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Ophthalmology > Anatomy > Flashcards

Anatomy Flashcards

1
Q

What are the retina and the optic nerve outgrowths of?

A

The brain

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2
Q

What are the 3 coats of the eye?

A
  1. Outer fibrous layer
  2. Middle vascular layer (uveal tract)
  3. Inner nervous layer (retina)
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3
Q

What are the 3 parts of the outer fibrous layer of the eye?

A
  1. Cornea
  2. Sclera
  3. Lamina cribrosa
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4
Q

What are the 3 parts of the middle vascular layer of the eye (uveal tract)?

A
  1. Iris
  2. Ciliary body - consisting of the pars plicata and pars plana
  3. Choroid
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5
Q

What are the 3 layers of the inner nervous layer of the eye?

A
  1. Pigment epithelium of the retina
  2. Retinal photoreceptors
  3. Retinal neurones
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6
Q

What are the 3 compartments of the eye?

A
  1. Anterior chamber
  2. Posterior chamber
  3. Vitrous chamber
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7
Q

What are the boundaries of the anterior chamber?

A

The space between the cornea and the iris

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8
Q

What are the boundaries of the posterior chamber (3)?

A

The triangular space (on either side of the pupil, when viewed in cross-section) between the iris anteriorly

The lens and zonule posteriorly

The ciliary body laterally

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9
Q

What are the boundaries of the vitrous chamber?

A

The space behind the lens and zonule

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10
Q

What are the 3 intraocular fluids?

A
  1. Aqueous humour
  2. Vitrous humour
  3. Blood
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11
Q

What is aqueous humour?

A

A watery, optically clear solution of water and electrolytes similar to tissue fluids

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12
Q

What is vitreous humour?

A

A transparent gel

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13
Q

What is the role of blood in the eye in addition to its usual functions?

A

Contributes to the maintenance of intraocular pressure

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14
Q

What layer of the eye contains most of the blood?

A

Choroid

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15
Q

What are the 2 functions of the choroidal vasculature?

A
  1. Retinal nutrition

2. Heat-exchanger for the retina

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16
Q

What is the function of the retina?

A

It absorbs light energy as light strikes the retinal pigment epithelium and converts it to nerve impulses

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17
Q

How is the eye clinically separated into 2 compartments?

A
  1. Anterior segment - all structures from (and including) the lens forward
  2. Posterior segment - all structures posterior to the lens
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18
Q

Where is the cornea?

A

Forms the anterior 1/6th of the outer coat of the eye

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19
Q

What forms the 5/6ths outer coat of the eye?

A

Sclera and lamina cribrosa

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20
Q

What are the 5 layers of the cornea from anterior to posterior?

A
  1. Epithelium and its basement membrane
  2. Bowman’s layer
  3. Stroma
  4. Descemet’s membrane
  5. Endothelium
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21
Q

What type of cells is the epithelium of the cornea made of?

A

Stratified squamous type of epithelium with 5-6 cell layers of regular arrangement

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22
Q

What is the Bowman’s layer made of?

A

Homogenous sheet of modified stroma

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23
Q

Which part of the cornea makes up 90% of the total corneal thickness?

A

Stroma

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24
Q

What does the stroma of the cornea consist of (3)?

A
  1. Lamellae of collagen
  2. Cells
  3. Ground substance
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25
Q

What is the Descemet’s membrane?

A

The basement membrane of the endothelium

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26
Q

What is the location of the iris?

A

It is the anterior-most part of the uvea

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27
Q

Where is the sensory innervation of the eyelids?

  1. Upper
  2. Lower
A
  1. Upper - ophthalmic division of the trigeminal (V) nerve

2. Lower - maxillary division of the trigeminal (V) nerve

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28
Q

What nerve innervates the orbicularis oculi?

A

Facial (VIIth) nerve

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29
Q

What happens to the lower eyelid with a facial nerve palsy?

What does it not cause?

A

Ectropion

Not ptosis

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30
Q

What innervates the levator palpebral muscle in the upper eyelid?

A

Oculomotor (III) nerve

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31
Q

What are the 2 major arteries that give off branches that supply the eye?

Where do the branches travel?

A
  1. External carotid artery via the face

2. Internal carotid artery via the orbit

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32
Q

What are properties of the sclera (5)?

A
  1. Collagenous
  2. Avascular (apart from some vessels on its surface)
  3. Relatively acellular
  4. Tough but thin
  5. Gives attachment to the extraocular muscles
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33
Q

What are properties of the cornea (3)?

A
  1. Sensitive to touch
  2. Avascular
  3. Transparent
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34
Q

What are the 2 functions of the cornea?

A
  1. Protection of invasion of microorganisms into the eye

2. Transmission and focusing (refraction) of the light

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35
Q

Where does the cornea derive its nutrition from (3)?

A
  1. Diffusion from blood vessels at the limbus
  2. From aqueous humour
  3. From the tear film
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36
Q

Where is the lacrimal gland?

What is its function?

What is its innervation?

A

Superotemporal part of anterior orbit

Secretes most of the aqueous component of the tear film

Innervated by parasympathetic fibres carried by the facial nerve

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37
Q

What is the function of blinking?

