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Opthalmology > Anatomy > Flashcards

Anatomy Flashcards

1
Q

what is the eyeball?

A

optical apparatus and is roughly 25mm in diameter

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2
Q

what is the shape of an eyeball?

A

• Spherical shape – comprised of 3 layers + fascial sheath

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3
Q

what are the 3 layers of the eyeball?

A 
Fibrous layer (outer)
Vascular layer (uvea)
Retina (inner)
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4
Q

what two parts make up the outer fibrous layer of the eye?

A

cornea
sclera
(junction between corneal limbus)

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5
Q

what is the cornea of the eye?

A

o anterior 1/6, approx. 540microns thick, thickest peripherally, avascular
o transparent fibrous layer – epithelium, Bowmans membrane, stroma, Descemets membrane, endothelium
o 2/3 of refractive power

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6
Q

what is the sclera of the eye?

A

o Posterior 5/6, tough, opaque layer
o extraocular muscles attach to the outer sclera
o collagen, ground substance, coarse weave

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7
Q

what are the 3 parts of the uvea of the eye?

A

choroid
ciliary body
iris

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8
Q

what is the role of the uvea of the eye?

A

role in absorbing reflected light + provides nutritional support

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9
Q

what is the structure of the choroid of the eye?

A

o Dark brown layer between sclera + retina
o Larger vessels externally, finer vessels internally
o Avascular area of retina

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10
Q

what is the ciliary muscle of the eye?

A

 Smooth muscle, ring overlying ciliary processes, posterior to corneoscleral junction
 Provides attachment for the lens
 Contraction and relaxation changes shape of lens, controlling focus
 Connects choroid with circumference of iris

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11
Q

what are the 3 parts of the ciliary body of the eye?

A

ciliary muscle
ciliary process
pars plana

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12
Q

what is the ciliary process of the eye?

A

 Ciliary epithelium secretes of aqueous humour and maintains ocular pressure

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13
Q

what is the iris of the eye?

A

o Contractible diaphragm with a central aperture, pupil
o Coloured part of the eye
o Separates the anterior and posterior chamber

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14
Q

what are the two muscles that make up the iris?

A

 Sphincter pupillae

 Dilator pupillae

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15
Q

what is the iridocorneal angle of the eye?

A

lies between the iris, the anterior tip of the ciliary body and the cornea. Site of aqueous drainage from the eye via the trabecular meshwork

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16
Q

what is the retina of the eye?

A

sensory neural layer

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17
Q

what are the 3 parts of the retina?

A

retina
macule
optic disc

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18
Q

what is the structure of the retina?

A

o Anterior continuation of the pigmented layer and a layer of supporting cells
o Extends over the ciliary body + posterior surface of iris – to the pupillary margin

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19
Q

what is the structure of the macule of the eye?

A

o Lateral to the optic disc
o Small oval area – made of cones (rods around the periphery)
o Yellow in colour
o Centre of the macule = Fovea – area of most acute vision – cones at highest density

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20
Q

what is the structure of the optic disc of the eye?

A

o Where sensory fibres + vessels conveyed by the optic nerve enter the eye – only point of entry/exit
o Contains no photoreceptors so insensitive to light = BLINDSPOT

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21
Q

what is the anterior segment of the eye?

A

in front of lens, divided into chambers

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22
Q

what is the anterior chamber of the anterior segment of the eye?

A

 Between cornea + iris

 Contains aqueous humour

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23
Q

what is the posterior chamber of the anterior segment of the eye?

A

 Between iris + supporting ligaments

 Contains aqueous humour

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24
Q

what is the posterior segment of the eye?

A

behind lens
2/3rds of eye
Contains vitreous humour

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25
Q

what are the 7 bones that make up the bony orbit?

A

o Frontal, zygomatic, sphenoid, ethmoid, lacrimal, maxilla + paletine
o Additional bone is nasal

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26
Q

what are the shapes of the bony orbit?

A

quadrangular pyramids

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27
Q

what is the structure of the apices of the bony orbit?

A

directed anterolaterally = optic canal

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28
Q

what is the structure of the bases of the bony orbit?

A

directed posterior laterally
Called orbital margins/rim
 Superior (frontal), inferior (maxillary), lateral (zygomatic), medial (lacrimal + ethmoid – orbital plate)

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29
Q

what is the role of the eyelid?

A

offer mechanical protection to the globe, spread the tears over the conjunctiva and cornea with each blink

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30
Q

what are the layers of the eyelid?

