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Ophthalmology SB > Anatomy > Flashcards

Anatomy Flashcards

1
Q

how is the eye protected from a direct blow

A

the superior orbital margin is more anterior than inferior orbital margin

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2
Q

what is commonly affected by orbital blowout fractures and why

A

medial wall and orbital floor

very thin

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3
Q

what can be damaged in a blowout fracture

A

orbital contents can become trapped

infraorbital NVB can be damaged

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4
Q

what is the external layer of the eyelid made of

A

orbicularis oculi

- composed of orbital and palpebral parts

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5
Q

what are the eyelids called

A

superior tarsus

inferior tarsus

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6
Q

what attached the eyelids to either side

A

medial/lateral palpebral ligament

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7
Q

what lifts the eyelids

A

tendon of levator palpebrae superioris

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8
Q

what is the name of the corneoscleral junction

A

limbus

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9
Q

what does the lacrimal gland do and what innervates it

A

lacrimal fluid

CN VII

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10
Q

where does the lacrimal fluid go

A 
Lacrimal gland
>>
over the eye
>>
lacrimal puncta
>>
Canaliculi
>>
lacrimal sac
>>
nasolacrimal duct
>> inferior meatus
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11
Q

what is used to track the symmetry of bilateral eye positions/movements

A

corneal reflections

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12
Q

what are the 3 layers of the eyes

A

Fibrous (outer layer)
Uvea (vascular layer)
Retina (photosensitive)

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13
Q

what are the 2 parts of the fibrous outer layer

A

sclera - muscle attachment

cornea - 2/3 of refractive power

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14
Q

what are the 3 parts of the uvea middle layer

A

iris - pupil diameter

ciliary body - controls iris, shape of lens and secretion of aqueous humour

choroid - nutrition and gas exchange

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15
Q

what are the segments of the eye

A 
anterior segment
- in front of lens
posterior segment
- behind the lens
- 2/3rds of eye
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16
Q

what is the anterior segment composed of

A

anterior chamber

  • between cornea and iris
  • contains aqueous humour

posterior chamber

  • between iris and suspensory ligaments
  • contains aqueous humour
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17
Q

what is the posterior segments composed of

A

contains vitreous body

  • vitreous humour
  • vitreous body common location for ‘floaters’
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18
Q

what is the route of circulation of aqueous

A

1 - Ciliary body secrete Aqueous
2 - Aqueous circulates within posterior chamber
2 - Aqueous passes through pupil into anterior chamber
4 - Aqueous reabsorbed into scleral venous sinus at iridocorneal angle

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19
Q

what is the role of aqueous fluid

A

nourishes lens and cornea

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20
Q

why is the iridocorneal angle clinically important

A

angle in “open-angle” & “closed-angle” glaucoma

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21
Q

what is included in the retina

A

optic disc
macula
fovea

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22
Q

where is the greatest density of cones

A

macula

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23
Q

what is the centre of the macula called and what is its features

A

fovea

area of most acute vision

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24
Q

where is the blind spot

A

at optic disc

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25
Q

what are the layers of the retina from anterior to posterior

A

1 - the axons of the ganglion cells
2 - the ganglion cells
3 - the photoreceptors

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26
Q

what lies anteriorly to the retina

A

the retinal veins and arteries

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27
Q

blood supply of the eye

A

internal carotid artery&raquo_space;> carotid canal&raquo_space;> cavernous sinus&raquo_space;> ophthalmic artery

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28
Q

venous drainage of the eye

A

superior ophthalmic vein

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29
Q

what are the muscles of the eye

A 
superior rectus
inferior rectus
medial rectus
lateral rectus
superior oblique
inferior oblique
levator palpebrae superioris
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30
Q

what is the innervation of the eye muscles

A

LR 6
SO 4
AO 3

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31
Q

what are the only eye muscles that do not have secondary movements

A

medial and lateral rectus

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32
Q

movement of Lateral rectus

A

ONLY abduct the eyeball

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33
Q

what muscles does moving lateral rectus move into plane

A

Superior Rectus
Inferior Rectus

(SILly)

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34
Q

what movement does SR have

A

when in abduction, SR can only elevate

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35
Q

what movements does IR have

A

when in abduction, IR can only depress

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36
Q

what movement does MR have

A

can only adduct eyeball. Bring towards nasal cavity

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37
Q

what muscles does MR bring into plane

A

Superior oblique
Inferior oblique

(MOO)

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38
Q

what movement does IO have

A

when in adduction, IO can only elevate

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39
Q

what movements does SO have

A

when in adduction, SO can only depress

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40
Q

what is a traumatic cause of diplopia

A

fractured zygoma

  • suspensory ligaments attach here
  • eye may be lowered towards orbital floor
  • diplopia/double vision
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41
Q

what is a complication of a zygoma fracture

A

infraorbital NVB within the infraorbital canal can be damaged resulting in a general sensory deficit of the facial skin