A

Spread of tears across the ocular surfaces

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38
Q

Where do tears drain?

A

Superior and inferior puncta at the nasal end of the eyelids

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39
Q

What is the pathway of the drainage of tears after the punta?

A

The tears go into the punctum, which drains into a single canaliculi, which unite in a common canaliculus, which finally ends in the lacrimal sac.
The tears then go from the lacrimal sac to the lasolacrimal duct, then drain into the inferior meatus to the nasopharyngeal cavity

40
Q

What is the primary function of the internal ocular structures of the eye?

A

To refine the image formed by the cornea, and to convert light energy into electrical energy for image formation by the brain

41
Q

What does the iris consist of?

A

Connective tissue containing muscle fibres, blood vessels and pigment cells

42
Q

What are the 2 main functions of the iris?

A
  1. Control light entry to the retina

2. Reduce intraocular light scatter (by its pigment)

43
Q

How does the pupil dilate?

What is it innervated by?

A

Contraction of dilator pupillae muscle (radial smooth muscles fibres), innervated by the sympathetic nervous system

44
Q

How does the pupil constrict?

What is it innervated by?

A

Contraction of the iris sphincter muscle (ring of smooth muscle fibres)
Innervated by the parasympathetic nervous system (oculomotor nerve)

45
Q

What is the ciliary body and its function (3)?

A
  1. Unites the iris with the choroid
  2. Makes aqueous humour
  3. Anchors the lens via the zonules, through which it modulates lens convexity
46
Q

What is the innervation of accommodation?

A

Controlled by parasympathetic fibres in the oculomotor nerve

47
Q

How does accommodation occur?

A

Muscle fibres in the ciliary body contract, causing its inner circumference to reduce
This relaxes the zonules, so that the lens becomes convex (fat) to focus on near objects.

48
Q

What does the choroid consist of (3)?

A
  1. Bruch’s membrane, consisting of:
    - basement membrane of RPE cells
    - basement membrane of choriocapillaries
  2. Choriocapillaries (capillaries that supply RPE and outer retina)
  3. Layer of larger choroidal bv external to choriocapillaries
  4. Pigmented cells scattered in choroid external to choriocapillaries

(in order of external surface of RPE to outside i.e. towards sclera)

49
Q

Where is the choroid?

What is its function?

A

Between the retina and the sclera

Gives oxygen and nutrition to the outer retinal layers

50
Q

What is the circulation of aqueous humour?

A

Aqueous circulates from the posterior to the anterior chamber through the pupil, leaving the eye through the trabecular meshwork. finally, it drains into the veins.

51
Q

Where is the trabecular meshwork?

A

Anterior chamber angle between the iris and the cornea

52
Q

At which points are the vitrous adherent to the retina (3)?

A
  1. Optic disc
  2. Ora serrata
  3. Fovea
53
Q

What type of vision does the macula provide?

A

Central vision

54
Q

What cells make up the majority of the fovea?

What type of vision does the fovea provide (2)?

A

Cones

  1. High quality vision
  2. Central, colour vision
55
Q

What vision does the majority of the retina provide?

A

Peripheral vision

56
Q

What are the layers of the retina from outside in (9)?

*****8

A
  1. Retinal pigment epithelium (RPE)
  2. Rods and cones (photoreceptors)
  3. External limiting membrane
  4. Outer nuclear layer (nuclei of rods and cones with bipolar cells)
  5. Inner nuclear layer (nuclei of bipolar cells)
  6. Inner plexiform layer (synapse of bipolar cells with ganglion cells)
  7. Ganglion cell layer
  8. Nerve fibre layer
  9. Internal limiting membrane
57
Q

What are the function of cones?

A

Fine vision (acquity) and colour appreciation

58
Q

What are the function of rods?

A

Vision in low light levels and detection of movement

59
Q

What type of cells are concentrated in the macula?

A

Cones

60
Q

What is the function of the retinal pigment epithelial cells (4)?

A
  1. Recycle vitamin A for the formation of photopigments
  2. Transport water and metabolites
  3. Renew photoreceptors
  4. Help to reduce damage by scattered light
61
Q

What is the blood supply to the retina (2)?

A
  1. Central retinal artery and vein

2. And from the choroid

62
Q

Where do the retinal vessels enter and leave the eye?

Where do they run in?

A

They enter and leave the eye through the optic nerve and run in the nerve fibre layer.

63
Q

What is the blind spot?

A

Optic disc which has no photoreceptors

64
Q

What bones form the bony walls of the orbit (6)?

A
  1. Frontal
  2. Maxillary
  3. Zygomatic
  4. Ethmoid
  5. Lacrimal
  6. Sphenoid bones
65
Q

What are the clinical implications of the fact that the medial wall and floor of the orbit are thin (2)?

A
  1. A forceful blow to the eyes forces the eye back into the orbit and decompression through fracture of the floor or medial wall minimises damage to the eyeball
  2. Infection in the maxillary or ethmoid sinus can easily spread to the orbit
66
Q

What 2 structures pass through the optic foramen at the apex of the eye socket?

