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neuro exam 2 > eye and orbit > Flashcards

eye and orbit Flashcards

1
Q

general orbit

A

depth 2x width
shaped like a quadrangular pyramid w/base facing anterolateral and apex posteromedial
contralateral medial walls parallel
contralateral lateral walls perpendicular

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2
Q

orbital axis

A

long axis thru orbit oriented 45 degrees to one another

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3
Q

optical axis

A

long axis thru globe parallel to medial walls of orbit

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4
Q

bones of orbit

A 
frontal
maxilla
sphenoid
lacrimal
ethmoid
palatine
zygomatic
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5
Q

apex of orbit

A

lesser wing of sphenoid surrounding optic canal

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6
Q

base

A

formed by the orbital margin and orbital opening

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7
Q

orbital margin

A

frontal
zygomatic
maxilla
thickened to provide support and protection to eye

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8
Q

roof of orbit

A

frontal bones and some spehnoid
separated orbit from ant cranial fossa
has fossa for lacrimal gland

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9
Q

floor of orbit

A

maxilla bone- separated orbit from maxillary sinus
zygomatic
palatine

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10
Q

medial wall of orbit

A 
separates orbit from sphenoid and ethmoidal air sinuses
ethmoid
lacrimal
maxilla
lacrimal fossa
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11
Q

lateral wall of orbit

A

zygomatic bone

sphenoid- greater wing

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12
Q

optic canal

A

II, ophthalmic a

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13
Q

superior orbital fissure

A

III, IV, V1, IV

superior ophthalmic v

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14
Q

inferior orbital fissure

A

inf opthalmic v
infraorbital a,v,n
sygomatic nn

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15
Q

ant ethmoidal foramen

A

ant ethmoidal a, n, v

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16
Q

post ethmoidal foramen

A

post ethmoidal a,n,v

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17
Q

nasolacrimal canal

A

nasolacrimal duct

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18
Q

blowout fracture- inferior

A

can involve maxillary sinus
inf rectus m trapped -> diplopia
enophthalmos due to fat

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19
Q

blowout fracture- medially

A

enophthalmos due to fat

can involve sphenoidal and ethmoidal air sinuses

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20
Q

blowout fracture-roof

A

can involve ant cranial fossa

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21
Q

orbital tumors

A

tumors in sphenoidal or ethmoidal sinuses or middle cranial or infratemporal fossas can erode thin walls of orbit or pass thru foramen
exopthalmos

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22
Q

periorbital fasica

A

lines bones of orbit
continuous w/periostreal dura at optic canal and superior orbital fissue
continuous w/orbital septum anteriorly
continuous w/muscular fascias of extraoccular eye mm

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23
Q

fat and fascias of orbit

A 
periorbital fascia
mm fascias
check ligaments
fascial sheath of eyeball
orbital fat
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24
Q

check ligaments

A

medial and lat
attach to med and lat orbit walls
limit abduction and adduction
prevent post retraction of eyeball by rectus mm

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25
Q

fascial sheath of eyeball

A

aka tenons capsule or fascia bulbi
thin membrane surrounding eyeball external to sclera
continuous w/muscular fascia of extraoccular eye mm
separates eyeball from orbital fat

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26
Q

orbital fat

A

cushion
lubrication
protection
w/anorexia eyes become sunken

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27
Q

eyelids

A

moveable folds of skin and CT which cover eye to protect spread lubrication over cornea

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28
Q

structure of eyelid

A 
skin
loose CT
orbicularis oculi and levator palpebrae superioris mm
tarsal plate
palpebral conjuctiva
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29
Q

tarsal plate

A

dense CT for structural support of eyelid
orbital septum
medial and lateral palbebral ligaments

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30
Q

orbital septum

A

part of tarsal plate
fibrous membrane connecting tarsi to margins of orbit
fnx to contain orbital fat w/in orbit
limit spread of infection btwn face and orbit

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31
Q

medial palpebral lig

A

connects tarsi to medial wall of orbit

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32
Q

lateral palpebral lig

A

connects tarsi to lateral wall of orbit

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33
Q

glands associated w/eyelid

A

tarsal/sebaceous glands
galnds of Zeis (smaller sebaceous)
glands of Moll (sweat)

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34
Q

glands become obstructed

A

can get chalazion or hordeoum cysts

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35
Q

orbicularis oculi

A

sphinchter m of eyelid
VII
therefore damage to VII cannot close eyelid completely

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36
Q

levator palebrae superioris

A 
lesser wing of sphenoid
skin of sup eyelid
elevates sup eyelid
III
sup portion attaches to sup tarsal plate innervated sympathetically
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37
Q

