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Neuro Endocrine > Eye and Eye movements > Flashcards

Eye and Eye movements Flashcards

1
Q

what bones make up the orbit and what foramina are found in the orbit

A 
frontal
ethmoid
sphenoid
zygomatic
lacrimal
maxillary

optic canal
superior orbital fissure
Inferior orbital fissure

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2
Q

What locations on the orbit are easy to fracture?

A

The lateral aspect of the orbit and the floor of the orbit due to how thin the bone is there

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3
Q

what is considered a blow out fracture of the eye and what are its symptoms?

A

indirect trauma to the orbit

usually happens medially and inferiorly into the maxillary bone

orbital contents can get entrapped in maxillary sinus

leads to Diplopia,
globe ptosis (eye sinks down)
exophthalmos (protrusion of the eyeball)

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4
Q

what angle does the orbital socket face from midline?
what angle does the lateral walls deviate from the medial walls?
What angle does the optical axis face

A

45 degrees

90 degrees

o degrees (looks directly straightforward

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5
Q

What are all the movements of the eye

A

Abduction and Adduction (vertical axis)

Elevation and depression (Horizontal axis

Intorsion (medial rotation)
Extorsion (lateral rotation)
(Anterior posterior axis)

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6
Q

Innervation and action of levator palpebrae superioris

A

INN: superior branch of Oculomotor (CN III)

Action: Elevates the superior eyelid

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7
Q

Innervation and action of superior oblique

A

INN: trochlear

action: Abducts
depresses
Medially rotates the eyeball

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8
Q

Innervation and action of inferior oblique Muscle

A

INN: Oculomotor

action: ABducts
Elevates
laterally rotates the eye

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9
Q

Innervation and action of Superior rectus Muscle

A

INN: Oculomotor

Elevates, adducts and rotates eyeball medially

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10
Q

Innervation and action of inferior rectus muscle

A

INN: Oculomotor

Depresses adducts and laterally rotates the eyeball

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11
Q

Innervation and action of medial rectus

A

INN: Oculomotor

Adducts the eyeball

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12
Q

Innervation and action lateral rectus

A

INN: Abducent

Abducts the eyeball

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13
Q

What muscles do Extorsion

A

Lateral rotation

Inferior Oblique
Inferior rectus

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14
Q

What muscles do Introsion

A

Medial rotation

Superior oblique muscle
Superior rectus

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15
Q

What muscles do elevation

A

Inferior oblique

Superior rectus

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16
Q

WHat muscles do depression

A

Superior oblique

Inferior rectus

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17
Q

WHat muscles do ABduction

A

INferior oblique
lateral rectus
superior oblique

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18
Q

WHat muscles do ADduction

A

Inferior rectus
Medial rectus
Superior rectus

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19
Q

How do clinicians test each muscle of the eye individually

A

They must trap the paired muscle to test the muscle they want by trapping the visual gaze so that the paired muscle they arent testing muscle fibers are perpendicular to the muscle fibers they are testing

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20
Q

To test the superior rectus how must the eye be looking

A

THe eye must be ABducted by the Lateral rectus

then you elevate the eye

(this would make the inferior oblique perpendicular)

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21
Q

To test the inferior rectus how must the eye be looking

A

THe eye must be ABducted by the lateral rectus

then you depress the eye

(THis would make the superior oblique perpendicular)

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22
Q

To test the superior oblique how must the eye be looking

A

THe eye must be ADducted by the medial rectus

then you depress the eye

(This makes the inferior rectus perpendicular)

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23
Q

To test the inferior oblique how must the eye be looking

A

the eye must be ADducted by the medial rectus

then you elevate the eye

(this makes the superior rectus perpendicular)

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24
Q

What modalities are carried in Long ciliary nerve

A

Comes off of nasociliary N

carries sensory and sympathetics

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25
Q

WHat modalities are carried in short ciliary nerve

A

comes off of naso ciliary N

travels through ciliary ganglion

carries sensory, parasympathetics and sympathetics

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26
Q

What muscle is innervated by the inferior branch oculomotor

A

Inferior oblique
Inferior rectus
Medial Rectus

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27
Q

What muscle is innervated by the superior branch of oculomotor

A

Levator palpebrae superioris

Superior rectus

28
Q

What nerves travel through the Common tendinous ring

A

Optic Nerve (and optical canal)