A

Skin – orbicularis oculi (muscle) – orbital septum + ligaments + tarsus – conjunctiva

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31
Q

what is two parts of the orbicularis oculi?

A

Orbital – thicker, redder colour, fibres form complete ellipse, used for tightly closing
Palpebral – thin, pale, arises rom medial palpebral ligament, used for lightly closing

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32
Q

what are the two tarsus of the eye?

A

o Superior tarsus – supports upper eye lid

o Inferior tarsus – supports lower eye lid

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33
Q

what is the structure of the tarsus?

A

dense bands of connective tissue

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34
Q

what are the ligaments of the of the eyelid?

A

o lateral palpebral ligament – connects tarsus to lateral margin
o medial palpebral ligament – connects tarsi to medial margin of orbit, orbicularis oculi originates + insert

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35
Q

what is the leviator palebrae superiors?

A

o tendon attaches to superior tarsus

o responsible for opening eye/lifting eyelid superiorly

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36
Q

what is the orbital septum?

A

o sheet of fascia – spans tarsi to margins of orbit

o Helps prevent spread of infection from superficial to deep

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37
Q

what are the two types of eye conjunctiva?

A

Palpebral

Bulbar

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38
Q

what is the palpebral conjunctiva?

A

inner surface of eyelids
more vascular than bulbar
contains follicles and papillae

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39
Q

what is the bulbar conjunctiva?

A

lines eyeball

less bascular

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40
Q

what does conjunctiva contain?

A

goblet cells which secrete part of tear film

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41
Q

what are the parts of the lacrimal apparatus?

A

lacrimal glands - excretory ducts - lacrimal canaliculi - nasocrimal ducts - accessory lacrimal glands

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42
Q

what is the role of the lacrimal glands?

A

Secretes lacrimal fluid (saline containing bactericidal enzyme lysozyme)
o Moistens + lubricates conjunctiva + cornea
o Also provides nutrients and oxygen

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43
Q

what is the role of the excretory ducts?

A

transfer lacrimal fluid lacrimal glands – conjunctival sac

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44
Q

what are the parts of the lacrimal canaliculi?

A

o Canals

o Lacrimal punctum (openings) on lacrimal papilla – lacrimal lake – lacrimal sac

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45
Q

what is the role of the nasocrimal ducts?

A

conveys fluid to inferior nasal meatus

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46
Q

what is the role of the tear film?

A

Has antimicrobial properties due to the action of lyzoyme

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47
Q

what is the structure of the tear film?

A 
o	Lipid Phase 0.2μm
o	queus Phase 3-4μm
o	Mucous Phase 1μm 
o	Microvilli
o	Epithelium
48
Q

what is the arterial blood supply of the eye?

A

internal carotid - ophthalmic artery
ophthalmic - central artery of the retina - end artery
ophthalmic - posterior ciliary arteries (8) - short posterior ciliary arteries (6) + long posterior ciliary arteries
ophthalmic - muscular branches - anterior ciliary arteries

49
Q

what is the venous supply of the eye?

A

central vein of retina - superior ophthalmic vein

vorticose veins + central vein of the retina - inferior ophthalmic vein - pterygoid venous plexus + cavernous sinus

50
Q

what are the retinal layers of the eye?

A
  1. Retinal Pigment Epithelium
  2. The Photoreceptors (rods and cones)
  3. Bipolar Nerve Layer (+ amacrine and horizontal nerve cells)
  4. The ganglion cells
  5. The axons of the ganglion cells lie anterior to the ganglion cells
51
Q

what is phototransduction?

A

retinol (II-cis retina) changes to all-trans retinal
transducin breaks away from rhodopsin
binds to cGMP PDE (breaks down cGMP to GMP_
decreased cGMP causes sodium channels to close - hyperpolarisation occurs sending a signal

52
Q

what is the range of visible light we see?

A

750nm – 350nm

53
Q

what is the structure of photoreceptors?

A

o Outer segment – optic discs stacked up
o Inner segment
o Cell body
o Synaptic terminal

54
Q

what are the two types of photoreceptor?

A

rods and cones

55
Q

what are the features of rods?

A
  • Achromatic
  • Peripheral retina
  • High convergence
  • High light sensitivity
  • Low visual acuity
  • 120 million
  • Slow recovery
56
Q

what are the features of cones?

A
  • Chromatic
  • Central retina
  • Low convergence
  • Low light sensitivity
  • High visual acuity
  • 6 million
  • High recovery
57
Q

how is light from visual fields process?

