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Ocular Block 6 > Aqueous > Flashcards

Aqueous Flashcards

1
Q

What are the aqueous compartments

A

Anterior chamber and posterior chamber

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2
Q

What are the anterior and posterior chambers separated by

A

Iris

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3
Q

What does the iris act as

A

One way valve

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4
Q

What is the direction of the flow of aqueous

A

Unidirectional, posterior to anterior

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5
Q

Why don’t we want RBCs and protein in aqueous

A

Cloud vision

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6
Q

Jobs of the aqueous

A
  • clear fluid that pressurized the eye

- provides nutrients to avascular structures

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7
Q

What produces the aqueous

A

Ciliary body

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8
Q

Where does aqueous exit the eye

A

Iridocorneal angle

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9
Q

What is the main drainage structure of the aqueous

A

Trabecular mesh work

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10
Q

What are the avascular structures that the aqueous provides nutrients for

A

Lens
Cornea
Trabecular mesh work

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11
Q

Central boundary of the posterior chamber

A

Capsule of the crystalline lens

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12
Q

Posterior boundary of the posterior chamber

A

Anterior hyaloid face of the vitreous body

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13
Q

Peripheral boundary of the posterior chamber

A

Non-pigmented ciliary epithelium of ciliary body

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14
Q

Anteiror border of hte posteiror chamber

A

Posterior pigment layer of the iris

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15
Q

Why does the aqueous not pass through the iris

A

Because of tight junctions between posteiror pigment epithelium of iris

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16
Q

Volume of aqueous in the posterior chamber

A

50 to 65 microliters

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17
Q

What are the 3 sub compartments of the posteiror chamber

A
  1. Retrozonular
  2. Zonular
  3. Pre zonular
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18
Q

This is the space between the posteiror zonules and anteiror hylaoid face of the vitreous body

A

Retro zonular compartment of the posteiror chamber

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19
Q

This is the space between anterior and posterior zonules

A

Zonular compartment of the posterior chamber

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20
Q

This is the space between posterior pigment epithelium of iris and anterior zonules

A

Pre zonular compartment of the posterior chamber

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21
Q

Posterior (central) boundary of the anterior chamber

A

Pupil and capsule of lens

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22
Q

Posteiror (peripheral ) boundary of the anterior chamber

A

Anterior border layer of the iris

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23
Q

Anterior boundary of the anterior chamber

A

Corneal endothelium

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24
Q

Peripheral boundary of the anterior chamber

A

Iridocorneal angle

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25
Q

Volume of aqueous in the anterior chamber

A

200-250 microliters

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26
Q

Depth of the anterior chamber

A

3.6mm to 2.7mm with age

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27
Q

Angle formed in the periphery of the anterior chamber by the fusing of the ideal tunic and fibrous Tunic

A

Iridocorneal angle (anterior chamber angle)

The longitudinal bundle of the ciliary muscle (Bruch’s) attached to the scleral spur

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28
Q

Iridocorneal angle from inferior to superior

A
  • iris root
  • ciliary body band
  • scleral spur
  • trabecular meshwork
  • schwalbes line

I cant see this shit

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29
Q

Anterior chamber volume

A

200-250

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30
Q

Posterior chamber volume

A

50-65

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31
Q

Aqueous humor is secreted at a rate of _________

A

2.5ul per minute

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32
Q

Volume of aqueous compartment turned over every ____________

A

100 minutes

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33
Q

What terminates at the schwalbes line

A

Decemets membrane

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34
Q

Inserts into the anterior face of the ciliary body

A

Iris root

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35
Q

Thinnest part of iris

A

Iris root

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36
Q

What is thin and susceptible to traumatic injury (iridodialysis)

A

Iris root

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37
Q

Widest band visible in the iridocorneal angle

A

Ciliary body band

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38
Q

What color does the ciliary body band appear

A

Brownish/grey

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39
Q

What’s the difference between the epithelium of the ciliary body in the posteiror chamber vs the anterior chamber

A

The ciliary body in the anterior chamber has no epithelium lining. Aqueous cannot pass through here

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40
Q

Internal projection of the sclera

A

Scleral spur

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41
Q

Provides attachment for longitudinal bundle of ciliary muscle and provides attachment for base of trabecular meshwork

A

Scleral spur

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42
Q

How might contraction or relaxation of the ciliary muscle affect aqueous outflow

A

Scleral spur pulled during accommodation, effects flow of aqueous, IOP fluctuates

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43
Q

Sits within the interval scleral sulcus above the scleral spur

A

Trabecular meshwork

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44
Q

The filtration apparatus that proves the main resistance to keep the eye pressurized

