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MB2: Ophthalmology > Anatomy > Flashcards

Anatomy Flashcards

1
Q

bones of the bony orbit

A 
frontal 
ethmoid 
zygomatic 
maxilla 
lacrimal 
palentine 
nasa 
sphenoid
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2
Q

where is the optic canal located in relation to the bony orbit

A

posteromedially

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3
Q

what is the gap between the greater/lesser sphenoid wing called and what passes through it

A

superior orbital fissure

cranial nerves III, IV, VI

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4
Q

what bone is the supraorbital notch found on and what is in it

A

frontal

supraorbital neurovascular bundle with supraorbital nerve as a branch of opthalamic branch of trigeminal

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5
Q

what bone is the infraorbital foramen found on and what is in it

A

maxilla

infraorbital neurovascular bundle with infraorbital nerve as a branch of maxillary division of the trigeminal

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6
Q

the bony orbit can be described as a pyramid shape. what is the base of this ‘pyramid’ known as

A

orbital rim

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7
Q

the eyes face ____ and the bony orbit faces ___ and so they do/dont line up

A

anterior
anterolateral
they dont line up

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8
Q

describe how the eye is protected by the bony rim

A

superior overhangs inferior to prevent eye trauma

bones are quite strong

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9
Q

what is a blowout fracture

A

traumatic strike to the bony rim carries energy back to the orbital plates and causes fracture

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10
Q

besides a blowout fracture where else is a fracture common after strike to bony orbit

A

orbit rim sutures

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11
Q

where are the bony plates found

A

frontal bone superior
ethmoid bone medially
maxilla inferiorly

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12
Q

most superficial muscle to the eyelid, function and innervation

A

orbicularis oculi
orbital - tight closing of eye
palpebral part for gentle eye closing
facial nerve CN VII

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13
Q

what muscular thick layer is deep to orbicularis oculi

A

superior and inferior tarsus

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14
Q

function of LPS and attachment

A

elevates superior eyelid
attaches to superior tarsus and superior eyelid
originates from lesser wing sphenoid

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15
Q

function of tarsus gland

A

produces lipids to prevent tears overflowing

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16
Q

describe the flow of lacrimal fluid over the eye and drainage

A

washes over eye lateral to medial and drains through canaliculi to lacrimal puncta, moving to lacrimal sac and nasolacrimal sac
drains to inferior meatus of nasal cavity

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17
Q

rectus muscles of the eye?

A

superior rectus
inferior rectus
lateral rectus
medial rectus

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18
Q

oblique muscles of the eye?

A

superior oblique

inferior oblique

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19
Q

what does the inferior oblique originate from and what does it attach to

A

originates from orbital plate of the maxilla and inserts onto the sclera

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20
Q

innervation to the muscles of the eye

A

LR6 SO4 AO3
lateral rectus is CN IV
Superior oblique is CN IV
all others are CN III

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21
Q

what covers the sclera of the eye

A

conjunctiva

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22
Q

what covers the iris of the eye

A

cornea

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23
Q

true/false - cornea receives nutrient from small conjunctival vessels

A

false - it is avascular and receives its nutrient from lacrimal fluid and aqueous

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24
Q

what is the conjunctival fornix

A

junction where the conjunctiva is reflected from the sclera to the eyelid

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25
Q

what is the limbus of the eye

A

corneoscleral junction

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26
Q

layers of the eye?

A

fibrous
uvea
retina

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27
Q

contents of the fibrous layer of the eye

A

sclera

cornea

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28
Q

contents of the uvea

A

iris
ciliary body
choroid

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29
Q

what is the anterior segment and what can it be subdivided into

A

segment of eye in front of lens
anterior chamber between iris and cornea
posterior chamber between iris and suspensory ligaments

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30
Q

what is the posterior segment of the eye and what makes it up

A

behind lens of the eye

made up of vitreous body, jelly like to transmit light and hold the retina in place

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31
Q

describe the circulation of aqueous in the anterior segment of the eye

A

ciliary processes secrete aqueous
circulates through posterior chamber and nourishes lens
passes into anterior chamber and nourishes cornea
reabsorbed by scleral venous sinus at iridocorneal angle

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32
Q

describe the venous drainage of the eye

A

superior/inferior opthalmic veins drain to cavernous sinus through superior orbital fissure
central vein drains direct to cavernous sinus
some smaller veins frain to the pterygoid plexus

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33
Q

what is the danger triangle of the face and why is it possibly dangerous

A

upper lip to external nose
all facial and forehead veins within the danger triangle drain to the cavernous sinus and cranial cavity
means superficial infections can spread deep to cranial cavity

