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Ocular Block 5 > Cranial Nerves And Of The Eye And Orbit > Flashcards

Cranial Nerves And Of The Eye And Orbit Flashcards

1
Q

What are the CN that innervate the eye and ocular structures?

A 
CNII: optic 
CNIII: oculomotor 
CNIV: trochlear 
CNV: trigeminal: ophthalmic 
CN V: trigeminal: max
CNVI: abducens
CNVII: facial
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2
Q

Afferent pathway

A

Orbital sensory innervation

Away from target organ

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3
Q

Sensations that affect eye

A

Pain, touch, reassure, warmth, cold,

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4
Q

Sensations from the cornea, iris, conj, and sclera consist of primarily ____

A

Pain

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5
Q

Light touch of the cornea

A

Registered as irritation or pain

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6
Q

The fibers of the trigeminal nerve serving the ocular structures are _____ and originate in the innervated structures

A

Sensory

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7
Q

What is the first branch of the trigeminal nerve

A

Ophthalmic branch

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8
Q

What is the first branch of the ophthalmic nerve

A

Nasociliary N

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9
Q

Sensory fibers form the structures of the medial canthal area-caruncle, canaliculi, lacrimal sac, medial aspect of the eyelids, and skin at the side of the nose-join to form

A

Infratrochlear nerve

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10
Q

The infratrochlear nerve penetrates the orbital septum and enters the orbit where

A

Below the trochlea

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11
Q

Where does the infratrochlear nerve run before it joins the next branch

A

Along the upper border of the medial rectus muscle

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12
Q

Where does the infratrochlear nerve become the nasociliary nerve?

A

As it runs across the upper border of the medial rectus muscle and other branches join it

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13
Q

Sensory fibers from the skin along the center of the nose, the nasal mucosa, and the ethmoid sinuses form the _______

A

Anterior ethmoid nerve

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14
Q

Fibers from the ethmoid sinuses and the sphenoid sinus form the _____

A

Posterior ethmoid nerve

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15
Q

Where do the ethmoid N enter the orbit and with what

A

With their companion arteries through the foramina within the frontoethmoid suture

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16
Q

Both ethmoid nerves join the _____ as it runs along the medial aspect of the orbit

A

Nasociliary nerve

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17
Q

Corneal sensory innervation is estimated to be _____ times as dense as other epithelial tissue innervation

A

4oo times

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18
Q

Where is the corneas sensory innervation?

A

In the epithelium, anterior stroma, and mid stroma. None in posterior stroma, Decemets membrane or endothelium

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19
Q

How do the long ciliary nerves course?

A

Between the choroid and sclera to the back of the eye where they leave the globe at points appx 3mm on each side of the optic nerve

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20
Q

What makes up the nasociliary nerve

A
  • Infratrochelar
  • Anterior and posterior ethmoid
  • long ciliary nerve
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21
Q

How do the short ciliary nerves run to the back of the eye where they emerge?

A

From limbus of cornea, join other sensory nerves from ant set, enter choroid, join choroidal nerves, course to back of eye, leave as 6-10 short ciliary nerves

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22
Q

Where do the short ciliary nerves exit the sclera

A

In a ring around the optic nerve in company with the short post ciliary arteries.

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23
Q

After the short ciliary nerve leaves the back of the eye, what is the next structure that it PASSES THROUGH?

A

Ciliary ganglion, does not synapse here!

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24
Q

After the short ciliary nerves leave the ciliary ganglion, what do they join

A

Nasociliary nerves

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25
Q

What kind of fibers does the short ciliary nerve carry?

A

Symp and parasympathetic in addition to sensory

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26
Q

Structures that exit the posterior of the eyeball

A
  • vortex veins (4)
  • long ciliary arteries (2)
  • long ciliary nerves (2)
  • short ciliary arteries (many)
  • short ciliary nerves (many)
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27
Q

The nasociliary nerve is formed by the joining of..

A
  • infratrochlear nerve
  • anterior and posterior ethmoid nerves
  • long ciliary nerves
  • sensory root of ciliary ganglion
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28
Q

How does the nasociliary nerve exit the orbit?

A

Passing through the oculomotor foramen WITHIN the common tendinous ring, and the superior orbital fissure into the cranial cavity

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29
Q

Does the nasociliary nerve run inside or outside the common tendinous ring?

