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Neuro Exam II > Eye and Orbit (FUNK) > Flashcards

Eye and Orbit (FUNK) Flashcards

1
Q

what is the shape of the orbit

A

shaped like a quadrangular pyramid with its base facing anterolateral and its apex facing posteromedial.

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2
Q

medial walls of the orbit are oriented how towards one another?
how about the lateral walls

A

The contralateral medial orbital walls are oriented parallel to one another; while the contralateral lateral orbital walls are oriented perpendicular.

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3
Q

orbital axis

A

long axis through orbit

oriented at 45 degrees to one another

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4
Q

optical axis

A

long axis through the globe

parallel to the medial walls

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5
Q

7 bones of the orbit

A 
frontal
ethmoid
lacrimal
maxillary
sphenoid
zygomatic
palatine
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6
Q

what is the apex of orbit

A

lesser wing of sphenoid surrounding optic canal.

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7
Q

what forms the base of the orbit

A

formed by the orbital margin and orbital opening

a. Orbital margin is formed by frontal, zygomatic, and maxilla bones.
b. Orbital margin is thickened to provide support and protection to the eyeball.

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8
Q

what makes up the roof?

A

frontal bone and some sphenoid- separates orbit from anterior cranial fossa

fossa for lacrimal gland

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9
Q

what makes up the floor

A

a. Maxilla bone – separates orbit from maxillary sinus
b. Zygomatic bone
c. Palatine bone

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10
Q

what makes up the medial wall

A

separates orbit from sphenoidal and ethmoidal air sinuses

a. Ethmoid bone
b. Lacrimal bone
c. Maxilla bone
d. The lacrimal fossa; houses the medial portion of the lacrimal system.

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11
Q

what makes up the lateral wall

A

a. Zygomatic bone

b. Sphenoid – greater wing

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12
Q

optic canal

A

optic nerve

ophthalmic artery

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13
Q

superior orbital fissure

A

CN III, IV, V1, XI

superior opthalmic vein

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14
Q

inferior orbital fissure

A

inferior ophthalmic vein
infraorbital artery, vein, nerve
zygomatic nerves

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15
Q

posterior ethmoidal formanen anterior ethmoidal foramen

A

anterior ethmoidal a, v, n

posterior ethmoidal a, v, n

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16
Q

nasolacrimal gland

A

nasolacrimal duct

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17
Q

orbital blow-out fracture

A

a massive zygomaticomaxillary fracture or a direct blow to the front of the orbit

may cause a rapid increase in intraorbital pressure and a resulting blow-out fracture of the thin orbital floor

in severe comminuted fractures of the orbital floor the orbital soft tissues may herniate and blood may spread into the underlying maxillary sinus

damage to the medial walls–> sphenoidal or ethmoidal air sinuses

damage to roof- anterior cranial fossa

clinical signs include diplopia, infraorbital nerve paresthesia, enopthlamamos (sinking in eye), edema, eccymosis, detached retina,

weakest part is the floor

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18
Q

where is the most likely fracture site in a blow out fracture

A

inferior and medial orbital walls

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19
Q

orbital tumor

A
  1. Malignant tumors originating in the sphenoidal and ethmoidal sinuses, middle cranial, or infratemporal fossa can erode through the thin walls of the orbit or pass directly through foramina. These tumors can compress the orbital contents.
  2. Can cause exophthalmos.
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20
Q

what are 4 fascias of the orbit

A

periorbital fascia

muscular fascia

check ligaments

fascial sheath of eyeball (Tenon’s capsule)

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21
Q

periorbital fascia

A

lines bones of orbit.

a. Continuous with periosteal dura at optic canal and superior orbital fissure.
b. Continuous with the orbital septum anteriorly.
c. Continuous with muscular fascias of extraocular eye muscles.

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22
Q

muscular fascia

A

surrounds extraocular eye muscles

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23
Q

check ligaments

A

a. Medial and lateral; attach to medial and lateral orbital walls.
b. Limit abduction and adduction of the eye.
c. Prevent posterior retraction of the eyeball by the rectus muscles.

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24
Q

fascial sheath of the eyeball (Tenon’s capsule)

A

a. Thin membrane surrounding eyeball; external to sclera.
b. Continuous with the muscular fascia of the extraocular eye muscles.
c. Separates eyeball from orbital fat.

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25
Q

what is the role of orbital fat

what happens in starvation

A

a. Cushion
b. Lubrication
c. Protection
d. CLINICAL CORRELATION: With starvation, the eyes often become sunken-in (enophthalmos) due to loss of orbital fat.

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26
Q

what are the 5 layers of supporting structures of the eye

A

skin
loose CT
muscular layer (orbicularis oculi and levator palpebrae superioris)
tarsal plate- dense CT

palpebral conjunctiva - epithelium

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27
Q

what is the function of the eyelid

A

protection; spread lacrimal fluid to lubricate cornea.