III lesion

A

ptosis

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38
Q

horners syndrome

A

ptosis due to loss of sympathetics to superior tarsal portion of LPS

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39
Q

palpebral conjunctiva

A

epi of internal eyelid

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40
Q

bulbar conjunctiva

A

outer epi of sclera

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41
Q

conjunctiva sac

A

btwn palebral and bulbar conjunctiva

opens at palpebral fissure

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42
Q

conjunctival fornices

A

sup and inf

formed where bulbar and palpebral conjuctiva are continuous

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43
Q

lacrimal apparatus

A

lacrimal gland
lacrimal cannaliculi
lacrimal sac
nasolacrimal duct

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44
Q

lacrimal galnd

A

compound tuboalveolar gland
located in lacrimal fossa in superolateral orbit
secretes lacrimal fluid into conjunctival sac
lubrication and antibacterial

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45
Q

lacrimal cannaliculi

A

located in medial angle of eye
begin at lacrimal papilla
lacrimal punctum is opening

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46
Q

lacrimal sac

A

receives fluid from lacrimal cannaliculi

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47
Q

nasolacrimal duct

A

drains lacrimal fluid to nasal cavity

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48
Q

flow of tears

A

lacrimal glans -> conjunctical sac-> surface of eye -> lacrimal papillae w/puncta -> cannaliculae -> lacrimal sac -> nasolacrimal duct

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49
Q

eye

A

3 tunics
lens
vitreous and aqueous chambers

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50
Q

external fibrous tunic

A

sclera

cornea

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51
Q

sclera

A

tough opaque fibrous layer covering post 5/6 of globe

provides structural support for eye and mm attachment

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52
Q

cornea

A

avascular, dehydrated, transparent layer covering ant 1/6 of globe
provides most of eyes refractile capabilities
numerous pain receptors w/in cornea

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53
Q

corneal neurovascularization

A

blood vessels grow into corneal stroma secondary to hypoxia

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54
Q

middle vascular tunic

A 
aka uvea
choroid
iris
ciliary body
ciliary m
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55
Q

choroid

A

highly vascualrized, loose CT, located deep to sclera
provides vascular supply to fibrous layers and outermost layers of retina
contains melanocytes which produce melanin to absorb photons

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56
Q

iris

A

central aperature forms pupil
controls amount of light entering pupil
sphincter pupillae m
dilator pupillae

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57
Q

sphincter pupillae

A

reduces diameter of pupil (meiosis)

parasympathetic via III

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58
Q

dilator pupillae

A

increases diameter of pupil (mydriasis)

sympathetics

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59
Q

ciliary body

A

ciliary processes

ciliary m

60
Q

ciliary processes

A

finger like extensions from ciliary body
secretes aqueous humor into post chamber
suspensory ligaments extend from ciliary processes to lens

61
Q

ciliary m

A

parasympathetics via from III

accommodation- control of lens thickness via suspensory ligaments

62
Q

accommodation- distant

A

when looking at distant objects the ciliary m relaxed w/tension on suspensory ligaments
ciliary processes pull on lens to stretch and thin it
default

63
Q

accommodation- near

A

ciliary m contracts pulling ciliary body med and ant to reduce tension on suspensory ligs
lens round and thick
due to parasympathetics from III

64
Q

inner neural tunic

A 
visual portion of retina
contains rods/cones 
contains ganglion cells which form optic n
ora serrata
optic disc
macular lutea
fovea centralis
65
Q

orra serrata

A

ant termination of retina

66
Q

optic disc

A

blind spot
located on post pole of globe
site of entry of II and central retinal a, v

67
Q

macula lutea

A

yellow pigmented zone located about 2.5mm to lat optic disc

68
Q

fovea centralis

A

oval depression in center of macula

site of greatest visual acuity due to density of cone cells

69
Q

blood supply of retina

A

central retinal a for neural portion except rods and cones

choroid vessels for pigmented epi and rod/cone layer

70
Q

retinal detachement

A

occurs when pigmented epi separated from underlying rods/cones
can cause blindness due to loss of blood supply

71
Q

cataracts

A

proteins of lens aggregate producing opaque lens

72
Q

eye chambers

A 
aqueous chambers (ant, post)
vitreous body
73
Q

anterior aqueous chamber

A

btwn cornea and iris

74
Q

post aqueous chamber

A

btwn iris and lens

75
Q

aqueous humor

A

fill ant and post chambers
produced in post chamber by ciliary processes
flows into ant via pupil
drains to venous system via sclera venous sinus