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34
Q

describe the arterial supply of the eye

A

internal carotid passes to opthalmic artery and passes optic canal to supply eyeball, lacrimal gland, muscles, forehead, scalp
ciliary arteries supply choroid
centra artery to retina

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35
Q

what is important about the arterial and venous drainage of the retina

A

they are end arteries/veins so occlusion leads to tissue ischaemia and death

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36
Q

what is the fundus

A

posterior layer where light is focused

optic disk, macula, fovea

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37
Q

what is the optic disk

A

point of CNII formation

only point of entry for blood vessels and axons of CN II

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38
Q

true/false - the optic disk is a visual blind spot

A

true

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39
Q

what is the macula

A

greatest density of cones

40
Q

what is the fovea

A

centre of macula and area of most acute vision

41
Q

layers of the optic disk and retina?

A

photoreceptors - posterior and sense light
ganglion cells - ant to photoreceptors and synapse photoreceptors for light perception
axons of ganglion cells - come together to form optic nerve

42
Q

describe the visual pathway

A

light enters the nasal and temporal retina of the eye
this enters the optic nerve and then enters the optic chiasma
nasal visual field crosses over to other side of the chiasm and combines with temporal to form optic canal
synapse with genicular bodies to form optic radiation
enters visual cortex

43
Q

movement of superior rectus and innervation

A

can only elevate in abduction

CN III

44
Q

movement of inferior rectus and innervation

A

when held in abduction can only depress

CN III

45
Q

movement of medial rectus and innervation

A

can only adduct eyeball

CN III

46
Q

movement of lateral rectus and innervation

A

can only abduct eyeball
CN IV
brings line of gaze into path superior and inferior rectus

47
Q

movement of superior oblique and innervation

A

when in adduction it can only depress

CN IV

48
Q

movement of inferior oblique and innervation

A

when in adduction can only elevate

CN III

49
Q

describe pure elevation

A

inferior oblique and superior rectus
synergistically elevate eyes
antagonistically rotates eyes

50
Q

describe pure depression

A

superior oblique and inferior rectus synergistically depress eyes and are antagonists to adduct/abduct

51
Q

what muscles mediate bilateral eye movement at the same time

A

yolk muscles

52
Q

for testing elevation and depression of the eyes, why does the testing of superior and inferior retus need done in abduction

A

to correctly angle the origin and attachment to allow for accurate true eye movements

53
Q

describe the passage of sympathetic innervation to the orbit

A

exits T1 and passes up sympathetic chain to superior cervical ganglion
enters internal/external carotid nerves and pass on surface of int/ext carotids
opthalamic artery carries sympathetic axons to orbit

54
Q

what cranial nerves are parasympathetic

A

sacral outflow

CN III, VII, IX, X

55
Q

describe parasympathetic innervation to the orbit

A

parasympathetic, mainly CN III, synapses in ciliary ganglion

56
Q

true/false - sympathetics and sensory fibres also synapse in ciliary ganglion

A

false - they can pass through it but they dont synapse

57
Q

describe the path of CN III

A

connects with CNS at pons/midbrain
passes through cavernous sinus
exits supraorbital fissure
splits into superior/inferior division

58
Q

sensory innervation of the opthalmic division trigeminal

A 
upper eyelid 
cornea 
conjunctiva 
tip of nose 
forehead
59
Q

sensory innervation of the maxillary division of the trigeminal

A

lower eyelid and maxilla

60
Q

sensory innervation of the mandibular division of the trigeminal

A

sensory to mandible and TMJ

motor for muscles of mastication

61
Q

describe the blink reflex

A

APs conducted from cornea to CN V1, carried to trigeminal ganglion to CN V and then to pons
connection to facial nerve
motor AP carried down CN VII to ocularis oculi

62
Q

what is the vestibulo-ocular reflex and what nerves mediate it

A

turning of eye in opposite to head movement on focusing on object to stabilise gaze
CN VIII, CNIII, IV, VI

63
Q

hat is the oculocardiac reflex and what nerves mediate it

A

reflex bradycardia in response to tension on extraocular muscles or pressure on eye
mediated by CN V1 and CNX

64
Q

parasympathetic actions on the eye

A

less light into eyes
focus on near objects
reflex lacrimation to wash away foreign stimuli and clean cornea

65
Q

sympathetic actions on the eye

A

opens eye wider

more light into eyes

66
Q

what is muellers muscle and what innervates ir

A

elevates eyelid marginally

small slip of smooth muscle off LPS that has sympathetic innervation

67
Q

describe pupillary constriction

A

parasympathetics constrict by sphincter pupillae muscles

68
Q

describe pupillary dilation

A

sympathetic widens pupil by activating dilator pupillae muscles

69
Q

origin and insertion of dilator pupillae muscles?

