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NeuroEndo Test 1 > Eye and Eye Movement > Flashcards

Eye and Eye Movement Flashcards

1
Q

What bones make up the orbit?

A 
Maxillary
Frontal
Zygomatic
Ethmoid
Lacrimal
Sphenoid
Palantine

Many Friendly Zebras Enjoy Lazy Summer Picnics

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2
Q

What foramina are found in the orbit?

A

Superior orbital fissure
Optic Canal
Inferior orbital fissure

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3
Q

What are the relationship between the sinuses?

A 
Frontal= superior medial
Ethmoid= medial
Maxillary= inferior
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4
Q

What happens if you have chronic infections in the ethmoid sinus?

A

Erode into the orbit and cause optic neuritis

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5
Q

What is an orbital blow out fracture? What bones are normally involved? What are symptoms

A

Fracture of the orbital walls

Medially and inferiorly involving maxillary bone because those are the weak areas
- orbital contents can prolapse and become entrapped in maxillary

Dipolia, globe ptosis, exopthalmos

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6
Q

Which muscles of the eye are not innervated by the oculomotor nerve? Which nerves are they innervated by instead?

A

Lateral rectus m. - abducens n.

Superior oblique m. - trochlear n.

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7
Q

What nerve closes the eye? What nerve opens the eye?

A 
Close= facial n.
Open= occulomotor n.
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8
Q

What is the origin, insertion, innervation, and main action of the levator palperbrae superioris?

A

Sphenoid
Superior eyelid
Occulomotor n.
Elevate superior eyelid

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9
Q

What is the origin, insertion innervation, and main action of the Superior oblique muscle?

A

Sphenoid
Goes through trochlea and attaches on sclera
Trochlear n.
ABducts, depresses, and medially rotates

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10
Q

What is the origin, insertion innervation, and main action of the inferior oblique m.?

A

Anterior floor of orbit
Sclera (goes ant –> post)
Oculomotor N,
ABducts elevate and laterally rotates

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11
Q

What is the origin, insertion innervation, and main action of the superior rectus m.?

A

common tendinous ring
sclera
oculomotor n.
elevate, aDduct, medially rotate

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12
Q

What is the origin, insertion innervation, and main action of the inferior rectus

A

common tendinous ring
sclera
Depress, aDducts, laterally rotate

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13
Q

What is the origin, insertion innervation, and main action of the medial rectus?

A

Common tendinous ring
Sclera
Oculomotor n.
ADduct

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14
Q

What is the origin, insertion innervation, and main action of the lateral rectus?

A

common tendinous ring
sclera
Abducent n.
ABduct

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15
Q

How do you test the extraocular muscles?

A

H-test

Need to trap one muscle to test other by changing the gaze axis. If muscle perpendicular to then will be “trapped”

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16
Q

How do you test the superior rectus muscle?

A

Have patient aBduct eye (gaze angle 23 degrees) –> inferior oblique trapped so only test elevation

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17
Q

How do you test the inferior rectus?

A

Have patient aBduct eye (gaze angle 23 degrees) –> superior oblique trapped so only test depression

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18
Q

How do you test the superior oblique m.?

A

Have patient aDduct eye (gaze angle 51 degrees) –> trap inf. rectus m. –> testing depression only

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19
Q

How do you test the inferior oblique m.?

A

Have patient aDduct eye (gaze angle 51) –> trap superior rectus –> test elevation only

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20
Q

What does the frontal n. branch into in the orbit? Where does the frontal n. come from?

A

supratrochlear (more medial)
Supraorbital

V1 ophthalmic n.

21
Q

Besides the frontal nerve what else branches from V1 in the orbit?

A

nasocilliary n. medially

lacrimal n. laterally

22
Q

What branches form the sensory root of the ciliary ganglion? What kind of fibers does it carry?

A

Short ciliary n.
Carries parasympathetic and sympathetic
Sensory to the cornea

23
Q

What are the branches of the nasociliary n.?

A

Long ciliary n.
Posterior and anterior ethmoidal n. (goes into nasal cavity, anterior is superior)
Infratrochlear (sensory to nose)

24
Q

What nerves are found in the lateral wall of the cavernous sinus?

A

Oculomotor n.

ABducent n.

25
Q

What nerves go through the tendentious ring and superior orbital fissure?

A

Oculomotor superior division
Nasocilliary
Abducent
Oculomotor n. inferior division

26
Q

What nerves go through just the superior orbital fissure and not the tendentious ring?