76
Q

sclera venous sinus

A

at iridocorneal angle
covered by trabecular meshwork (endothelial lines spaces)
drains to vorticose and ant ciliary vv

77
Q

glacoma

A

due to excessive aqueous humor
most often due to decreased drainage, but can be due to increased production
caused increased ocular pressure which can lead to blindness

78
Q

vitrous body

A

btwn lens and post surface of eye

filled w/vitreous humor

79
Q

neural ectoderm

A

aka optic vessels
derived from evaginations of forebrain neuroectoderm
meninges carried along w/eye
optic vessels invaginate to forme double walled optic cup
cup maintains connection to forebrain at optic stalk
choroid fissure forms on ventral surface of cup
forms retina and optic n

80
Q

choroid fissure

A

hyaloid vessels

closes wk 7

81
Q

surface ectoderm

A

lens placode -> lens vesicle -> lens

82
Q

mesenchye

A

fibrous - sclera and cornea

vascular- choroid, iris, ciliary body

83
Q

retina and optic n

A

outer layer of cup- pigmented layer of retina
inner layer of cup- all neural layers of retina
nerve fibers from retina migrate thru chorioid fissure to form II

84
Q

congential retinal detachement

A

inner and outer cup layers fail to fuse

85
Q

chorioid

A

derived from vascular layer of mesenchyme surrounding optic cup

86
Q

iris and ciliary body

A

outer portion from vascular mesenchyme surrounding optic cup
inner portion derived form optic cup
melanocytes migrate in first 6-10 months

87
Q

iridopupillary membrane

A

vascular structure which originally separates the ant and post chambers
degenerates around wk 15

88
Q

congenital atresia of pupil

A

due to failure of iridopupillary membrane to degenerate

89
Q

coloboma

A

failure of choroid fissure to fuse during the 7th wk of development
may also involve the retina

90
Q

sclera and cornea

A

are derived from fibrous layer of mesenchyme surrounding optic cup

91
Q

aqueous and vitreous chambers

A

form in areas of cell death

vitreous humor is likely derived from neural crest cells

92
Q

lens

A

derived from lens vesicle

93
Q

congenital aphakia

A

agenesis of lens placode

94
Q

extrinsic eye m

A

from mesoderm of myoderms

95
Q

ophthalmic a

A

from internal carotid

enters orbit via optic canal

96
Q

brr of ophthalmic a

A 
central retinal a
short post ciliary 
long post ciliary 
ant ciliary aa
lacrimal
supraorbital
post ethmoidal
ant ethmoidal
medial palpebral 
supratrochlear
dorsal nasal
97
Q

central retinal a

A 
pierces optic sheath and runs within optic n
supplies retina (except rods/cones and pigmented epi layers)
98
Q

short post ciliary a

A

pierce sclera near optic n to supply choroid

99
Q

long post ciliary a

A

pierce sclera anteriorly to supply ciliary body and iris

100
Q

ant ciliary aa

A

arise from mm brr to cliary body and iris

101
Q

lacrimal a

A

to lacrimal gland and lat portions of eyelids

102
Q

supraorbital a

A

to forehead and scalp

103
Q

medial palpebral a

A

medial eyelids

104
Q

supratrochlear

A

to forehead and scalp

105
Q

dorsal nasal

A

supplies dorsal surface of nose

106
Q

vv of orbit and eyeball

A

central retinal v
vorticose vv
sup and inf ophthalmic vv

107
Q

central retinal v

A

usually drains directly to cavernous sinus

108
Q

vorticose vv

A

drain choroid, ciliary body, and iris

109
Q

sup and inf ophthalmic vv

A

drain to cavernous and pterygoid venous plexuses respectively

110
Q

thrombophlebitis of cavernous sinus

A

may send clot to central retinal v and cause blindness

111
Q

extortions

A

superior pole of eyeball rotated laterally

112
Q

intortion

A

superior pole of eyeball rotated medially

113
Q

medial rectus

A 
common tendinous ring
medial surface of eyeball
adducts eye
III
if damaged lose adduction, eye 'stuck' in abdcution
114
Q

lateral rectus

A 
common tendinous ring
lateral surface of eyeball
adducts eye
VI
if damaged lose abduction, eye 'stuck' in adduction
115
Q

superior rectus

A 
common tendinous ring
sup surface of eyeball
elevated, adducts, intorsion
III
if damaged loss of elevation when eye is fully abducted
116
Q

inf rectus

A 
common tendinous ring
inf surface eyeball
depress, adduct, extorsion
III
loss of depression when eye fully abducted
117
Q

inf oblique

A 
ant portion of floor of orbit
inf surface of eyeball, post to equator
elevates, abducts, extorsion
III
loss of elevation when eye fully adducted
118
Q

sup oblique

A

common tendinous ring
sup surface of eyeball, post to equator
mm passes thru trochea ad changes direction to attach to eyeball
depress, abducts, intorsion
IV
loss of depression when eye fully addcuted

