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Opthalmology > Anatomy- Reflexes > Flashcards

Anatomy- Reflexes Flashcards

1
Q

what supplies the sensory innervation of the face

A

trigeminal nerve CN V (ophthalmic, maxillary, mandibular)

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2
Q

what does the ophthalamic nerve supply

A

forehead, upper eyelid, cornea, conjunctiva, skin of the root/bridge/ tip of the nose

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3
Q

what does the maxillary nerve supply

A

skin of the lower eyelid and maxilla, skin of the ala of the nose, skin/mucosa of the upper lip

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4
Q

what does the mandibular nerve supply

A

skin over the mandible, and TMJ

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5
Q

what supplies the sensory innervation of the angle of the mandible

A

C2,3 spinal nerves

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6
Q

what is the sensory (afferent) limb of the blink/corneal reflex

A

action potentials conducted from cornea via CN V1 (ophthamlic) branches to trigeminal ganglion then along CN V to pons

connections there to CN VII (facial nerve)

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7
Q

what is the motor (efferent limb) of the blink/corneal reflex

A

action potentials conducted via CN VII to eyelid part of orbicularis oculi

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8
Q

where do sympathetic axons leave the spinal chord

A

between T1 and L2 - thoracocolumbar outflow

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9
Q

how do sympathetic axons reach organs

A

via splanchnic nerves

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10
Q

how do sympathetic axons reach the sympathetic chains

A

spinal nerves

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11
Q

how do sympathetic axons reach the eyes

A

pre synaptic:

exit at T1 spinal nerve

ascend sympathetic trunk

synapse in superior cervical sympathetic ganglion

post synaptic:

enter internal and external carotid nerves

pass onto surface of the internal and external carotid arteries (form a plexus)

carried to organs and into the orbit

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12
Q

where do all parasympathetic axons leave the spinal chord

A

via cranial nerves III, VII, IX, and X
and
via sacral spinal nerves

craniosacral outflow

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13
Q

what supplies the parasympathetics to the organs of the neck, chest and abdomen as far as the mid-gut

A

vagus

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14
Q

where to parasympathetics in the sacral spinal nerves go

A

to the hindgut, pelvis and perineum

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15
Q

what ganglion do parasympathetic axons go through to get to the eye and ciliary muscles

A

ciliary ganglion

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16
Q

what ganglion do parasympathetic axons go through to get to the lacrimal gland, nasal, palatine and pharyngeal gland

A

pterygopalatine ganglion

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17
Q

where does the CNIII (oculomotor) nerve join with the CNS

A

at junction between midline and pons

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18
Q

what sinus does the oculomotor nerve go through

A

cavernous sinus

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19
Q

where does the oculomotor nerve exit the cranial cavity

A

via superior orbital fissue (where it enters the orbit)

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20
Q

what does the oculomotor supply somatic motor innervation to

A

superior, medial and inferior rectus
inferior oblique
levator palpebrae superioris
ciliary glanglion (sphincter papillae and cilliary muscles)

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21
Q

what does the superior division of oculomotor nerve supply

A

superior rectus and LPS

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22
Q

what does the inferior division of oculomotor nerve supply

A

MR, IR, IO, and cilairy ganglion

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23
Q

what do the ciliary nerves supply

A

automonic axons to control diameter of iris and refractive shape of the lens

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24
Q

what types of fibres are in the long ciliary nerves

A

sympathetic and somatic sensory

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25
Q

what types of fibres are in the short ciliary nerves

A

sympathetic, parasympathetic, somatic sensory fibres

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26
Q

what nerves form the first part of the blink reflex

A

the long ciliary nerves

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27
Q

what are the autonomic reflexes of the eye

A

maximal eyelid elevation in fight or flight

pupillary dilation/ constriction to adjust to light

focussing lens far and near vision: accommodation reflex

lacrimation reflex tear production

vestibulo-ocular reflex

oculocardiac reflex

28
Q

what is the vestibulo ocular reflex

A

turns the eyes in the opposite direction to the head to stabilise gaze

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

29
Q

what is the oculocardiac reflex

A

reflex bradycardia in response to tension on extraocular muscles or pressure on eye

CNS connection between CN V1 (ophthalamic) and CN X

30
Q

what are the sympathetic functions of the eye

A

opens eyes wider

gets more light into eyes

focus on far objects

emotional lacrimation

31
Q

what are the parasympathetic functions of the eye

A

gets less light into eyes

focus on near objects

reflex lacrimation

(allow obricularis oculi to work - more somator motor)