A

o Light from objects in the right visual field is processed by left primary visual cortex
o Light from objects in the lower visual field is processed by the upper primary visual cortex

58
Q

for what visual field does the retina cross over?

A

Nerve fibres from the nasal half of each retina cross over at the optic chiasm.

59
Q

where is does the visual process terminate?

A

Striate Complex

60
Q

where is the visual field mapped?

A

retina, LGN, superior colliculus & cortex

61
Q

what is the origin of the levitator palpebrae superioris?

A

Lesser wing of sphenoid bone, superior and anterior to optic canal

62
Q

what is the origin of the superior oblique?

A

Body of sphenoid

63
Q

what is the origin of the inferior oblique?

A

Anterior part of floor of orbit

64
Q

what is the origin of the superior rectus?

A

Common tendinous ring

65
Q

what is the origin of the inferior rectus?

A

Common tendinous ring

66
Q

what is the origin of the medial rectus?

A

Common tendinous ring

67
Q

what is the origin of the lateral rectus?

A

Common tendinous ring

68
Q

what is the insertion point of the levitator palpebrae superioris?

A

Superior tarsus and skin of superior eyelid

69
Q

what is the insertion point of the superior oblique?

A

Its tendon passes through a fibrous ring or trochlea, changes its direction and inserts into sclera deep to superior rectus muscle

70
Q

what is the insertion point of the inferior oblique?

A

Sclera deep to lateral rectus muscle

71
Q

what is the insertion point of the superior rectus?

A

Sclera just posterior to corneoscleral junction

72
Q

what is the insertion point of the inferior rectus?

A

Sclera just posterior to corneoscleral junction

73
Q

what is the insertion point of the medial rectus?

A

Sclera just posterior to corneoscleral junction

74
Q

what is the insertion point of the lateral rectus?

A

Sclera just posterior to corneoscleral junction

75
Q

what is the innervation of the levitator palpebrae superioris?

A

CN3

76
Q

what is the innervation of the superior oblique?

A

CN4

77
Q

what is the innervation of the inferior oblique?

A

CN3

78
Q

what is the innervation of the superior rectus?

A

CN3

79
Q

what is the innervation of the inferior rectus?

A

CN3

80
Q

what is the innervation of the medial rectus?

A

CN3

81
Q

what is the innervation of the lateral rectus?

A

CN6

82
Q

what is the action of the levitator palpebrae superioris?

A

Elevates superior eyelid

83
Q

what is the action of the superior oblique?

A

Abducts, depresses and medially rotates eyeball

84
Q

what is the action of the inferior oblique?

A

Abducts, elevates and laterally rotates eyeball

85
Q

what is the action of the superior rectus?

A

Elevates, adducts and rotates eyeball medially

86
Q

what is the action of the lateral rectus?

A

Depresses, adducts and roatates eyeball laterally

87
Q

what is the action of the medial rectus?

A

Adducts eyeball

88
Q

what is the action of the lateral rectus?

A

Abducts eyeball

89
Q

sensory innervation of the eye comes from which nerve?

A

trigeminal

90
Q

what is the sensory afferent of the blink reflex?

A

Action potentials conducted from cornea via CNV1 branches (nasocillary) - To trigeminal ganglion then along CN V - to pons - Central CNS Connections between CN V + CNVII - Motor Efferent Limb Action potentials conducted via CNVII - eye lid part of orbicularis occuli

91
Q

where to the presynaptic axons form CNS for the eye arise?

A

o Exit spinal cord in T1 spinal nerve
o Ascend within
o Synapse in superior cervical sympathetic ganglion

92
Q

what is the route of post synaptic sympathetic innervation?

A

o Eneter internal + exteral xarotid nerves
o Pass onto the surface of internal + external arteries
o Carried to the organs of the head of the surface of the brnaces of these arteries
o Oprhalmic artery carries sympathetic axons into the orbit

93
Q

what is the route of the oculomotor nerve?

A
  • Connects with CNS at junction between midline and pons
  • Passes through the cavernous sinus, exits via superior orbital fissure
  • Divides into the inferior and superior branch as it enters the orbit through the orbit fissure
94
Q

what are the long ciliary nerves?

A

o Branches of CNV1 (nasocillary branch)
o Pass to the eyeball, by passing the ciliary ganglion, convey post synaptic fibres to dilator pupillae and afferent fibres from the iris and cornea
o Sympathetic and osmatic sensory

95
Q

what are the short ciliary nerves?