42
Q

what area does CN V1 supply the general sensory

A
  • the upper eyelid
  • the cornea
  • all the conjunctiva
  • the skin of the root/bridge/tip of the nose
43
Q

what area does CN V2 supply the general sensory

A
  • the skin of the lower eyelid
  • the skin over the maxilla
  • the skin of the ala of the nose
  • the skin/mucosa of the upper lip
44
Q

what area does CN V3 supply the general sensory

A

the skin over the mandible and temporomandibular joint

45
Q

what provides the general supply of the angle of the mandible

A

C2, 3 spinal nerves

46
Q

what is the afferent limb of the blink reflex

A

action potentials are conducted centrally via CN V1 to the trigeminal ganglion then in CN V (the trigeminal nerve) to the pons

47
Q

what is the efferent limb of the blink reflex

A

action potentials are conducted peripherally in CN VII to the eyelid part of orbicularis oculi

48
Q

how do sympathetic axons course from the CNS to the organs

A

cell body of presynaptic neurone in the CNS
»> presynaptic axon
ganglion of the cervical part of the sympathetic trunk
» postsynaptic axon
Organs

49
Q

what happens at the synapse in sympathetic innervation

A

the presynaptic axon releases acetylcholine

50
Q

what happens at the organ in sympathetic innervation

A

the postsynaptic axon releases noradrenaline to stimulate the organ to respond

51
Q

where do presynaptic sympathetic axons synapse

A

in the superior cervical sympathetic ganglion

52
Q

at what levels do sympathetic axons descend the spinal cord

A

T1 - L2

53
Q

for innervation of the eye, what happens after the synapse at the superior cervical sympathetic ganglion

A

enter the internal carotid nerve & external carotid nerve
pass onto the surface of the internal and external carotid arteries
(internal is the one important for the eye)

54
Q

what are the nerves with parasympathetic axons

A

CN III, VII, IX and X

55
Q

where is the ganglion located in parasympathetic innervation

A

within the organ

56
Q

what is released in parasympathetic innervation

A

presynaptic axon - ACh

postsynaptic axon - ACh

57
Q

what does CN X supply

A

organs of the neck/chest & abdomen as far as the midgut

58
Q

what nerve is responsible for parasympathetic innervation of the eye

A

CN III

59
Q

what does CN III supply

A

SR, LPS - superior branch
MR, IR, IO, - inferior branch

presynaptic parasympathetic axons to the ciliary ganglion - inferior branch

60
Q

what does CN III travel through

A

superior orbital fissure

61
Q

what do ciliary nerves supply and control

A

autonomic axons to control the diameter of the iris (& pupil) & the refractive shape of the lens

62
Q

what are the autonomic reflexes of the eye

A
  • maximal eyelid elevation
  • pupillary dilation/constriction i.e. the (pupillary) light reflex
  • focussing the lens i.e. the accommodation reflex
  • lacrimation
  • the vestibulo-ocular reflex
  • the oculocardiac reflex
63
Q

what is the vestibulo-ocular reflex

A

turns the eyes in the opposite direction to a head movement (to stabilise the gaze on an object during head movements)
- CNS connections between CN VIII & CNs III, IV & VI

64
Q

what is the oculocardiac reflex

A
  • reflex bradycardia in response to tension on the extraocular muscles or pressure on the eye
  • CNS connections between CN V1 & CN X
65
Q

what are the sympathetic functions of the eye

A

open eyes wider
get more light into eyes
focus on far objects
emotional lacrimation

66
Q

what are the parasympathetic functions of the eye

A

allow orbicularis oculi to work
get less light into eyes (protect retina from bright light)
focus on near object
reflex lacrimation (wash away stimulant)

67
Q

how are eye opened wider

A

postsynaptic sympathetic fibres reach levator palpebrae superioris via:
the superior cervical sympathetic ganglion&raquo_space;» the internal carotid nerve&raquo_space;»the internal carotid plexus»»>axons carried on the ophthalmic artery and on its branches to the orbital structures

68
Q

what is in control of dilating pupils

A

sympathetic innervation

dilator pupillae fibres

69
Q

what is in control of pupil constriction

A

parasympathetic innervation

sphincter pupillae fibres

70
Q

what is a fixed dilated/blown pupil a sign on

A

serious CN III pathology

71
Q

what is the (pupillary) light reflex

A

shine light in one eye, both pupils constrict

eye stimulated = direct light reflex
eye not stimulated = consensual light reflex

