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NBEO STEP 1 > Anatomy > Flashcards

Anatomy Flashcards

1
Q

What is telecanthus?

A

increased distance between the medial canthi of the eyelids.

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2
Q

What is phthiriasis palprebrarum?

A

infection of the eyelashes caused by pthiriasis pubis

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3
Q

A lesion on the eyelid has telangiectasia, what is it?

A

BCC

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4
Q

What is the thinnest layer of skin in the body?

A

eyelid

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5
Q

does the eyelid skin contain fat?

A

no

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6
Q

What are the layers of the eyelid?

A
  1. skin
  2. subcutaneous areolar
  3. orbicularis
  4. sub muscular areolar
  5. orbital septum
  6. posterior muscular system
  7. tarsal plate
  8. palpebral conj
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7
Q

What is the subcutaneous areolar layer? What does it contain?

A

loose connective tissue
The upper lid’s subcutaneous areolar layer contains the levator aponeurosis as it travels to inset into the tarsal plate and skin

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8
Q

what is another name for muscle of riolan?

A

pars ciliaris

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9
Q

What causes paralysis of the orbicularis muscle? Why does this happen? What is the result?

A
  1. Bell’s palsy
  2. sarcoid

orbicularis is innervated by zygomatic branch of CN 7 (voluntary motor), paralysis causes it to loose its laxity leading to ectropion

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10
Q

What is the main cause of Bell’s palsy? what do patient’s normally complain of?

A

idiopathic

extropion, tearing, exposure keratopathy

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11
Q

what is another name for Horner’s?

A

pars lacrimalis

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12
Q

What is the function of Horner’s muscle?

A

pump tears

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13
Q

What receptors are on muellers?

A

alpha-2- receptors
= sympathetic receptors

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14
Q

what receptors are located on the dilator?

A

alpha-1-receptors

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15
Q

What drug works on alpha 2 receptors and what drug works on alpha 1 receptors?

A

alpha -2 receptors: upneeq = agonist

alpha -1- receptors: phenylephrine

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16
Q

What is located in the sub muscular areolar layer?

A

levator aponeurosis + the palpebral part of the lacrimal gland + peripheral & marginal arcades

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17
Q

What is the function of the orbital septum?

A

barrier to the orbit, prevents fat from falling onto the lid margins and keeps infections localized to anterior part of the eyelid

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18
Q

what is the orbital septum/ where is it attached?

A

Periorbita - part that covers bones projects forward and becomes the septum. It also moves backwards and fuses with the dura
mater of the ONH.

ie. the orbital septum is continuous with the periorbita and the periosteum of the skull.

medially it attaches to the posterior lacrimal crest

superiorly, it is an insertion point for the levator aponeurosis

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19
Q

where does the levator originate?

A

lesser wing of the sphenoid

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20
Q

What does the posterior muscular system contain?

A

LPS, superior(Mueller’s) and inferior tarsal muscle

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21
Q

What is mueller’s muscle

A

superior tarsal muscle. It originates from Mueller’s and goes into the tarsal plate

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22
Q

In TED, what causes the stare appearance?

A

retraction of Mueller’s

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23
Q

What is the normal interpalprebral fissure distance?

A

10-12 mm

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24
Q

What is the function of the tarsal plate? what is it made of? what condition occurs if the tarsal plate is not working?

A

rigidity to the eyelids
connective tissue
floppy eyelid syndrome

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25
Q

what is in the palpebral portion of the conj?

A
  1. epithelial layer
    a. goblet cells
  2. stroma = vascularized CT
    a. immune cells, IgA, macrophage, mast, esosinophils, PMNs
    b. accessory lacrimal glands - glands of wolfing
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26
Q

what is the function of goblet cells? where are they found?

A

make mucin

inferior nasal fornix and bulbar conj

27
Q

What condition/ drug affects meibomian glands?

A

accutane ( decreases the size and oil selection leading to dry eye)

rosacea

sebaceous gland carcinoma ( seen more on the UL because contains more meibomian glands)

28
Q

OIS

A

lack of oxygen to the carotid artery, leads to entire eyeball problem

NOTE: diff from sleep apnea!!

29
Q

what is holocrine, apocrine and merocrine secretion?

A

holocrine: whole cell is shed into the lumen

apocrine: part of the plasma membrane buds off and enters the lumen. for secretion

merocrine: cells secrete substances via exocytosis. The cells are intact

30
Q

what are the sensory nerves of the eyelids?

