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Ophthalmology > Anatomy: Autonomic Pathways and Eye Reflexes > Flashcards

Anatomy: Autonomic Pathways and Eye Reflexes Flashcards

1
Q

Organs in the head and neck with autonomic innervation

A

Skin
Eyes
Lacrimal Glands
Saliva Glands

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2
Q

Skin Autonomic Innervation

A

Sympathetic innervation of arteriole, sweat glands and arrestor muscles

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3
Q

Eyes autonomic innervation

A

Smooth muscle of iris (pupil diameter)

Smooth muscle of the ciliary body associated with the lens (focussing)

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4
Q

Lacrimal Glands Autonomic Innervation

A

Lacrimal fluid production

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5
Q

Saliva Glands autonomic innervation

A

Saliva production

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6
Q

Sympathetic innervation: route

A

originates from autonomic centres in the brain.
passes down spinal cord
Exits spinal cord with T1-L2 region (thoracolumbar outflow)
Travel to sympathetic chains running length of vertebral column
Pass into all spinal nerves (anterior and posterior rami)
Pass into splanchnic nerves to eventually supply organs

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7
Q

Presynaptic sympathetic axons from CNS

A

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

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8
Q

Post-synaptic sympathetic axons

A

Enter internal and external carotid arteries.
Carried to the organs of the head on the surface of the branches of these arteries
ophthalmic artery carries sympathetic axons into the orbit.

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9
Q

Parasympathetic Axons exit CNS

A

Leave the CNS via cranial nerves III, VII, IX and X and sacral spinal nerves

Craniosacral outflow

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10
Q

Parasympathetic Supply

A

Internal organs, not body wall

In head
- eye, lacrimal gland and salivary glands

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11
Q

Vagus nerve

A

Supples organs of the neck, chest, abdomen as far as the midgut

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12
Q

Sacral spinal nerves

A

Carry parasympathetic axons to the handout, pelvis and perineums

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13
Q

Ciliary ganglion

A

parasympathetic ganglion
Located in bony orbit
Fibres from CN III

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14
Q

Cranial nerve III

A

Oculomotor
Connects with CNS at junction of midbrain and pons
passes through cavernous sinus
Exits via superior orbital issues

Somatic motor to majority of extra ocular muscles

presynaptic parasympathetic axons to the ciliary ganglion

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15
Q

Sensory innervation: face

A 
CN V1 (ophthalmic nerve) 
CN V2 (maxillary nerve)  
CN V3 (mandibular nerve)
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16
Q

CN V1 innervates

A

Upper eyelid
Cornea
Conjunctiva

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17
Q

CN V2 innervates

A

Skin of lower eyelid

Skin over the maxilla

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18
Q

CN V3 innervates

A

Skin over mandible and TMJ (except angle of mandible)

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19
Q

Corneal Reflex

A

Blink

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20
Q

Corneal Reflex Afferent Limb

A

Sensory (afferent) limb

Action potentials conducted from cornea via CN V1 branches to trigeminal ganglion.
Then along CN V to pons

21
Q

Corneal Reflex Efferent Limb

A

Motor (Efferent) limb

Action potentials conducted via CN VII to eyelid part of orbiculares oculi

22
Q

Autonomic Reflexes of Eye (5)

A 
Wide eye opening of fight or flight
Pupillary light reflex 
Accommodation Reflex 
Vestibula-ocular reflex 
Oculocardiac Reflex
23
Q

Vestibule-ocular reflex

A

Turns the eye in the opposite direction to a head movement

Stabilizes gaze on an object during head movement

24
Q

Vestibule-ocular reflex Cranial nerves

A

CNS connections between CN VIII and CN III, IV and VI

25
Q

Oculocardiac Reflex

A

Reflex bradycardia in response to tension on extra ocular muscles or pressure on eye

26
Q

Oculocardiac Reflex cranial nerves

A

CNS connections between CN VI and CN X

27
Q

Wide Eye Opening Reflex

A

Levator palpebrae superioris (controlled by CN III)

  • Contains skeletal muscle plus smooth muscle
  • Muellers muscle
28
Q

Muellers Muscle

A

used during wide eye opening reflex to elevate the eyelid by a further 2cm under sympathetic innervation

29
Q

Postsynaptic sympathetic fibres travel via… (4)

A

Superior cervical sympathetic ganglion

internal carotid nerve

internal carotid plexus

Axons carried on ophthalmic artery and on its branches to orbital structures

30
Q

Pupillary Constriction

A

Parasympathetic constrict the pupil
- in bright light and ‘rest and digest’

Sphincter pupilae fibres encircle pupil around the internal circumference of iris

31
Q

Miotic pupil

A

non-physiologically constricted pupil

e.g. components off Horner’s syndrome

32
Q

Fixed ‘pin point’ pupil

A

Often a serious pathological sign

e.g. opiate drugs

33
Q

Fixed ‘dilated’ pupil

A

also called a blown pupil
often a serious pathological sign

E.g. CN III pathology

34
Q

Pupillary dilation

A

Sympathetic innervation dilates the pupil

35
Q

Mydriatic pupil

A

Non-physiologically enlarged pupil

e.g. mydriatic drugs induce dilation of pupil

36
Q

Dilator Papillar Fibres arrangment

A

Radially arranged

Originate around the external circumference of iris - fixed

insert around the internal circumference of iris -mobile

37
Q

pupillary light reflex

A

Special sensory (afferent) limb of the reflex is the ipsilateral CN II (optic)

CNS connections occur in the midbrain

Motor (efferent) limb of the reflex is bilateral via CN III

38
Q

Light reflex- bilateral

A

Direct light reflex occurs in the stimulated eye

Consensual light reflex occurs in the. non-stimulated eye

39
Q

Pupillary Light Reflex Neurones

A 
1st neurones 
2nd Neurones (bilateral) 
3rd neurones (bilateral) 
4th neurones (bilateral
40
Q

Lens Accommodation Reflex

A

Suspensory ligament of lens connects the circumferences of the lens and the ciliary body

41
Q

Ciliary body

A

Muscular and vascular

Smooth muscle like a sphincter around circumference

42
Q

Ciliary muscle- ‘far vision’

A

Relaxes
- no parasympathetics

Ligaments tighten and lens flattens to focus on an object in the distance

43
Q

Ciliary muscle - ‘near vision’

A

Contracts
-parasynmpathetic

Ligament relaxes and lens become spherical to focus on near objects

44
Q

Clinical assessing components of accommodation reflex (3)

A

Bilateral pupillary constriction
- parasympathetic constriction of sphincter pupillae

Bilateral convergence of both eyes towards midline
- medial rectus

Bilateral relaxation of lens
- lens becomes spherical due to contraction of ciliary muscles

45
Q

Cranial nerve for lens accommodation. reflex

A

CN III (oculomotor)

46
Q

Lacrimation (3)

A

basal tears
Reflex tears
Emotional tears

47
Q

basal tears

A

Corneal health
Clean/nourish and hydrate vascular cornea
Contains lysozyme 9hydrolyses bacterial cell walls)

48
Q

Reflex tears

A

Extra tears in response to mechanical or chemical stimulation

Afferent limb in Cn V1 from cornea/ conjunctiva

Efferent limb is psaarasympathetic axons originating from CN VII

49
Q

Emotional tears

A

happy, sad or frightened

Ophthalmology (8 decks)

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