32
Q

what types of muscle in levator palpebrae superioris

A

skeletal and smooth (F or F) muscle

33
Q

how do postsynaptic sympathetic fibres reach levator palpebrae superioris

A

superior cervical sympathetic ganglion

internal carotid nerve

internal carotid plexus

axons carried on the ophthalmic artery…

and on its branches to the orbital structures

34
Q

how does sympathetics affect the pupil

A

dilate it- in dim light and in fight or flight/ the sick patient

35
Q

what is a mydriatic pupil

A

non physiologically enlarged pupil

36
Q

what do mydriatic drugs do

A

induce dilation of the pupil

37
Q

what dilates the pupil

A

dilator pupillae muscle fibres

38
Q

describe the arrangement of dilator pupillae fibres

A

radially arranged
originate around the external circumference of iris (fixed)
insert around the internal circumference of iris (mobile)

39
Q

how does parasympathetics affect the pupil

A

constrict the pupil

in bright light and rest an digest

40
Q

what is a miotic pupil

A

non physiologically constricted pupil (seen in horners syndrome)

41
Q

what is a fixed pin point pupil a sign of

A

serious- e.g. opiate drugs

42
Q

what is a fixed dilated pupil a sign of

A

serious- e.g. CN III pathology

43
Q

what constricts the pupil

A

sphuncter pupillae fibres encircle pupil

44
Q

where are sphincter pupillae fibres

A

around the internal circumference of the eye

45
Q

what is the sensory afferent limb of the pupillary light reflex

A

ipsilateral CN II - optic nerve

CNS connection occurs in midbrain

46
Q

what is the motor efferent limb of the pupillary light reflex

A

bilateral CN III- oculomotor nerves

47
Q

why in the pupillary light reflex is the afferent on one side and efferent on both sides

A

so a torch shone in one eye will cause a consensual light reflex in the non stimulated eye

48
Q

what are the 4 neurones chains in the pupillary light reflex

A

1st- retinal ganglion- optic nerve- optic chiasm- synapse in pretectal nucleus in midbrain

2nd- (bilateral) midbrain- pretetcal nucleus- synapse again in Edinger westphal nucleus

3rd- (bilateral) EW nucleus- CN III- CN III inferior division- synapse in ciliary ganglion

4th- (bilateral) short ciliary nerves- sphincter pupillae muscles

49
Q

what is significant about the Edinger Westphal nucleus

A

location of the cell bodies of the parasympathetic axons of CN III

50
Q

what does the suspensory ligament of the lens do

A

connects the circumference of the lens and the ciliary body

51
Q

describe the ciliary body

A

muscular and vascular, sphincter around a circumference

52
Q

in what vision does the ciliary muscle relax

A

far - makes ligament tighten to focus on an object in the distance

53
Q

when does the ciliary body contract

A

in near vision- relaxes the ligament which makes the lens become spherical to focus on near objects

54
Q

what innervation controls the constriction of the ciliary muscle

A

parasympathetic

55
Q

what innervation controls the relaxation of the ciliary muscle

A

happens when there is no parasympathetic actions

56
Q

what are the 3 aspects of the accommodation reflex

A

bilateral pupillary constriction (CN III)

bilateral convergence (medial rotation of both eyes CN III)

bilateral relaxation of the lens (CN III)

57
Q

in the accommodation reflex what is the purpose of bilateral pupillary constriction

A

to prevent diverging light rays from hitting the periphery of the retina and resulting in a blurred image.
Reduces amount of light that get into eye, only focused ray of light get in

58
Q

in the accommodation reflex what is the purpose of bilateral convergence

A

simultaneous movement of both eyes in opposite directions to obtain or maintain single binocular vision
(Cross eyes)

59
Q

in the accommodation reflex what happens in bilateral relaxation of the lens

A

lens become spherical due to the contraction of the ciliary muscles

60
Q

what is the role of basal tears

A

important in cornea (avascular) health- clean, nourish and hydrate

contain lysozyme (hydrolyses bacterial cell walls)

61
Q

what is the role of reflex tears

A

extra tears in response to mechanical or chemical stimulation

62
Q

what are the afferent and efferent limbs of the reflex tears reflex

A

afferent limb is CN V1 from cornea/conjunctiva

efferent limb is parasympathetic axons originating from CN VII

63
Q

what nerves carries parasympathetic axons for the lacrimal gland

A

CN VII

then branches of V2 then V1

64
Q

what nerves does facial expression

A

CN VII somatic

65
Q

what are the symptoms of horners syndrome (ipsilateral)

A

miosis
ptosis
reduced sweating (annhydrosis)
increased warmth and redness

66
Q

what causes horners syndrome

A

Impaired sympathetic innervation to head and neck-
compression of the cervical parts of the sympathetic trunk:
- root of neck trauma
- carotid dissection
- internal jugular vein engorgement
- deep cervical node metastases
- pancoast tumour (lung apex)

Opthalmology (16 decks)

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