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28
Q

what does the tarsal plate insert onto

A

orbital septum - fibrous membrane connecting tarsi to margins of orbit
functions to contain orbital fat within the orbit, also helps limit the spread of infections b/w face and orbit

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29
Q

what is the function of the medial palpebral ligament

lateral palpebral ligament?

A
  1. Medial palpebral ligament – connect tarsi to medial wall of orbit.
  2. Lateral palpebral ligament – connect tarsi to lateral wall of orbit.
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30
Q

palpebral conjunctiva

A

epithelium of internal eyelid

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31
Q

bulbar conjunctiva

A

outer epithelium of sclera

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32
Q

what is the conjuntival sac

A

between palpebral and bulbar conjunctiva; opens at palpebral fissure.

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33
Q

what is the conjunctival fornices

A

(superior and inferior) are formed where bulbar and palpebral conjunctiva are continuous.

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34
Q

what is the lacrimal gland
where is it
what does it do

A

a. Compound tubuloalveolar gland
b. Located in lacrimal fossa in superolateral orbit.
c. Secretes lacrimal fluid – watery, serous secretion – into conjunctival sac.
d. Lacrimal fluid keeps sclera and cornea moist and contains an antibacterial agent for protection.

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35
Q

where are the lacrimal cannaliculi

A

a. Located in medial angle of eye.

b. Begin at the lacrimal papilla; the lacrimal punctum is the opening

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36
Q

what is the lacrimal sac

A

receives fluid from lacrimal cannaliculi

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37
Q

what is the nasolacrimal duct

A

drains lacrimal fluid to nasal cavity

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38
Q

what is the flow of tears

A

lacrimal gland → conjunctival sac → surface of eye → lacrimal papillae with puncta → cannaliculae → lacrimal sac→ nasolacrimal duct

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39
Q

what are the components of the external fibrous tunic

what is corneal neovascularization

A
  1. Sclera
    a. Tough, opaque fibrous layer covering posterior 5/6 of globe.
    b. Provides structural support for eye and provides for muscle attachment.
  2. Cornea
    a. Avascular, dehydrated, transparent layer covering anterior 1/6 of globe.
    b. Provides most of eye’s refractile capabilities.
    c. Numerous pain receptors located within cornea
    d. CLINICAL CORRELATION: Corneal neovascularization = blood vessels grow into corneal stroma secondary to hypoxia.
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40
Q

what are the components of the middle vascular tunic (uvea)

A

choroid
iris
ciliary body

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41
Q

what is the choroid

A

a. Highly vascularized, loose connective tissue; located deep to sclera.
b. Provides vascular supply to fibrous layers and outermost layers of retina.
c. Contains melanocytes which produce melanin to absorb photons of light.

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42
Q

what is the iris

what are the muscles of the iris

A

a. Central aperture forms pupil; controls the amount of light entering the pupil.
b. Muscles

  1. Sphincter pupillae
    a. Reduces diameter of pupil (miosis) to decrease light entering eye.
    b. Parasympathetic innervation (CN III).
  2. Dilator pupillae
    a. Increases diameter of pupil (mydriasis) to increase light entering eye.
    b. Sympathetic innervation.
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43
Q

what is the ciliary body and what are its two main functions

A

ciliary processes and ciliary muscle

  1. secrete aqueous humor
  2. accommodation
44
Q

what are the ciliary processes what do they secrete

A
  1. Finger-like extensions from ciliary body.
  2. Secrete aqueous humor into posterior chamber.
  3. Suspensory ligaments (zonule fibers) extend from ciliary processes to len.
45
Q

what is the ciliary muscle
what is it innervated by
what is its function

A
  1. Parasympathetic innervation (CN III)
  2. Accommodation
    a. Control of lens thickness via suspensory ligaments.
    b. When looking at distant objects, the ciliary muscle is relaxed and there is tension on the suspensory ligaments of the lens. The ciliary processes pull on the lens and cause it to be stretched and thinned.
    c. When focusing on near objects, the ciliary muscle contracts. The ciliary muscle pulls the ciliary body medially and anteriorly and reduces tension on suspensory ligaments. Less tension on the suspensory ligaments means that the lens becomes rounded and thicker.
    d. No stimulation – lens is thin and flat to focus distant.
    e. Parasympathetic stimulation (CN III) – lens round to focus near.
46
Q

inner neural tunic is what

A

the retina

there are 10 layers (look at heck’s lecture)

47
Q

what do the ganglion cells that are in the retina form

A

will form the optic nerve

48
Q

what is the ora serrata

A

anterior termination of the retina

49
Q

what is the optic disc

A

– located on the posterior pole of globe. Represents site of entry of optic nerve (CN II) and the central retinal artery and vein. No photoreceptive cells.

blind spot

50
Q

what is the macula lutea

A

a yellow-pigmented zone located about 2.5 mm lateral to optic disk.

