?

A

Double Vision

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5
Q

Orbital trauma can lead to damage to the XXXX

This results in a general sensory deficit of the YYYYY

A

Orbital trauma can lead to damage to the neurovascular bundle

This results in a general sensosry deficit of the facial skin

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6
Q

What supplies

Purple

Blue

Pink?

A

CN V1 Opthalmic Nerve

CN V2 Maxillary Nerve

CN V3 Mandibular Nerve

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7
Q

What nerve is supplying the skin? (Purple)

A

CN V1

Opthalmic Nerve

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8
Q

What supplies the:

  • Forehead
  • Upper Eyelid
  • Cornea
  • Conjunctiva
  • Skin of the top of the nose
A

CN V1

Opthalmic

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9
Q

What nerve is supplying the skin?

(Blue)

A

CN V2

Maxillary

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10
Q

What supplies the:

  • Skin of the lower eyelid
  • Skin over the maxilla
  • Skin over the ala of the nose
  • Skin/mucosa of the upper lip?
A

CN V2

Maxillary

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11
Q

What nerve is supplying the skin?

(Pink)

A

CN V3

Mandibular

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12
Q

What supplies the skin over the TMJs and the mandible?

A

CN V3

Mandibular

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13
Q

What supplies the angle of the mandible?

A

C2,C3 Spinal Nerves

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14
Q

Describe the blink reflex

A
  • Action potentials conducted centrally via CN V1 to the trigeminal ganglion
  • Then conducted in CN V to the Pons
  • CNS connections between CN V and CN VII
  • Action potentials are conducted peripherally via CN VII to the eyelid part of the orbicularis oculi
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15
Q

What are the two nerves involved in the blink reflex?

A

CN V (Specificially CN V1)

CN VII

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16
Q

Briefly describe the path of sympathetic axons from the CNS to the organs of the head region?

A
  • Cell body of the presynaptic neurone in the CNS
  • Presynaptic Axon
  • Ganglion
  • Postsynaptic Axon
  • Organ
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17
Q

SYMPATHETIC

What is released by the presynpatic axon?

What is released by the postsynaptic axon?

A

Presynaptic axon releases acetylcholine

Postsynaptic axon releases noradrenaline

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18
Q

Describe the pathway presynpatic sympathetic axons from the CNS?

A

Descend in the spinal cord

Exit spinal cord at T1 spinal nerve

Ascend within the sympathetic trunk

Synapse in the superior sympathetic ganglion

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19
Q

Descrieb the pathway of the post-synaptic axons from the CNS?

A
  • Enter the internal and external carotid nerve
  • Pass onto the surface of the internal and external carotid arteries
  • Carried to the organs on the surface of the branches of these arteries
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20
Q

What carries sympathetic axons (post-synaptic) into the orbit?

A

Opthalmic Artery

(Branch of the internal carotid)

21
Q

What does this photo show?

A

The superior cervical sympathetic ganglia passing alongside the internal and external carotids

Then axons go onto the surface of the carotids

22
Q

Is the ganglion located inside or outside the organ in:

  • Sympathetic
  • Parasympathetic
A

Sympathetic = Outside

Parasympathetic = Inside

23
Q

Briefly describe the path of parasympathetic axons of the CNS to the organs of the head region?

A
  • Cell body of the presynaptic neurone in the CNS
  • Presynaptic axon in CN III, VII, IX, X
  • Ganglion
  • Postsynaptic Axon
  • Organ
24
Q

PARASYMPATHETIC

What is released by the presynaptic axon?
What is released by the postsynaptic axon?

A

Acetylcholine

Acetylcholine

25
Q

Compare release of acetylcholine and noradrenaline in sympathetic and parasympathetic?

A

Sympathetic = Acetylcholine in pre

Noradrenaline in post

Parasympathetic = Acetylcholine in pre

Acetylcholine in post

26
Q

Describe the exit of parasympathetic presynaptic axons from the CNS?

A

All leave the CNS in:

  • CN III
  • CN VII
  • CN IX
  • CN X

and in the sacral spinal nerves

27
Q

Where do parasympathetic pre-synaptic axons from the CNS go

  • CN III
  • CN VII?
A

CN III (Cranial Nerve 3)

Carries parasympathetic to the eye

To ciliary ganglion in the orbit

CN VII (Cranial Nerve 7)

Carries parasympathetic to the lacrimal duct, submandinbular, and sublingual salivary glands

28
Q

Where do parasympathetic pre-synaptic axons go

  • CN IX?
  • CN X?
  • Sacral spinal nerves?
A

CN IX = CN 9 = Glossopharyngeal

Supplies the parotid salivary gland

CN X = CN 10 = Vagus Nerve

Organs of the chest/neck/abdomen as far as the midgut

Sacral Spinal Nerves

Hindgut, Pelvis, Peritoneum

29
Q

What does CN III supply?