A

o Branches of CNV1
o Parasympathetic + sympathetic to ciliary body + iris
o Postsynaptic parasympathetic fibres originating in the ciliary ganglion, afferent fibres from nasociliary nerve that pass through the ganglion and post synaptic sympathetic fibres

96
Q

what is the role of the ciliary nerves?

A

• Ciliary nerves supply autonomic axons to control diameter of iris & refractive shape of lens

97
Q

what are the autonomic reflexes of eye?

A
  1. Maximal eyelid elevation/wide opening of fight or flight
  2. Pupillary dilation/constriction adjusting light entry pupillary light/reflex
  3. Focusing lens far & near vision: accommodation reflex
  4. Lacrimation reflex tear production
98
Q

how do pupils dilate?

A

sympathetic
Dilator pupillae fibres are radically arranged around external circumference of iris
When radial fibres contract, pull muscle to pull pupil

99
Q

how do pupils constrict?

A

parasympathetic

Sphincter pupillae fibres encircle pupil – around the internal circumference of iris

100
Q

what is the light reflex?

A

o Direct light reflex occurs in the stimulated ee

o A consensual light reflex occurs in non-stimulated

101
Q

what is the 4 neurone chain of light reflex chain?

A

 1st Neurone – retinal ganglion cells, pass via ipsilateral optic nerve, decussate in optic chiasm, synapses in pretectal nucleus in midbrain
 2nd Neurone – located entirely within midbrain & connect pretectal nucleus to next sunapse in Edinger-Westphal Nucleus (location of cell bodies of parasympathetic axons of CN III)
 3rd Neurone- pass from EW nucleus, via CN3 then its inferior division to synapse in ciliary ganglion
 4th Neurone – course in short ciliary nerves to sphincter pupillae

102
Q

what apparatus is involved in focusing the lens

A

ciliary body

103
Q

how does the lens change for far vision?

A

o Sympathetic stimulation
o Muscle ring is relaxed, diameter of muscle ring becomes larger
o Lens suspended is under tension as periphery is stretched
o Ligament tightens and lens flattens to focus on object in distance – less convex

104
Q

how does the lens change for near vision?

A

o Parasympathetic
o Muscle is contracted, ring becomes smaller
o Lens tension is reduced, ligament relaxes & lens becomes spherical – more convex

105
Q

what is the accommodation reflex?

A

o Active process of changing the shape of lens for near vision

106
Q

how does the accommodation reflex occur?

A

 Bilateral pupillary constriction, parasympahteic constriction of sphincter – CNIII
 Bilateral convergence of both eyes towards midline, medial recrys CNIII
 Bilateral relaxation of the lens, lens become spherical due to contraction CNIII

107
Q

what are the different types of tears?

A

reflex
emotional
basal

108
Q

what is the process of reflex tears?

A 
parasympathetics
CNVII (muscles of facial expression) → CNVII (stylomastoid foramen) → CNVII (internal acoustic meatus) → CNVII (branch containing parasympathetic axons for lacrimal) → V2 → V1 → Lacrimal Gland
109
Q

what is the innate immune system of the eye?

A
  • Physical Barrier – no skin transparent + exposed
  • Commensal bacteria – not many
  • Chemical agents – yes
  • Cells – yes
110
Q

what are the alternative methods of eye immune system?

A
  1. Blink reflex and physical properties
  2. Chemical Properties of eye surface
  3. Immune cells in eyes – tears
111
Q

how do tears act in the eyes immune system?

A

• Tears – physical, flushing, mucus layer – anti adhesive

112
Q

what are the chemical properties of the eye surface?

A
  • Tears – chemical
  • Lysozyme – gram -ve bacteria, fungi (destroy cell walls)
  • Lactoferrin and transferrin – gram +ve bacteria
  • Tear lipids – antibacterial to cell membranes/scavenger of bacterial products
  • Angiogenin – antimicrobial effect
  • Secretory IgA – revents attachment
  • Complement
  • IL-6, IL-8, MIP – antimicrobial molecules that recruit leukocytes
113
Q

what are the immune cells in the eyes?

A

(neutrophils, macrophages, conjunctival mast cells)

114
Q

what is the adaptive immune system of the eye?

A
  1. Antigen Presenting Cells – APC = dendritic cells, B cells, macrophages
  2. Lymphatic Drainage to lymphnode
  3. Variety of effector cells – CD4+ T cells, CD8+ T cells, B cells
115
Q

what are Langerhan cells?

A
  • Principle APC for external eye
  • Rick n class II MHC molecules
  • Abundant at corneo-scleral limbus, less in peripheral cornea, absent from central 1/3rd of cornea

Opthalmology (15 decks)

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