A

upper eyelid - frontal (supraorbital/supratrochlear) and lacrimal branches of V1

lower eyelid: infraorbital and zygomaticofacial branches of V2

infratrochlear nerve (branch of the nasocilliary nerve - branch of V1) innervates medical aspect of the upper and lower eyelids

31
Q

blood supply of the eye - CRA, PCA, ACA

A

ICA -> ophthalmic artery -> CL MS LSE

CRA-> supplies ON from point to entry to the inner retinal layers

PCA -> SPCA & LPCA
- SPCA piece the ONH around it and then travel in the suprachoridal space (between Choroid & sclera)
-anastomose in the sclera and make the circle of zin - haller (supplies laminar part of the ON)
- supply the choroid up to the equator
- supply the sclera
- LPCA travel in the suprachoroidal space to the ciliary body
- supplies the sclera
- join with the ACA to form MACI (supplies iris and CB)
- once reaches the ORA, send recurrent branches back to supply the choroid anterior to the equator

ACA
- ICA -> Ophthalmic -> muscular (7) supplies the recti muscles ( LR only one with 1) -> become the ACA (which start after muscles are supplied by muscular artery till past the recti muscles) -> bifurcate (some go under the bulbar conj) or some piece the sclera and join the LPCA to make MACI )
- note: before making MACI, recurrent branches are sent off to supply the choroid anterior to the equator

32
Q

blood supply of the eye - lacrimal artery

A

Ophthalmic -> lacrimal artery
- supplies the lacrimal gland -> then pierces the orbital septum and terminates as the lateral palpebral arteries (2) .

These supple the skin & conj of the lateral 1/2 of the upper and lower eyelids

33
Q

blood supply of the eye - supraorbital artery

A

passes forward above the levator palpebrae superiors and supplies the (LPS, SR, SO)

exits orbit via supraorbital foramen

supplies the skin, muscles of the forehead and scalp

joins with the superficial temporal and supratrochlear arteries in the scalp

34
Q

medial palpebral artery

A

branch off of the ophthalmic artery

supply: the medial 1/2 of the upper and lower eyelids and conj.

35
Q

palpebral arcades

A

made from the joining of the medial and lateral palpebral arteries.

marginal palpebral arcades - closer to the eyelid

peripheral palpebral arcades - supply formic, posterior conj. also join with the ACA to supply anterior conj

36
Q

facial artery

A

branches off of the ECA prices circulation to the superficial areas of the eyelid

37
Q

Why do patient’s with uveitis experience circumlimbal injection and decreased aqueous humor production?

A

because the ACA provide circulation to the bulbar conj and the CB

38
Q

lymph nodes

A

both mimic the veins which mimic the arteries

located in the conj

lateral lymphatics drain into the parotid/pre-auricular lymph node

medial lymphatic drain into the submandibular lymph node

39
Q

what causes a swollen lymph node?

A

PET PIG

P - parunauds oculoglandular syndrome
E - EKC (#1 reason)
T - trachoma

P - pubic lice
I - inclusion conjunctivitis
G - gonorrhea

40
Q

does bacterial conjunctivitis cause pre-auricular lymphadenopathy?

A

NOOO

41
Q

What prevents back flow from the lacrimal sac onto the eye?

A

valve of reosenmueller

42
Q

what events nasal fluid to back flow back into the eye?

A

valve of hasher

43
Q

what bone is the lacrimal gland located in?

A

frontal bone

44
Q

how does the lacrimal gland produce tears?

A

via parasympathetic innervation from

CN 7-> Vivian nerve -> pterygopalatine Ganglion -> lacrimal gland

45
Q

what is another name for the pterygopalatine ganglion?

A

sphenopalatine gagnolino

46
Q

What is the lacrimal papilla?

A

puncta îs located here and keeps the puncta open

47
Q

What is the spiral of tillaux? What does this mean for the muscles?

A

the recti muscles insertion in the orbit form this

the closer the limbus the muscles attaches, the stronger its pull

48
Q

Where does the medial rectus insert?

A

5.5 mm from the limbus

ie. this is the longest

49
Q

Where does the lateral rectus insert?

A

6.9 mm from the limbus

50
Q

Where does the inferior rectus insert?

A

6.5 mm from the limbus

51
Q

Where does the inferior rectus insert?

A

6.5 mm from the limbus

52
Q

Where does the SR muscle insert? How is it related to the LPS?

A

7.7 mm from the ring. This is the shortest

sheath covering SR is connected to sheath covering LPS and the superior conj fornix. Why eyelid retracts when looking up

53
Q

EOMs compared to other muscles in our body

A

more blood and nerves

faster and more fatigue resistant

54
Q

Adipose tissue compartments in the orbit

A

intraconal - ie. in the muscle cone of the 4 recti muscles (separates recti muscles from the ON)

extraconal - b/w the EOMs and wall

55
Q

what recti originate from the dural sheath surrounding the ONH?

A

SR and MR

this is why during optic neuritis (inflammatory response against the optic nerve’s myelin) we get pain on eye movement due to the pulling of these muscles on the ON’s inflamed coverings

56
Q

What in the origin and insertion for the superior oblique?

A

origin: lesser wing of the sphenoid . Note moves forward and goes through the troche before inserting on the superior lateral globe behind the equator

57
Q

what is the trochlea?

A

physiologic origin of the SO

58
Q

What in the origin and insertion for the inferior oblique?

A

ordinates anteriorly at the maxillary bone and inserts on the inferior lateral globe behind the equator

59
Q

how much can the eye abduct and adduct?

A

adduct 51-54 degrees
abduc 23 degrees

60
Q

when the eye is adducted , what are the muscles used for depression and elevation?

what about when the eye is abduct?

A

adduct: SO and IO

abduct: SR and IR

61
Q

Versions follow which law?

A

hering’s law for yolked muscles

62
Q

What inhibits versions?

A

trauma

INO

63
Q

what is INO and what causes it?

A

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NBEO STEP 1 (14 decks)

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