A

Inside

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30
Q

____ of all cases of herpes zoster (shingles) will affect the ophthalmic division of trigeminal.

A

10%

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31
Q

What indicates that the nasociliary nerve has been affected by herpes zoster via the infratrochlear nerve?

A

Rash on the side or tip of the nose

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32
Q

Why is the cornea almost always affected in herpes zoster that presents with rash on side or tip of nose?

A

Nasociliary nerve is affected via the infratrochlear nerve, thus the corneal will effected by way of the short/long ciliary nerves coming off of the nasociliary

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33
Q

What is the rash on the side/tip of nose called in herpes zoster (shingles)

A

Hutchinsons sign

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34
Q

Sensory fibers from the skin and muscles of the forehead and upper eyelid come together and form the

A

Supratrochlear nerve

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35
Q

How does the supratrochlear nerve enter the orbit

A

By piercing the superior medial corner of the orbital septum

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36
Q

Sensory fibers from the skin and muscles of the forehead and upper eyelid form a second nerve called the

A

Supraorbital nerve

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37
Q

How is the supraorbital nerve in relation to the supratrochlear nerve

A

Lateral

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38
Q

How does the supraorbital nerve enter the orbit

A

As one or two branches

-one branch enters through the supraorbital notch, accompanying the supraorbital artery

39
Q

Where does the supraorbital nerve join the supratrochlear nerve and what does it form at that point?

A

Midway in the orbit , forms frontal nerve

40
Q

How does the frontal nerve course?

A

Back through the orbit between the levator muscle and the periorbita

41
Q

How does the frontal nerve exit the orbit

A

Through the superior orbital fissure above the common tendinous ring

42
Q

Is the frontal nerve inside or outside the common tendinous ring?

A

Outside

43
Q

What is the 3rd branch of the ophthlamic division of trigeminal

A

Lacrimal nerve

44
Q

Sensory fibers from lateral aspect of the upper eyelid and temple area come together and enter the lacrimal gland. They join the sensory fibers hat serve the gland itself to form the

A

Lacrimal nerve

45
Q

How does the lacrimal nerve leave the gland and run in the orbit?

A

Runs posteriorly along the upper border of the lateral rectus muscle where it receives a branch from the zygomatic nerve containing autonomic innervation from the lacrimal gland

46
Q

Where does the lacrimal nerve exit the orbit?

A

Through the superior orbital fissure above the muscle cone

47
Q

What is the most important sensory nerve of the orbit?

A

Ophthalmic nerve

48
Q

After exiting the orbit, the nasociliary nerve, lacrimal nerve, and frontal nerve join and form the

A

Ophthalmic division of the trigeminal nerve

49
Q

After all of the nerves come together to form the ophthlamic nerve, where does it go?

A

Enters the lateral wall of the cavernous sinus where it receives sensory fibers from the oculomotor, trochlear, and abducens

50
Q

The infraorbital nerve, formed by the sensory fibers from the cheek, upper, and lower eyelid enters the maxillary bone though the

A

Infraorbital foramen

51
Q

How does the infraorbital nerve run through the maxillary bone?

A

It runs posteriorly through the infraorbital canal and groove; while it is isn the maxillary bone, branches join it from the upper teeth and maxillary sinus

52
Q

As the infraorbital nerve leaves the infraorbital groove it exits the orbit through the _____________

A

Inferior orbital fissure

53
Q

After the infraorbital nerve passes through the inferior orbital fissure what happens

A

Joins other fibers in forming the maxillary nerve

54
Q

Sensory fibers from the lateral aspect of the forehead enter the orbit through a foramen in the zygomatic bone as the ____________

A

Zygomaticotemporal nerve

55
Q

Fibers from the lateral aspect of the cheeks and lower eyelid enter the orbit through a Forman in the zygomatic bone as the __________

A

Zygomaticofacial nerve

56
Q

What do the zygomaticotemporal and zygomaticofacial nerve join to become?

A

Zygomatic nerve

57
Q

How does the zygomatic nerve course?

A

Courses along the lateral orbital wall

58
Q

How does the zygomatic nerve exit the orbit?

A

Through the inferior orbital fissure and joint with the maxillary nerve

59
Q

The maxillary nerve traverses the area between the __________

A

Maxilla and the sphenoid bone

60
Q

As the maxillary nerve passes near the pterygopalatine fossa, it receives ____

A

Some autonomic fibers from the pterygopalatine fibers from the pterygopalatine ganglion

61
Q

Where are the autonomic fibers from the pterygopalatine fossa that run through the maxillary nerve destined?

