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NEUROLOGY phase 1b > 1b Visual System > Flashcards

1b Visual System Flashcards

1
Q

What is the palpebral fissure?

A

The line of the eye where the eyelashes sit

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2
Q

What is the limbus?

A

The border between the cornea and the slcera?

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3
Q

What is the caruncle?

A

The inner most fleshy corner part of the eye

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4
Q

What is the medial canthus?

A

Where the caruncle meets the sclera

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5
Q

What are three layers of the eye and briefly describe them?

A

Sclera - hard and opaque, protective outer coat
Choroid - pigmented and vascular
Retina - neurosensory tissue

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6
Q

What is the uvea?

A

Vascular coat of eyeball composed of iris, ciliary body and choroid

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7
Q

What neurotransmiter controls the release of tears?

A

Acetylcholine

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8
Q

Where are tears produced?

A

Lacrimal gland

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9
Q

What is the water content of the sclera?

A

High

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10
Q

What is the cornea?

A

The transparent, dome-shaped window covering the front of the eye.

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11
Q

What is the water content of the cornea like?

A

Low water content

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12
Q

What happens if the cornea becomes hydrated?

A

becomes cloudy

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13
Q

What is the function of the iris?

A

Controls the amount of light which is entering into the eye - has tiny muscles which dilate and constrict the eye

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14
Q

What is the structure of the lens?

A

It is composed of an outer acellular thin capsule,
encasing a core of regular elongated cell fibres.

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15
Q

What percentage of the eyes refractory power comes from the lens?

A

1/3 of the eye focusing power - higher refractive index than aqueous fluid and vitreous

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16
Q

What is a cataract?

A

The lens may loose its transparency with age,
resulting in an opaque lens, known as Cataract.

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17
Q

What is the retina?

A

Thin layer of tissue which lines the inner part of the eye

Responsible for capturing the light rays which enter into the eye - light impulses are then sent to the brain for processing via the optic nerve

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18
Q

What is the function of the optic nerve?

A

Transmits electrical impulses from the retina to the brain

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19
Q

What is the visible portion of the optic nerve called?

A

The optic disc

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20
Q

Where does the optic nerve connect to the back of the eye?

A

Near the macula

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21
Q

What is the blind spot?

A

Where the optic nerve meets the retina, there are no light sensitive cells

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22
Q

What is the macula?

A

A small and highly sensitive part of the retina responsible for detailed central vision - located roughly in the centre of the retina

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23
Q

what is the structure found at the center of the macula?

A

Fovea

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24
Q

Which part of the eye allows us to perform tasks which require central vision like reading?

A

Fovea

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25
Q

What is the concentration of cones and rods like in the fovea?

A

Cones are high, rods and low

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26
Q

Why is the fovea particularly important?

A

Only the fovea has the highest concentration of cones in order for us to perceive high detail

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27
Q

What is the anatomical land mark for the physiological blind spot?

A

Optic disc

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28
Q

What is central vision?

A

Detailed, day vision, colour vision, reading, facial recognition - only the fovea

assessed by visual acuity assessment

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29
Q

what is peripheral vision for?

A

Shape, movement and night vision, as well as navigation

assessed by visual field assessment§

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30
Q

What is the result of extensive loss of visual field?

A

Unable to navigate in an unfamiliar environment,

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31
Q

What is found in the outer layer of the retina?

A

Photoreceptor cells - involved in the detection of light

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32
Q

What is found in the middle layer of the retina?

A

Bipolar cells (2nd order neurones)

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33
Q

What is the function of the bipolar cells?

A

Local signal processing to improve contrast sensitivity

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34
Q

What does the inner layer of the retina contain?

A

Retinal ganglion cells (3rd order neurones)

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35
Q

What is the function of the retinal ganglion cels

A

Transmission of signal from the eye to the brain

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36
Q

What is the structural differences between the cones and the rods?

A

Rods = Longer outer segment
Cones = Shorter outer segment

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37
Q

What is the difference between rods and cones?

A

Rods = More sensitive to light, but slower response
Cones = Less sensitive to light, but faster response

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38
Q

Which photoreceptor cell is responsible for day light fine vision and colour - photopic vision?

A

Cones

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39
Q

Which photoreceptor cells is responsible for night vision?

A

Rods

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40
Q

What is scotopic vision?

A

Peripheral and night vision

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41
Q

Where can one find the highest concentration of Rod photoreceptors in the retina?

A

20-40 degrees away from fovea

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42
Q

what is refraction?

A

Then light goes from one’s medium to another, it changes velocity

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43
Q

What happens to the path of light when it changes from one medium to another?

A

Path changes

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44
Q

What is the angle of incidence?

A

Equal to the angle of reflection, is the angle at which light is reflected off the new medium

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45
Q

What are the two types of lenses?

A

Concave and convex

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46
Q

What does a convex lens do to light?