A

Oculomotor

  • Somatic motor sensory to superior rectus, medial rectus, inferior rectus and inferior oblique
  • Somatic motor sensory to the levator palpebrae superioris
  • Presynaptic parasympathetic axons to the ciliary ganglion of the orbit
30
Q

Label the picture (A-> F)

A

A = Ciliary Ganglion

B = CN III (Oculomotor)

C = CN VI (Abducens)

D = CN III (Oculomotor)

E = Superior Orbital Fissue

F = CN IV (Trochlear)

31
Q

Name the parts (A and B)

A

A = The Pons

B = CN III

32
Q

What do the ciliary nerves supply?

A

Autonomic axons to control the diameter of the iris (pupil) and refractive shape of the lens

33
Q

What axons are contained in the ciliary nerves?

A

Long = Sympathetic, somatic sensory

Short = Sympathetic, parasypathetic, somatic sensory

34
Q

What forms the first part of the afferent limb of the blink reflex?

A

The long ciliary nerves

35
Q

Name the six four reflexes of the eye?

What are the two extra reflexes?

A
  • Maximal Eyelid Opening (Fight or flight)
  • Pupillary dilation/constriction (Pupillary light reflex)
  • Focusing the lens (Accomodation reflex)
  • Lacrimation (Tear Reflex Production)
  • Vestibulo-ocular reflex (Stable gaze during head turn)
  • Oculocardiac Reflex (Bradycardia due to tension)
36
Q

Describe the vestibulo-ocular reflex?

Describe the bradiocardiac reflex?

A

This is when you are able to focus your gaze on an object while turning your head (Thinking spotting in ballet)

This is reflex bradycardia caused by tension on the extraocular muscles or raised pressure

37
Q

Describe the sympathetic functions of the four ocular reflexes?

A

Opening Eyes Wider

Pupillary relfex = more light in eyes

Accomodation = Focus on far objects

Lacrimation when emotional

38
Q

Describe the parasympathetic functions of the four ocular reflex?

A

Allows orbicularis oculi to work

Pupillary reflex = less light into eyes

Accomodation = focus on near objects

Reflex Lacrimation = wash away objects

39
Q

What kind of muscle is in the levator palpebrae superiorsis?

A

Skeletal Muscle

Smooth Muscle

40
Q

How is the levator palpebrae superiorsis innervated?

A

Post synaptic sympathetic fibres

Come from the superior cervical sympathetic ganglion

Carried on the surface of the opthalmic artery

41
Q

Describe the muscles around the eye

A

Mobile insertion of DILATOR PUPILLAE FIBRES all around the internal circumfrence of the iris

Fixed insertion of DILATOR PUPILLAE FIBRES all around the external circumfrance of the iris

SPHINCTER PUPILLAE FIBRES are all around internal circumfrence of iris

42
Q

Describe effect of sympathetic and parasympathetic on pupil?

A

Sympathetic = Dilates

Parasympathetic = Constricts

43
Q

Label this diagram

A

A = Mobile attachment of dilator pupillae fibres

B = Sphincter Pupillae Fibres

C = Fixed attachment of dilator pupillae fibres

44
Q

Describe direct and consensual light reflex?

A

Direct light reflex:

  • Line shon into the eye causes pupil constriction

Consensual light reflex:

  • Light shon into one eye causes pupil constriction in both
45
Q

What is the special sensory afferent limb of the light reflex?

What is the motor limb of the reflex?

A

Ipsilateral CN II (Optic Nerve)

Bilateral CN III (Oculomotor)

46
Q

What controls the refractive shape of the lens?

How is this connected to the lens?

A

Smooth Ciliary Muscle

This is a circumference around the ciliary body

Ciliary body attached to lens by suspensory ligaments

47
Q

Descibe ciliary muscle movement in

  • Near vision
  • Far vision
A

Near Vision = Parasympathetic

Ciliary muscle contracts

Lens becomes spherical

Far vision = Sympathetic

Ciliary muscle reflaxes

Lens becomes flatter

48
Q

What are the three types of tears?

A

Basal - Clean and nourish cornea, contain lysozyme

Reflex - Afferent limb is CN V1, efferent limb is parasympathetic axons originating from the CN VII

Emotional - Happy/Sad/Frightened

49
Q
A

Ophthalmology (19 decks)

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