A

Lacrimal gland

62
Q

How does the maximally nerve enter the skull

A

Through the foramen rotundum

63
Q

What is the most superior nerve in the cavernous sinus

A

Oculomotor

64
Q

What is the most inferior nerve in the cavernous sinus

A

Maxillary

65
Q

What is the most medial nerve in the cavernous sinus

A

Abducens

66
Q

Order of the CN from superior to inferior in the cavernous sinus

A 
Oculomotor 
Trochlear
Abducens (medial)
Ophthalmic 
Maxillary
67
Q

What artery runs through the cavernous sinus

A

Internal carotid

68
Q

Cranial nerves that supply striated muscles of the orbit and adnexa

A

Oculomotor
Trochlear
Abducens
Facial

69
Q

How does the oculomotor nerve run in the cavernous sinus

A

Pierces the roof of the cavernous sinus and runs within the two dural layers of the its lateral wall above the trochlear nerve

70
Q

While in the cavernous sinus, the oculomotor nerve sends __________ to the ophthalmic nerve

A

Small sensory branches

71
Q

Where does the oculomotor nerve enter the orbit?

A

Through the superior orbital fissure, having divided into superior and inferior divisions

72
Q

Where are both divisions of the oculomotor nerve located

A

Within the oculomotor foramen

73
Q

How does the superior oculomotor branch run

A

Medically above the optic nerve

74
Q

After coursing with the optic nerve, how does the superior division of oculomotor go?

A

Enters the superior rectus on its inferior surface

75
Q

How does the superior oculomotor branch innervate the levator palpebrae superioris through the superior rectus?

A

Additional fibers either pierce the muscle or pass around its border to innervate the levator palpebrae superioris

76
Q

How does the inferior branch of he oculomotor run in relationship to optic nerve

A

Runs below the optic nerve and divides into three branches

77
Q

What does the first branch of the inferior oculomotor nerve do

A

Enters the medial rectus on its lateral side

78
Q

What does the second branch of the inferior oculomotor nerve do

A

Enters the inferior rectus on its upper surface

79
Q

What does the theirs branch of the inferior oculomotor nerve

A

Gives off parasympathetic fibers that form the parasympathetic root extending to the ciliary ganglion

80
Q

How does the inferior oculomotor branch run after it gives off its three branches?

A

Runs along the lateral border of the inferior rectus, crossing it to enter the inferior oblique muscle near its midpoint

81
Q

What kind of innervation is trochelar

A

Motor only

82
Q

What does the trochlear nerve innervate?

A

Superior oblique muscle

83
Q

The trochlear nerve and hte cavernous sinus

A

Enters the wall of the cavernous sinus and lies abtween the oculomotor nerve and the ophthalmic division of the trigeminal nerve

84
Q

While in the cavernous sinus, what does the trochlear nerve do

A

Sends sensory fibers to the ophthalmic nerve

85
Q

How does the trochelar nerve enter the orbit

A

Through the superior orbital fissure above the common tendinous ring OUTSIDE the muscle cone

86
Q

How does the trochlear muscle run

A

With the frontal nerve to the medial side of the orbit above the levator and superior rectus muscles and enters the upper surface of the superior oblique muscle

87
Q

Within the cavernous sinus, the abducens lies near the _____

A

Lateral wall of the internal carotid artery

88
Q

How does the abducens nerve enter the orbit?

A

Through the superior orbital fissure WITHIN the common tendinous ring

89
Q

What does the abducens nerve innervate

A

The lateral rectus muscle on the medial side

90
Q

This gives motor supply to the frontalis, procerus, corregator, and orbicularis oculi muscles

A

The temporal and zygomatic branches of the facial nerve (upper two)

91
Q

What are the roots of the facial nerve?

A

Large motor root that innervates the facial muscles and the smaller root contains sensory and parasympathetic fibers

92
Q

What do the sensory fibers of the smaller root of the facial root carry?

A

Taste sensations from tongue

93
Q

What do the parasympathetic fibers from the smaller root of the facial nerve do

A

Supple secretomotor fibers to various glands of the face including the lacrimal glands

Ocular Block 5 (8 decks)

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