A

Takes the light rays and brings to a single focal point

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47
Q

What does a concave lease do?

A

takes light rays and spreads them out

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48
Q

What is an example of an application of a converging lens?

A

A camera

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49
Q

What is emmetropia?

A

Perfect eye - adequate correlation between the axial length and refractive power

Parallel light rays fall on the retina without the need for accomodation

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50
Q

What is ametropia?

A

Mismatch between axial length and refractive power so parallel light rays do not fall onto the retina

Causes myopia(near sightedness), hyperopia(far sightedness), presbyopia(unable to focus)

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51
Q

Where do the light rays converge in myopia?

A

Parallel rays converge at a focal point which is anterior to the retina - in front of it

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52
Q

What are the causes of myopia?

A

Excessive long globe and excessive refractive power

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53
Q

What are the symptoms of myopia?

A

Blurred distant vision
Squinting to attempt to improve visual activity
Headaches

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54
Q

What are the treatments for myopia?

A

Diverting lens in glasses
Contact lenses
Refractive lens surgery

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55
Q

What is hyperopia?

A

Parallel rays converge at a focal point posterior to the retina
Etiology : not clear, inherited Causes

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56
Q

What are the causes of hyperopia?

A

•excessive short globe (axial hyperopia) : more common
•insufficient refractive power (refractive hyperopia)

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57
Q

What are the symptoms of hyperopia?

A

visual acuity at near tends to blur relatively early
* nature of blur is vary from inability to read fine print to near vision is clear but suddenly and intermittently
blur
* blurred vision is more noticeable if person is tired , printing is weak or light inadequate

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58
Q

What are the asthenopic symptoms of hyperopia?

A

Eye pain
Headache
Burning sensation in eyes
Blepharoconjuctivitis

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59
Q

What is amblyopia?

A

When there is an uncorrected hyperopia of more than 5D in one eye

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60
Q

What type of lens is used in glasses to treat hyperopia?

A

Converging lens

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61
Q

What is the near response triad?

A

Three actions of the eye in order for adapt for near vision

Increase depth of field (pupillary miosis)
Align both eyes towards a near object (convergence)
Increase refractive power of lens for near vision (accommodation)

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62
Q

What is pupillary miosis ?

A

Pupil constricts which increases the depth of field of the eye

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63
Q

Which muscle is responsible for the contraction of the pupil?

A

Sphincter pupillae

64
Q

What is the benefit of a larger depth of optic field?

A

Eye is able to maintain clear forms over a certain range of viewing distances which relying on accomodation

65
Q

What is convergence?

A

When the eyes adduct medial,y at the same time to align the eyes towards a near object

66
Q

How does convergence occur?

A

Simultaneous contraction of the medial rectus extra ocular muscles from both eyes

67
Q

Which muscles allow for accomodation of the eye?

A

Circular ciliary muscles

68
Q

What does accomodation do?

A

Increases the refractive power of lens for near vision

69
Q

What is presbyopia?

A

Naturally occuring loss of accommodation onset from age 40
Distant vision is intact

70
Q

How is presbyopia corrected?

A

Corrected by reading glasses - increases refractive power of the eye

71
Q

Why does the lens lose its ability to accommodate?

A

Natural lens loses elasticity

72
Q

What is the treatment of presbyopia?

A

Convex lenses in near vision - reading glasses or bifocal

73
Q

What are the two types of optical correction?

A

Contact lenses
Intraocular lenses

74
Q

What is an intraocular lense?

A

Replacement of a cataract crystalline lens

75
Q

What is the visual pathway?

A

Transmits signal from eye to visual cortex

76
Q

What are visual pathway landmarks?

A

Eye, optic nerve, optic chiasm, optic tract, lateral geniculate neurons, optic radiation, primary visual cortex

77
Q

Where do the cell bodies of the optic nerve originate?

A

The retina

78
Q

Where do the optic nerve from each eye, converge?

A

Optic chiasm

79
Q

What happens to the ganglion nerve fibres at the optic chiasm?

A

About half of the ganglion nerve fibres cross at the optic chiasma, and exit along the contra-lateral Optic Tract, while the remaining ganglion nerve fibres exit along the Optic Tract on the same side.

80
Q

Where do the ganglion nerve fibres synapse?

A

Lateral Geniculate nucleus

81
Q

What is the fourth order neurone in the visual pathway?

A

Optic radiation - takes information from the lateral geniculate ganglion to the primary visual cortex in the occipital lobe

82
Q

What cortex is involved in higher visual processing?

A

Extra-striate Cortex

83
Q

What are the first second and third order neurones of the retinal visual pathway?

A

First Order Neurons – Rod and Cone Retinal Photoreceptors
Second order Neurons – Retinal Bipolar Cells
Third Order Neurons –Retinal Ganglion Cells

84
Q

what happens to the retinal ganglion fibres after entering into the optic nerve?