A

Trochlear n.
Frontal n.
Lacrimal n.

27
Q

What do the parasympathetic fibers travel with to the eye? What muscles do they effect?

A

Oculomotor n.

Sphincter pupillae
Ciliary m.

28
Q

What nerve do sympathetics of the eye run with?

A

Nasocilliary

Dilator pupillae
Superior and inferior tarsal muscles

29
Q

What is Horner’s syndrome? What is the symptoms?

A

Compression of the sympathetic trunk or cervical ganglion

Drooping of superior eyelid (ptosis)
Absence of sweating (anhydrosis)
Constriction of pupil (miosis)
Redeness and increased skin temperature (vasodilation)

“HORNy PAM”

30
Q

What is the pupillary light reflex? (4 steps)

A
  1. Light sensed by CN II and will synapse in the pretectal nucleus
  2. Cells from pretectal nucleus will synapse in Edinger-Westphal nucleus
  3. Preganglionic parasympathetic neurons will travel with CN III and will synapse in the siliary ganglion
  4. Postganglionic parasympathetic neurons will synapse in the pupillary constrictor muscle

SENSORY AND MOTOR COMPONENT

31
Q

What is the corneal reflex? (3 steps)

A
  1. Receptors in corneal detect touch or irritation and travel in CN V and synapse in Trigeminal Sensory nucleus or spinal trigeminal nuclei
  2. Cells from the trigeminal nuclei project to facial nucleus
  3. Neuron in facial nerve will cause eye to blink (facial nerve closes eye)
32
Q

If you have trochlear palsy what way does the head tilt?

A

Away from affected side

Diplopia worse on downward gaze

33
Q

If you abducens palsy what happens?

A

Cannot look laterally with the affected eye

34
Q

What causes a down and out eye?

A

Oculomotor palsy

Loss of innervation of ocular muscle except SO and LR still functioning causing down and out look

35
Q

What are symptoms of oculomotor palasy?

A

Down and out eye
Complete Ptosis= loss of innervation to levator palpebrae superiororis (scan also get from sympathetic issue)
Pupil dilation=loss of parasympathetic innervation to the pupil

36
Q

What are the 3 layers of the eye? What do they contain?

A 
Fibrous= sclera and cornea
Vascular= choroid (tiny BVs), ciliary body, and iris
Inner= retina (connected to optic n.)
37
Q

What are the 2 conjuctiva of the eye? Where do they come together at?

A 
Palperbal= lines innermost part of eyelid
Bulbar= outermost part of eyelid

Superior and inferior conjutival formix

38
Q

What two muscles keep the eyelid open? What are they innervated by?

A

Superior tarsal= sympathetic
- keeps eyelid open

Levator palpebrae superioris m. = CN III
- initially opens

39
Q

How can you get a subconjuctival hemorrhage?

A

Rupture of blood vessel between sclera and bulbar conjuctivitis due to blowing eye, pooping, throwing up etc.

40
Q

How do you get complete v. partial ptosis?

A 
Complete= CNIII issue aka levator palpebrae superioris m. 
Partial= sympathetic nerve problem, post ganglionic fibers causing paralysis of tarsal muscle (of muller)
41
Q

What causes papilledema?

A

Increased intracranial pressure

EMERGENT need to find cause of ICP, could be tumor, trauma, encephalitis, hydrocephaly

42
Q

Where does the arterial supply of the eye come from? What are the branches?

A

Internal carotid a.

Ophthalmic
Ethmoidal
Lacrimal
Central retinal a. (goes right into optic nerve 
Supratrochlear
Supra-orbital
43
Q

What does the supraorbital a. anastomose with?

A

Superficial temporal a.

44
Q

What does the supratrochlear anastomose with?

A

angular a.

45
Q

What does the lacrimal a. anastomose with?

A

middle meninges

46
Q

What does the ethmoidal as. anastomose with?

A

sphenopalatine

47
Q

How effective are the eye anastomoses?

A

When there is a slow occuluion then they can work but if it is quick than they won’t be able to compensate –> central retinal artery doesn’t get blood –> blindness

48
Q

What is the difference (imaging and cause wise) of occlusion of the central retinal vein and central retinal artery?

A

Vein= Ketchup appearance

  • hardening of the central retinal artery and hypertension can compress central vein
  • hemorrhages
  • dilated vein

Artery= pale and red spot

  • atherosclerosis or embolism
  • veins and arteries attenuated
  • cherry red spot

NeuroEndo Test 1 (14 decks)

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