Frontal Nerve
Lacraimal Nerve (V1)
Trochlear Nerve (CN IV)

Oculomotor Nerve superior and inferior branches
Nasociliary nerve
Abducent Nerve
(these 4 also travel through superior orbital fisure)

29
Q

WHat is horners syndrome

A

When the cervical ganglion is cut so that you lose all sympathetics to the face

patients present with
constriction of the pupil: miosis
 Drop eye lid: Ptosis
Anhydrosis= no sweat
Dilation of the blood vessels so redness and increased temperature in the face
30
Q

What do Parasympathetic innervation do in the eye

A

Sphinctor muscle

ciliary muscle

31
Q

What do sympathetic innervation do in the eye

A

DIlator pupillae

superior and inferior tarsal muscles

32
Q

What does seensory innervation do in the eye

A

Choroid
iris
Cornea

33
Q

Lesions to the trochlear nerve

A

Trochlear palsy

headtilts away from the affected side to compensate for the laterally rotated eye

Diplopia on downward gaze

34
Q

Lesions to the Abducens nerve

A

Abducens palsy

Cannot look laterally with the affected eye
cannot ABduct the eye

35
Q

Lesion to the oculomotor nerve

A

Oculomotor palsy

Down and out eye: due to ocular muscle innervation only leaving Superior oblique and Lateral rectus intact

Complete ptosis: loss of innervation to levator palpebrae superioris

Pupil dilation:
Loss of parasympathetic innervation to the pupil

36
Q

What are the 4 neurons in the pathway for the pupilary light reflex

A

1) Light sensed by CN II and will synapse on the pretectal nucleus
2) Cells from pretectal nucleus will synapse in edinger-westphal nucleus (bi-laterally)
3) Preganglionic parasympathetic neurons will travel with CN III and will synapse in the cilary ganglion
4) Postganglionic parasympathetic neurons will synapse in the pupillary constrictor muscle

Optic Nerve = sensory
oculomotor = motor

37
Q

What is the 3 neuron pathway of the coneal reflex

A

1) receptors in corneal will detect touch or irritation, travel in CN V1 and synapse in trigeminal sensory nucleus or spinal trigeminal nucleus
2) Cells from the trigeminal nuclei project to facial nucleus
3) neuron in facial nerve will cause eye to blink

Sensory= V1
Motor= CN VII
38
Q

What are the 3 layers of the eye

A

Fibrous layer
Vascular Layer
Inner layer

39
Q

What makes up the Fibrous layer

A

Sclera and the cornea

40
Q

What makes up the vascular layer

A

Choroid
ciliary body
Iris

41
Q

What makes up the inner layer

A

Retina

42
Q

What is found in the middle of CN II

A

Central Retinal vein and Artery

this supplies the Retina

and is surrounded by meninges

43
Q

What are the two conjunctiva and what do they do

A

Palpebral conjunctiva: lines the innermost part of the eyelids

Bulbar (ocular) cojunctiva: lines the outermost part of the eyeball

44
Q

What innervates the superior tarsal muscle

A

Sympathetics to help open the eye

45
Q

WHat are the two types of conjunctivitis

A

can be bacterial and viral

bacterial conjunctivits produces yellow discharge called pheum

viral conjunctivitis produces a watery secretion

46
Q

Subconjunctival hemorrhage

A

this is a bleed between the sclera and the bulba conjunctival

this can be caused from a blood vessel popping due to too much pressure

47
Q

Complete PTOSIS

A

Loss of the Levator Palpebrae superioris

caused by destruction of Oculomotor CN III pr one of its branches to the Levator Palpebrae superioris muscle

48
Q

Partial PTOSIS

A

Loss of the Tarsal muscle (of Muller)

innervated by Postganglionic sympathetic fibers that originate at the level of T1