A

become myelinated to improve signal transmission

85
Q

What type of visual defect do you get when you have a lesion which is anterior to the optic chiasm?

A

Lesions anterior to Optic Chiasma affect visual field in one eye only

86
Q

What type of visual defect do you get when you have a lesion which is posterior to the optic chiasm?

A

Lesion occurring posterior to the Optic Chiasma will affect visual field simultaneously in both eyes,
because of the fibre crossing at the chiasma.

87
Q

Where do the crossed fibres predominantly originate from?

A

predominantly originate from the nasal retina,
responsible for the temporal half of the visual field in each eye.

88
Q

Where do the uncrossed fibres predominantly originate from?

A

The uncrossed fibres predominantly originate from the temporal retina,
responsible for the nasal half of the visual field in each eye.

89
Q

Lesion at optic chiasm?

A

Bitemporal hemanopia - temporal field deficit in both eyes

90
Q

Lesions posterior to optic chiasm?

A

Right sided lesion – Left Homonymous Hemianopia in Both Eyes
Left sided lesion – Right Homonymous Hemianopia in Both Eyes

91
Q

What is the most common cause of bitemporal hemaniopia?

A

Typically caused by enlargement of Pituitary Gland Tumour

92
Q

What is the most common cause of homonymous hemianopia?

A

On the other hand, homonymous hemianopia is typically caused by stroke,
or cerebrovascular accidents in the brain.

93
Q

What does damage of the primary visual cortex lead to?

A

Homonymous Hemianopia with Macular Sparing

94
Q

Why is the macula spared in damage t the primary visual cortex?

A

Area representing the Macula receives dual blood supply from Posterior Cerebral Arteries from both sides

95
Q

What happens to the pupil in the light?

A

Constriction

96
Q

What nerve mediates pupillary constriction?

A

Parasympathetic nerve - within CNIII

97
Q

What causes the circular muscles to contract and what does this lead to?

A

parasympathetic stimulation - pupil constriction

98
Q

What causes the radial muscles to contract and what does this lead to?

A

Sympathetic stimulation - pupil dilation

99
Q

When does the pupil dilate?

A

In dark environments

100
Q

Why does the pupil constrict in light?

A

decreases spherical aberrations and glare
increases depth of field
reduces bleaching of photo-pigments

101
Q

Describe the afferent pathway of pupillary reflex?

A

A small sub section of retinal ganglion cells participate in the pupillary reflex pathway

Pupil specific ganglion cells exit at the posterior third of optic tract before entering lateral geniculate nucleus

Synapses at brainstem pretectal nucleus

Afferent pathway from each eye synapses again at edinger westphal nuclei on both sides of brainstem

102
Q

Describe the efferent pathway of the pupillary reflex?

A

Edinger-Westphal Nucleus -> Oculomotor Nerve Efferent ->
Synapses at Ciliary ganglion ->
Short Posterior Ciliary Nerve -> Pupillary Sphincter

103
Q

Where do the afferent fibres of the pupillary reflex become the efferent?

A

Edinger-Westphal Nuclei

104
Q

What is the direct and consensual reflex?

A

Direct Light Reflex –Constriction of Pupil of the light-stimulated eye
Consensual Light Reflex – Constriction of Pupil of the other (fellow) eye

105
Q

What is the neurological basis of the direct and consensual reflex?

A

Afferent pathway on either side alone will stimulate efferent (outgoing) pathway on both sides

106
Q

What is the observed difference in afferent and efferent defects?

A

In short, afferent defect produces different responses between eyes, depending on which eye is stimulated.

Efferent defect produces the same unequal responses between left and right eye, no matter whether left or right eye is stimulated.

107
Q

What is the swinging torch test?

A

Shining light between right and left rapidly

108
Q

What is a relative afferent pupillary defect?

A

When the damage to the afferent pathway is incomplete

109
Q

What is the best way to test the relatife afferent pupillary defect?

A

Swinging torch test

110
Q

Describe a positive swinging torch test for a relative afferent pupillary defect?

A

Both pupils constrict,
when light swings to the left eye with intact afferent pathway.

Both pupils will paradoxically dilate,
when the light swings to the right eye with damaged afferent pathway, as a result of relatively reduced drive for pupillary constriction in both eyes.

111
Q

What facilitates the movement of the eye?

A

It is facilitated by the six extraocular muscles in the orbit,
innervated by the three cranial nerves.

112
Q

What is duction?

A

Eye movement in one eye, without making any reference to the movement in the other eye

113
Q

What is version?

A

Simultaneous movement of both eyes in the same direction?

114
Q

What is vergence?

A

Simultaneous movement of both eyes in the opposite direction

115
Q

What is convergence?

A

Simultaneous adduction (inward) movement in both eyes when viewing a near object

116
Q

What is a saccade?