72
Q

how does the afferent limb differ from the efferent limb in the light reflex

A

afferent - ipsilateral CN II (the optic nerve) i.e. just side light is getting shone in

efferent - bilateral via CNs III (the oculomotor nerves)

73
Q

how do ciliary muscles work to control the refractive shape of the lens

A

relaxes in “far vision” (no parasympathetics) the ligament tightens & the lens flattens to focus on distance

contracts in “near vision” (parasympathetic) the ligament relaxes & the lens becomes spherical to focus on reading

74
Q

what are the 3 types of lacrimation

A

basal tears - clean, nourish and hydrate avascular cornea

reflex tears - extra tears in response to stimuli

emotional tears

75
Q

what controls reflex tears

A

the afferent limb of the reflex is CN V1 (the ophthalmic nerve) from the cornea/conjunctiva

the efferent limb is parasympathetic axons originating from CN VII (the facial nerve)

76
Q

what is raised intracranial pressure and what can cause it

A

Increase in pressure within the cranial cavity

Brain tumour, Head injury, Hydrocephalus (increased fluid around the brain), Meningitis, Stroke

77
Q

what is the Monro-Kellie hypothesis

A

the pressure-volume relationship between ICP, volume of CSF, blood, and brain tissue, and cerebral perfusion pressure (CPP)

78
Q

what are the components of intracranial pressure

A

brain
blood
CSF

79
Q

what will people with RIP have

A 
transient blurred vision
double vision
loss of vision
papilloedema (swelling of optic disc due to increased ICP)
pupillary changes
80
Q

what are the optic nerves covered by

A

meninges

81
Q

what is meninges and what are its layers

A

Protective coverings of brain and spinal cord
1 - dura mater
2 - arachnoid mater
3 - pia

82
Q

what is in the subarachnoid space and where is it found

A

Circulating CSF and blood vessels
completely surrounds both brain & spinal cord - cushions and protects

between arachnoid mater and pia mater

83
Q

features of dura mater

A

tough
sensory supply CN V
encloses dural venous sinuses

84
Q

features of pia mater

A

Adheres to brain (and vessels and nerves entering or leaving)

85
Q

where is CSF produced

A

choroid plexus of the lateral and third ventricles

86
Q

where is CSF reabsorbed

A

dural venous sinuses

- via arachnoid granulations found in the arachnoid mater

87
Q

where can the a sample of CSF be obtained

A

Lumbar puncture at L3/4 or L4/5

88
Q

how many ventricles are in the brain and what are they called

A

4

right lateral, left lateral, 3rd and 4th ventricle

89
Q

what connects the third and fourth ventricle

A

cerebral aqueduct

90
Q

what is the circulation of CSF

A 
1 - secreted by choroid plexus
2 - to right and left lateral ventricles
3 - then to 3rd ventricle
4 - via cerebral aqueduct
5 - the 4th ventricle
6 - into subarachnoid space
7 - reabsorbed from the subarachnoid space via the arachnoid granulations
8 - into the dural venous sinuses
91
Q

what will happen to CNII with raised ICP

A

Raised ICP will be transmitted along the subarachnoid space in the optic nerve sheath and compress optic nerve

92
Q

what will also happen as a result of raised ICP

A

Compress central artery and vein of the retina

Can lead to bulging or swollen optic discs

93
Q

visual symptoms of raised ICP

A 
transient visual obscurations (graying-out of vision), 
transient flickering
blurring of vision
constriction of the visual field
decreased colour perception
94
Q

what are signs of CN III damage

A

lose/slowness of pupillary light reflex, dilated pupil, ptosis, eye turned inferolaterally

95
Q

what nerve of the eye is most susceptible to damage and why

A

CN IV
Long intracranial course
Susceptible to stretching and compression

96
Q

signs of CN IV damage

A

Paralysis of superior oblique muscle

Inferior oblique is unopposed

  • eye cannot move inferomedially
  • diplopia when looking down
97
Q

signs of CN VI damage

A

Paralysis of lateral rectus muscle

Eye cannot move laterally in horizontal plane

98
Q

what are the two component of seeing via the retina

A

Rods

  • sensitive to low levels of light
  • night vision / peripheral vision

Cones

  • detailed vision (acuity)
  • colour vision
99
Q

what are the parts of the visual pathway

A

Optic nerve
Optic chiasm
Optic radiation
Visual cortex

100
Q

what are the common refractive errors

A

Emmetropia - no refractive error

Hypermetropia - long sighted

Myopia - short sighted

Astigmatism - defect in the eye or in a lens caused by a deviation from spherical curvature

Presbyopia - comes to us all. long-sightedness caused by loss of elasticity of the lens of the eye

Ophthalmology SB (7 decks)

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