A

Trabecular meshwork

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45
Q

90% of aqueous humor outflow

A

Trabecular meshwork

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46
Q

What is the gate keeper to Schlemm’s Canal

A

Trabecular meshwork

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47
Q

Resistance to aqueous outflow becomes too high in

A

POAG

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48
Q

Too much resistance does what to IOP

A

Increases

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49
Q

Peripheral termination of Descemet’s membrane

A

Schwalbes line

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50
Q

Most superior structure in the iridocorneal angle

A

Schwalbes line

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51
Q

What color does schwalbes line appear

A

Glossy whitish color

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52
Q

Where does the other 10% of aqueous humor leave the iridocorneal angle

A

Iris root/ciliary body band

53
Q

If outflow of the aqueous humor is impeded

A

The pressure in the eye will go up and may damage retinal ganglion cells (glaucoma)

54
Q

What can cause enhanced resistance to aqueous humor drainage through the trabecular meshwork

A
  • build up of pigment or other things
  • chronic corticosteroid use
  • elevated episcleral venous pressure
  • narrow angles
  • pupillary dilation
  • relative pupillary block
  • peripheral anterior synechiae
  • POAG
55
Q

Slit lamp and the iridocorneal angle

A

You cant see the anatomy of the iridocorneal angle with a slit lamp alone, but you can assess peripheral depth of anterior chamber using van Herrick technique

56
Q

What does a grade one VH mean

A

Closed angle (1:<1/4)

57
Q

What does a VH grade 4 mean

A

Open angle (1:1)

58
Q

Can van herrick replace gonioscopy?

A

No

59
Q

What side of the eye do you assess van herrick technique

A

Usually temporally

60
Q

Other than van herrick what else can you use to check angle

A

Goniolens

61
Q

What structure must remain visible when checking angle

A

Trabecular meshwork

62
Q

Why cant aqueous pass through iris

A

It’s a 1 way valve

63
Q

Angle closure caused by relative pupillary block

A

Resistance to movement of aqueous humor from the posterior chamber to the anterior chamber can cause pressure in PC to elevate and push the iris root to impede flow through the TM

64
Q

What is the difference between laser iridotomy and surgical iridectomy

A

Iridotomy the laser just puts a small hole in the iris

Iridectomy takes out a whole wedge

65
Q

Posterior synechiae

A

Iris is stuck to lens, adhesion can block flow. Need to be broken with atropine

66
Q

Dark room provocative test

A

Checking angles in dim light so iris bunches up, this can block angle so you wanna check it

67
Q

Iris cyst

A

Can block flow

68
Q

Neovascularization of TM

A

Can cause increased resistance

69
Q

Peripheral anterior synechia

A

Iris to cornea

70
Q

Basal infoldings

A
  • Na/K ATPase pumps
  • aqueous pumps
  • increased surface area for secretion
71
Q

What is aqueous humor derived from

A

Ultrafilatrate of blood

72
Q

Aqueous contains ______% of protein content of blood plasma

A

Less than 1%

73
Q

Why does aqueous contain so little protein

A

Protein causes light scatter and would be detrminetnal to the eyes optical system

74
Q

What are the two steps in formation of aqueous humor

A
  1. Ciliary body microvasculature: elaboration of a plasma filtrate
  2. Ciliary epithelium: formation of aqueous humor from plasma filtrate
75
Q

What forms the major arterial circle of hte iris

A

Long posterior ciliary arteries and anterior ciliary arteries

76
Q

Anterior arterioles supply what

A

Stroma

77
Q

Posterior arterioles supply what

A

Ciliary muscle

78
Q

What capillaries are fenestrated?

A

Caps from the anterior arterioles are fenestrated and leak plasma protein, fluids, and ions into the ciliary stroma. They are leaky because the endothelial cells lining the caps lack tight junctions

Caps from the posterior arterioles are non-fenestrated

79
Q

What is the first step in aqueous production

A

Fenestrated caps in the anteiror arterioles leak stuff into the stroma

80
Q

How do ions flow from into the stroma

A

From pigmented into non pigmented into stroma into PC.