A

radially arranged
fixed onto external iris
mobile on the internal circumference of iris

70
Q

what is a mydriatic pupil

A

non-physiologically enlarged pupil

71
Q

what may cause mydriatic pupil

A

mydriatic drugs

72
Q

what is a miotic pupil

A

non-physiologically constricted pupil

73
Q

what may cause a miotic pupil

A

horners syndrome

74
Q

what may cause a blown pupil

A

CN III pathology

75
Q

what may cause fixed pin point pupils

A

opiate drugs

76
Q

describe the path of the pupillary light reflex

A

bright light is shone into eye and this interpretation is taken by optic nerve to ipsilateral pretectal nucleus in the brain
stimulates BOTH edinger westphal nuclei in the midbrain
CN III carries motor function to pupils to cause bilateral constriction in stimulated and consensual eye

77
Q

describe lens accommodation in far vision

A

parasympathetic innervation causes relaxation of the ciliary body to lead to tightening of the suspensory ligaments and flattening of the lens to accommodate farther light as it requires less refraction

78
Q

describe lens accommodation in close vision

A

sympathetic innervation causes contraction of the ciliary body leading to slackening of suspensory ligaments and the rounding of the lens
this leads to more accommodation of closer objects in vision as they require more refraction

79
Q

what are the function of basal tears

A

corneal health
cleans/nourishes and hydrates cornea
contains lysozyme

80
Q

what are the function of reflex tears and what are the afferent/efferent nerves controlling

A

extra tears in response to mechanical/chemical stimuli
afferent is CN V1
efferent is facial VII

81
Q

what are the types of tears

A

reflex
basal
emotional

82
Q

describe reflex lacrimation in response to ANS innervation

A

parasympathetic
facial nerve carries APs through internal acoustic meatus
passes through synapse with geniculate ganglion and branch that goes through pterygoid canal to enter pterygopalentine ganglion
joins with CN V1/2- these dont have lacrimal innervation

83
Q

what provides sensory supply to dura mater

A

trigeminal nerve

84
Q

what sinuses are enclosed in the dura mater

A

dural venous sinuses

85
Q

what is found in the subarachnoid space

A

CSF and blood vessels

86
Q

where is the subarachnoid space accessed in a lumbar puncture and when does it end

A

L3/4 or L4/5

S2

87
Q

describe CSF production and circulation in the brain

A

produced in choroid plexus in lateral and third ventricles
passes from R/L lateral ventricles to midline third
then through cerebral aqueduct to 4th
then subarachnoid space and central canal
reabsorbed by subarachnoid granulations into dural venous sinuses

88
Q

what is the monro-kellie hypothesis

A

describes how pressure within the intracranial cavity must remain constant

89
Q

what may cause raised ICP

A

any condition causing swelling of the brain or increased pressure surrounding the brain

90
Q

true/false - most patients with raised ICP have visual problems

A

true

91
Q

what does ICP normally sit around and what level requires intervention

A

5-15

>20

92
Q

what is papilloedema

A

raised ICP causing compression on the optic tracts/nerves

this leads to bulging/swelling of optic disk as well as compression of the central artery/vein of the retina

93
Q

visual symptoms associated with papilloedema

A

transient visual obscuration
flickering
blurred vision
decreased colour perception

94
Q

what are the dura septae and why are they clinically relevant in raised ICP

A

brain can herniate through these folds of dura mater in raised ICP and cause cord compression or cranial nerve compression/stretch

95
Q

what may raised ICP do to CN III and how may this present

A

compression/stretch oculomotor if medial lobe herniates through temporal notch
paralysis of sphincter pupillae
slow/lost pupillary light reflex, dilated pupil, ptosis, inferolaterally turned eyelid

96
Q

what may raised ICP do to CN IV and how may this present

A

prone to trauma as winds around midbrain and stem
paralysis of SO so eye cannot move inferomedially
diplopia when looking down
eye may be more fixed upwards due to IO

97
Q

what may raised ICP do to CN VI and how may this present

A

susceptible to damage by petris ridge of temporal bone

paralysis of LR muscle so eye cannot move laterally or may be medially deviated

MB2: Ophthalmology (8 decks)

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