119
Q

III

A

GSE, GVE-P

120
Q

superior division of III

A

levator palpebrae superiorsis and sup rectus

121
Q

inf division of III

A

medial rectus, inf rectus, inf oblique

pre-ganglionic parasympathetics to ciliary ganglia

122
Q

oculomotor n palsy

A

ptosis or complete closure of eye due to loss of levator
diploplia
eye will be abducted and depressed (down and out)
dilation of pupil (due to loss of sphincter )
loss of accommodation (due to loss of ciliary m)

123
Q

IV

A

GSE

sup oblique m

124
Q

trochlear n palsy

A

diploplia
eye slightly elevated and adducted
loss of depression when eye fully adducted

125
Q

VI

A

GSE

lateral rectus m

126
Q

abducent n palsy

A

diplopia

loss of eye abduction

127
Q

II

A

SSA- vision
covered in meninges
axons of ganglion cell layer of retina which pass thru optic disc then exit via lamina cribosa of sclera posterior

128
Q

V1 bbr

A

GSA
nasociliary
frontal
lacrimal

129
Q

nasociliary n

A 
sensory root to ciliary ganglia 
short ciliary nn
long ciliary nn
post and ant ethmoidal nn
iinfratrochlear n
130
Q

short ciliary nn

A

arise from ciliary ganglia on lat side of optic n

carry postganglionic sympathetics, parasympathetics, and sensory

131
Q

long ciliary nn

A

arise from nasociliary n on medial side of optic n

carry postganglionic sympathetics, and sensory fibers

132
Q

posterior ethmoidal n

A

to ethmoidal air cells and dura

133
Q

ant ethmoidal n

A

ethmoidal air cells, nasal cavity, dura

terminates as external nasal n

134
Q

infratrochlear

A

exits orbit at medial angle, sensory to skin at root of nose, eyelids, palpebral conjunctiva, lacrimal sac

135
Q

frontal n brr

A

supratrochlear n

supraorbital n

136
Q

lacrimal n

A

sensory to lacrimal gland, lateral portion of superior eyelid
carries postganglionic parasympathetics and sympathetic fibers to lacrimal gland

137
Q

ciliary ganglion

A

located btwn lateral rectus m and optic n

contains postganglionic parasympathetic cell bodies

138
Q

ciliary ganglion recieves

A

sensory root from nasociliary n
parasympathetic motor root from III
sympathetic motor root from internal carotid plexus

139
Q

parasympathetics to intraoccular mm

A

preganglionics in edinger-westphal nucleus
preganglionic fibers travel w/III
postganglionics in ciliary ganglion
postganglionic fibers then distribute via short ciliary nn to sphincter pupillae and ciliary mm

140
Q

sympathetics to intraoccular mm

A

preganglionic cells T1-2 -> superior cervical sympathetic ganglion -> from here postganglionics travel w/internal carotid plexus -> gives a motor root to ciliary ganglion-> postganglionics pass thru ciliary ganglion w/o synapsing and distribute via long and short ciliary nn to dilator pupillae and superior tarsal mm

141
Q

parasympathetics lacrimal gland

A

preganglionic in salivatroy nucleus in brainstem
travel w/greater petrosal n (VII) to pterygopalatine ganglia where they synapse
postganglionics then travel with zygomatic (V2) and lacrimal (V1) nn
increase lacrimal secretions

142
Q

sympathetics lacrimal gland

A

T1-4 -> superior cervical sympathetic chain ganglion -> leave as postganglionics via deep petrosal n -> greater and deep petrosal nn merge to form n of pterygoid canal -> zygomatic (V2) and lacrimal (V1) nn
vasomotor and more watery lacrimal fluid

143
Q

pupillary light reflex

A

fnx- protect eye from excessive light exposure
afferent-II
efferent- III

144
Q

corneal reflex

A

protect eye from objects
afferent- V1
efferent- VII

145
Q

accommodation

A 
afferent- II
efferent- III (GSE and GVE-P)
1. ciliary mm contract -> rounding of lens  III GVE-P
2. pupils constrict III GVE-P
3. eyes adduct III GSE

neuro exam 2 (11 decks)

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