Tight junctions prevent aqueous from going back in

81
Q

What is the blood aqueous barrier

A

Tight junctions in the ciliary epithelium don’t allow aqueous to come back in

82
Q

What is the second step of aqueous production

A

Formation of aqueous humor from plasma filtrate
-ions from filtrate actively transported into the pigmented ciliary epithelium and move to the nonpigmented ciliary epithelium via gap junctions

Ions pumped into intercellular clefts between cells of the NPE

Presence of these ions in the cleft draws water out into the cleft

83
Q

What is the blood aqueous barrier

A

Tight junctions between the NPE cells restrict flow towards the PC

84
Q

What happens in the blood aqueous barrier breaks down

A

Proteins from stroma into PC. Inflammatory cells

85
Q

What happens if gap junction are unable to communicate with adjacent cells

A

Decrease production, IOP decreases. Uveitis usually has a drop in IOP

86
Q

What is found along the basal infoldings of the ciliary epithelium

A

Na-K ATPase and carbonic anhydrase

87
Q

What is a method used to decrease aqueous production in glaucoma therapy

A

Carbonic anhydrase inhibition

88
Q

Protein content in the aqueous humor of PC

A

0%

89
Q

Protein content in the aqueous humor of the AC is

A

1%

90
Q

What chamber actually has protein in the aqueous

A

AC

91
Q

Convective flow current

A

Aqueous enters the anterior chamber and immediately rises near the iris due to the warm iris vasculature and falls near the cooler corneal endothelium

92
Q

Pigment from iris pigment epithelium deposits in a ________ on the corneal endothelium

A

Vertical line

93
Q

What is the vertical line that falls on the corneal endothelium called

A

Kruckenbergs spindle

94
Q

What does the vertical spindle fall that way

A

Caused by settling of pigment as it falls on the cooler corneal endothelium

95
Q

What is the blood aqueous barrier

A

Tight junctions between non pigmented ciliary epithelium

96
Q

Where else does the blood aqueous barrier exist

A

Iris

97
Q

What can peripheral iridotomy result in

A

Cataract

98
Q

What are the two pathways of egression of aqueous outflow

A

Conventional (TM) or unconventional (uveosleral)

99
Q

What path does 90% of the aqueous outflow take

A

trabecular meshwork

100
Q

Flow through the meshwork is ____ dependent

A

Pressure
-must be high enough to push through trabecular meshwork to reach schlemms canal. If resistance is too high, IOP elevates, glaucaom

101
Q

Where does the TM sit

A

Internal scleral sulcus

102
Q

Where does the base of the TM attach

A

Scleral spur

103
Q

Where does the apex sit of the TM

A

Schwalbes line

104
Q

What extends into the TM

A

Longitudinal fibers of ciliary muscle

105
Q

Self cleaning filter containing phagocytes

A

TM

106
Q

What is in the apex of the TM

A

Stem cell niche

107
Q

What is the non filtering portion of the TM

A

Apex

Because it is above schlemms canal

108
Q

What portion of the TM filters

A

Base

109
Q

What is the TM divided into

A

Uveal and corneoscleral meshwork

110
Q

Iris process

A

Reach up into and merge with the trabecular beams of the uveal meshwork. Iris processes do not impede aqueous outflow

111
Q

What part of the TM faces the AC

A

Uveal meshwork

112
Q

Netlike structure with openings, beams composed of collagen and elastin surrounded by endothelial cells that are continuous with corneal endothelium

A

Uveal meshwork

-very versatile, maintain TM

113
Q

Deep to uveal meshwork

A

Corneoscleral meshwork

114
Q

Flat perforated sheets, channels become progressively smaller deeper into the tissue

A

Corneoscleral meshwork

115
Q

Innerwall of schlemms canal

A

Juxtacanaliuclar connective tissue

116
Q

Situated between corneoscleral meshwork and inner wall endothelium of schlemms canal

A

Juxtacanalicular connective tissue

117
Q

Amorphous, contains fibroblasts cells, extracellular matric material, and elastic-like fibers

A

Juxtacanalicular CT

118
Q

Provides bulk of aqueous humor resistance

A

Juxtacanalicular CT

119
Q

Where is schlemms canal located

A

Outermost part of internal scleral sulcus

120
Q

Outer wall of schlemms canal sontains channels that drain through the _______ via venous plexi

A

Scleral

121
Q

During accommodation, the scleral spur

A

Moves posteriorly and enhances flow across the entire TM by opening up flow channels which increases the effective filtration area

122
Q

Plaque

A

Increased IOP

123
Q

Uveoscleral outflow during accommodation

A

Decreased outflow

124
Q

Pressure and uveoscleral outflow pathway

A

Pressure independent

125
Q

Pathway of uveoscleral outflow

A
  • aqueous humor enters ciliary body band and iris root
  • passes between the bundles of muscle fibers of the ciliary body to enter hte supracilaory space
  • from the supraciloary space the aqueous is pumped through the sclera and to the episclera
126
Q

Drugs to suppress aqueous humor formation

A

-carbonic anhydrase inhibitors (diamox), alphagan A2 agonist

127
Q

Drugs to enhance outflow through trabecular pathway

A

ROCK inhibitors

Pilocarpine

128
Q

Drugs that enhance outflow through the uveoscleral pathway

A

Prostaglandin analogs (Xalatan)

Ocular Block 6 (7 decks)

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