A
  1. Optic nerve

2. Ophthalmic artery

67
Q

What 7 structures pass through the superior orbital fissure?

A
  1. Lacrimal nerve
  2. Frontal nerve
  3. Nasociliary nerves (ophthalmic division of the trigeminal (V) nerve)
  4. Oculomotor (III) nerve
  5. Trochlear (IV) nerve
  6. Abducent (VI) nerve
  7. SUperior ophthalmic vein
68
Q

What 2 structures pass through the inferior orbital fissure?

A
  1. Inferior ophthalmic vein

2. Maxillary division of the trigeminal (V) nerve

69
Q

What are the 7 extraocular muscles?

A
  1. Medial rectus
  2. Lateral rectus
  3. Superior rectus
  4. Inferior rectus
  5. Superior oblique
  6. Inferior oblique
  7. Levator muscle
70
Q

How do the 4 extraocular rectus muscles attach to the eyeball anteriorly and posteriorly?

A
  1. Anteriorly on the sclera

2. Posteriorly, they have a common attachment to a ring of connective tissue which surrounds the optic foramen

71
Q

What are the clinical implications of compression at the orbital apex and why?

A

May lead to loss of corneal sensation, reduced ocular movement and impaired visual function, and displacement of the globe forwards (proptosis)

This is because the 4 extraocular rectus muscles form a cone within which are the sensory and autonomic nerves and arteries to the eyeball, including the optic nerve and the motor nerves to all the extraocular muscles including the levator but excluding the superior oblique

72
Q

What is the memory aid to remember what nerves innervate what extraocular muscles?

A

LR6 SO4

Lateral rectus - VI abducens
Superior oblique - IV trochlear
All others (including levator) - III oculomotor

73
Q

What is the action of the medial rectus muscle?

A

Adduction of the eye (medially)

74
Q

What is the action of the lateral rectus muscle?

A

Abduction of the eye (laterally)

75
Q

What is the action of the superior rectus muscle?

  1. Primary action
  2. Secondary action
  3. Tertiary action
A
  1. Elevation
  2. Intorsion
  3. Adduction
76
Q

What is the action of the inferior rectus muscle?

  1. Primary action
  2. Secondary action
  3. Tertiary action
A
  1. Depression
  2. Extorsion
  3. Adduction
77
Q

What is the action of the superior oblique muscle?

  1. Primary action
  2. Secondary action
  3. Tertiary action
A
  1. Intorsion
  2. Depression
  3. Abduction
78
Q

What is the action of the interior oblique muscle?

  1. Primary action
  2. Secondary action
  3. Tertiary action
A
  1. Extorsion
  2. Elevation
  3. Abduction
79
Q

Which is the chief sensory nerve of the eye?

A

Optic nerve

80
Q

What is the blood supply to the optic nerve?

A

Branches of the ophthalmic artery

81
Q

What are the sensory nerves of the eyeball, conjunctiva and skin of eyelids extending up across the forehead and back towards the occiput?

A

Branches of the ophthalmic division of the trigeminal (V) nerve

82
Q

What is the clinical significance of having branches of the trigeminal nerve sensory to the eye?

A

Shingles of the eye can also cause a rash in that dermatome

83
Q

What is the innervation leading to accomodation?

A

Parasympathetiic nerve fibres to the ciliary body

84
Q

What substances are given for pupil dilation (2)?

A
  1. Topical inhibitor of the parasympathetic system e.g. tropicamide
  2. Sympathetic agonist e.g. phenylephrine
85
Q

Describe the visual pathways (4)?

A
  1. The 2 optic nerves unite at the optic chiasm above the sella turcica of the sphenoid bone
  2. Nerve fibres from the nasal retinal (temporal vision) cross to the opp side of the chiasm (so post-chiasmal fibres on the left subserve the field of vision on the right)
  3. The optic tracts extend from the chiasm to the lateral geniculate body
  4. The nerves, which began as fibres on the surface of the retina, form synapses with neurones passing through the optic radiation to reach the visual cortex in the occipital lobes
86
Q

What type of visual loss does a pituitary tumour pressing on the optic chiasm cause?

A

Bitemporal hemaniopia

87
Q

What visual loss would a unilateral lesion behind the chiasm cause?

A

Hemaniopia on the opp side

88
Q

What supplies the optic tract and radiations?

A

Branches of the middle cerebral artery

89
Q

What supplies the visual cortex?

A

Posterior cerebral artery

90
Q

What supplies the macula?

A

Dual blood supply from the middle and posterior cerebral arteries

91
Q

What are the clinical implications of an occulsion of the arterial supply to the visual cortex?

A

Would cause bilateral field loss which spares central vision (macular sparing) because the macula as a dual blood supply

92
Q

What is visual acuity?

A

Measure of the ability of the eye to see that two closely positioned objects are separate

93
Q

What nerves provide innervation of the cornea?

A

Ophthalmic nerve (CN V1)

94
Q

Why does damage to the cornea cause a lot of pain?

A

Nerve endings are exposed

95
Q

When looking through the ophthalmoscope, is the optic disc placed nasally or temporally?

A

Nasally

Ophthalmology (12 decks)

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