A

Short fast burst

117
Q

When might you use a saccade eye movement?

A

Reflexive saccade to external stimuli
Scanning saccade
Predictive saccade to track objects
Memory-guided saccade

118
Q

What is a smooth pursuit?

A

Smooth Pursuit is a slow sustain movement,
up to 60 degrees per second.

It is an involuntary movement,
driven by a moving target.

119
Q

What are the straight muscles of the eye called?

A

Superior rectus
Inferior rectus
Lateral rectus
Medial rectus

120
Q

What are the names of the two muscles of the eye which are not straight

A

Superior oblique
Inferior Oblique

121
Q

what does the superior rectus do to the eye?

A

Moves the eye up

122
Q

What does the inferior rectus do to the eye?

A

moves the eye down

123
Q

what does the lateral rectus do?

A

Moves the eye towards the outside of the head - towards temple

124
Q

What does the medial rectus do?

A

Moves the eye towards the midline

125
Q

Describe the action of the superior oblique?

A

Passes under the Superior Rectus.
Moves the eye in a diagonal pattern down and out

126
Q

Describe the action of the inferior oblique?

A

Moves the eye in a diagonal pattern - up and out.

127
Q

Which eye muscles are innervated by the superior branch of the third cranial nerve - occulomotor?

A

Superior Rectus – elevates eye
elevator palpebrae superioris - raises eyelid (not shown)

128
Q

Which eye muscles are innervated by the inferior branch of the third cranial nerve - occulomotor?

A

Inferior Rectus – depresses eye
Medial Rectus – adducts eye
Inferior Oblique – elevates eye
Parasympathetic Nerve – constricts pupil

129
Q

Which eye muscles are innervated by the fourth cranial nerve?

A

Superior oblique - depresses eyes

130
Q

Which eye muscles are innervated by the 6th cranial nerve?

A

Lateral Rectus – abducts eye

131
Q

What position of the eye best tests the lateral rectus?

A

Abduction

132
Q

What position of the eye best tests the medial rectus?

A

Adduction

133
Q

What position of the eye best tests the superior rectus?

A

Abducted and Elevated

134
Q

What position of the eye best tests the inferior rectus?

A

Depressed and abducted

135
Q

What position of the eye best tests the inferior oblique?

A

Elevated and adducted

136
Q

What position of the eye best tests the superior oblique?

A

Depressed and adducted

137
Q

what is supraduction and supraversion?

A

elevation of one eye, and elevation of both eyes

138
Q

What is infraduction and infraversion?

A

Infraduction – one eye
Infraversion – both eyes

139
Q

What is dextroversion?

A

Movement of the eyeballs to look at the right

140
Q

What is levoversion?

A

Movement of the eyes to look at the left

141
Q

What is torsion?

A

Torsion – rotation of eye around the anterior-posterior axis of the eye

142
Q

What does the eye look like in third nerve palsy?

A

affected eye is down and out

143
Q

How is the eyelid effected in third nerve palsy?

A

Droopy eyelid - due to loss of elevator palepbrae superioris

144
Q

Why does third nerve palsy result in a down and out movement of the eye?

A

Unopposed superior oblique innervated by fourth nerve (down)
Unopposed lateral rectus action innervated by sixth nerve (out)

145
Q

What does 6th nerve palsy result in?

A

patients are deficit in abduction in the affected eye

Affected eye will deviate inwards

146
Q

What is a nystagmus?

A

Oscillatory eye movement

147
Q

What is Optokinetic Nystagmus?

A

Smooth pursuit followed by a reset ot the eye position in the center with a burst of saccade movement

148
Q

What does presence of the opto-kinetic nystagmus show?

A

The presence of Opto-kinetic Nystagmus signifies that the subject has sufficient visual acuity to perceive the grating.

149
Q

What is the neurotransmitter of the lacrimal system?

A

Acetylcholine

150
Q

What is the role of the Meibomian glands?

A

secretes the lipid layer which protects the tear film from rapid evapouration

151
Q

How do mucin molecules affect the tear film?

A

they bind water molecules to the hydrophobic corneal epithelial cell surface

152
Q

Describe the synthesis of photo pigments

A
  1. discs with deactivated photo pigments are shedded from the tips and phagocytosed by the retinal epithelial cells
  2. deactivated photopigments are regenerated inside the retinal epithelial cells and transported by to the photo receptors
153
Q

What is asthenopia?

A

Eye strain condition which manifests through non-specific symptoms such as fatigue, pain in and around the eyes, blurred vision and occasional double vision

154
Q

What is the most common cause of homonymous hemaianopia?

A

Stroke of another cerebrovascular accidents of the brain

155
Q

Lesions posterior to what result in homonymous hemianiopia?

A

Posterior to the chiasma

NEUROLOGY phase 1b (13 decks)

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