Horners syndrome usually involves loss of this muscle

49
Q

Papilledema

A

Cause: is increased intracranial pressure (ICP)

Emergent: need to find the cause of the increased ICP

can detect by seeing the optic disk in the back of the eye when looking into the eye

50
Q

What is the macula and the fovea

A

Macula: center of vision

Fovea: an area of the macula most concentrated by cones

optic disk: is your blind spot

51
Q

what are the arteries of the eye

A 
Ophthalmic artery coming off of internal carotid artery
gives rise to:
short posterior ciliary artery
long posterior ciliary artery
Supratrochlear Artery
Supraorbital A
Ethmodial Arteries
Lacrimal A

Lacrimal artery will give rise:
anterior ciliary artery

also in Optic Nerve is the central retinal A

52
Q

Anastamoses with nerves in the eye

and the significance of them

A

Supratrochlear A = Angular A

Supraorbital A = superfical temporal A

Lacrimal A = Middle meningeal A

since it is important to get the eue blood and to central retinal A

therefore if their is a slow occulusion blood can find a way to central retinal A

if there is a fast occlusion you will go blind because cant enough blood to the eye

53
Q

What is the venous drainage of the eye

A

Will go back through superior ophthalmic V to cavernous sinus

Inferior Ophthalmic to pterygoid venous plexus

Angular Verin to facial V

54
Q

Central Retinal Vein Occulusion

A

looks like ketchup on the back of the eye

cause: hardening of the central retinal artery and hypertension in the CRA can compress the CRV

Hemorrhages
dilated veins

55
Q

Central Retinal Artery Occlusion

A

Pale and red spot

caused by atherosclerosis, embolisms

Retina appears white
cherry red spot since the choroid is still getting blood supply
Veins and arteries attenuated

56
Q

WHat is the pathway of the tear through the eye

A

goes from the lacrimal gland which is lateral of the eye
then it will cross the eye medially
then the Lacrimal canaliculi will wick the eyes into the lacrimal duct

the tears will then travel down the nasolacrimal duct into the inferior Nasal meatus

57
Q

Why does blinking help clear tears

A

The lacrimal part of the orbicularis oculi muscle kis attached to the lacrimal sac so blinking will help widen the opening of the lacrimal sac

58
Q

What is the route of parasympathetics from the brain to the lacrimal gland

A

Leave the superior salivatory nucleus as Facial Nerve
travel through the internal auditory foramen
through the hiatus for the greater pertrosal nerve as the greater petrosal Nerve
Meets up with deep petrosal Nerve and becomes the Nerve of the pterygoid canal and will enter the pterygoid canal
then will reach the pterygopalatine ganglion and synaspse their
Then the postganglionic parasympathetic fibers will travel on V2 the zygomatic branch
then will jump on a communicating branch
then will join on to the lacrimal Nerve of V1 and will reach the lacrimal Gland

59
Q

What are the two chambers of the eye

A

Anterior chamber: space between the cornea and the ris/pupil

Posterior chamber: Space between the iris/pupil and the lens and ciliary body

60
Q

What is the ciliary body

A

the circumferential tissue inside the eye composed of the ciliary muscle and ciliary processes

61
Q

What is the ciliary process

A

secretes the aqueous humor which fills the anterior and posterior chambers

62
Q

What is the flow of the Aqueous humor

A

1) ciliary process from the ciliary body
2) goes from the posterior chamber to the anterior chamber
3) into the scleral venous sinus (Schlemms Canal)

63
Q

What happens if the schlemms canal is blocked

A

this can lead to increased pressure and glaucoma

64
Q

What is hyphema

A

Rupture of an artery in the anterior chamber that causes it to fill up with blood

65
Q

Ciliary body and the impact on the lense

A

Contraction of ciliary muscles decreases the size of the ciliary body

this reduces tension on suspensory ligament of lens

the lens then becomes more rounded to aid in near vision

aids in accomadation

Neuro Endocrine (20 decks)

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