51
Q

what is the fovea centralis

A

– oval depression located in the central of the macula. Site of greatest visual acuity due to density of cone cells.

52
Q

what is the blood supply to the retina

A

a. Central retinal artery supplies neural portion of retina (except rods/cones).
b. Choroid vessels supplies pigmented epithelium and rod/cone layer

53
Q

how does retinal detachment occur and what can be the result of this

A

Retinal detachment occurs when the pigmented epithelium separates from the underlying rods and cones layer. Detachment can cause blindness if not corrected immediately due to loss of metabolic support and blood supply to rods and cones.

54
Q

what is the lens and what is its function

A
  1. Transparent, refractile, flexible, biconvex disk located posterior to iris.
  2. Function: Refraction (focusing light) and accommodation
55
Q

what is presbyopia

A

hardening (loss of elasticity) of the lens

inability to accomodate and focus on near objects

56
Q

what are cataracts

A

develop when the proteins of the lens aggregate producing opaque lens

57
Q

where is the aqueous anterior chamber

A

b/w cornea and iris

58
Q

where is the posterior chamber

A

b/w iris and lens

59
Q

what is aqueous humor
where is it produced
where does it flow
where does it drain and via what

A
  1. Refractive fluid filling anterior and posterior chambers.
  2. Produced in posterior chamber by ciliary processes of ciliary body.
  3. Flows from posterior chamber to anterior chamber via pupil.
  4. Drains to venous system via the scleral venous sinus (Canal of Schlemm) at the iridocorneal angle. The scleral venous sinus is covered by a trabecular meshwork (endothelial lined spaces) which helps drain aqueous humor.
  5. Scleral venous sinus drains to vorticose and anterior ciliary veins.
60
Q

what is glaucoma

A

Glaucoma is a condition caused by excess aqueous humor in the anterior and posterior chambers. Most often due to decreased outflow of aqueous humor (failure to drain due to blockage of scleral venous sinus) or from increased production of aqueous humor. Glaucoma results in increased intraocular pressure; can cause blindness if left untreated.

61
Q

where is the vitreous body

A

b/w lens and posterior surface of the eye

filled with vitrous humor–> a transparent refractile jelly-like substance

62
Q

what is exopthalmos

A

a. Protrusion of eyeball from orbit.

b. Seen in certain diseases such as hyperthyroidism, orbital tumors.

63
Q

what is enopthalamos

A

a. Protrusion of eyeball from orbit.

b. Seen in certain diseases such as hyperthyroidism, orbital tumors.

64
Q

what is the main artery that supplies the orbit and the eye itself

where does this artery enter the orbit

A

ophthalmic artery (branch of internal artery)

enters orbit via the optic canal

65
Q

what does ciliary mean in terms of arteries

A

going to the eye itself (usually outer layers)

66
Q

what are the branches off the ophthalmic artery (11)

A 
central retinal artery
shorter posterior ciliary
long posterior ciliary 
anterior ciliary 
lacrima
supraorbital 
posterior ethmoidal 
anterior ethmoidal
medial palpebral 
supratrochlear
dorsal nasal
67
Q

central retinal artery

A
  1. Pierces optic sheath and runs within optic nerve.

2. Supplies inner layers of retina (except rods/cones and pigmented epithelium layers).

68
Q

short posterior ciliary arteries

A

pierce sclera near optic nerve to supply choroid.

69
Q

long posterior ciliary arteries

A

pierce sclera anteriorly to supply ciliary body/iris.

70
Q

anterior ciliary arteries

A

arise from muscular branches; to ciliary body and iris.

71
Q

lacrimal artery

A

to lacrimal gland and lateral portions of eyelids

72
Q

supraorbital artery

A

to forehead and scalp

73
Q

medial plpebral a.

A

medial eyelids

74
Q

supratrochlear

A

to forehead and scalp

75
Q

dorsal nasal

A

supplies dorsal surface of nose

76
Q

where does the central retinal vein drain

A

directly to cavernous sinus

77
Q

what does the vorticose vein drain

A

B. Vorticose veins drain the choroid, ciliary body, and iris.

78
Q

what do superior and inferior ophthlamic veins drain

A

C. Superior and inferior ophthalmic veins – exit orbit via superior and inferior orbital fissures (respectively). Drain to cavernous sinus and pterygoid venous plexus (respectively).

79
Q

what can happen with thrombophlebitis of the cavernous sinus

A

D. CLINICAL CORRELATION – Thrombophlebitis of the cavernous sinus may send a clot to the central retinal vein; may lead to vision loss.

80
Q

what can increased ICP do to the eye

A

Increased intracranial pressure can affect the eye due to the fact that the meninges and CSF continue along the optic nerve.

Thus, the optic nerve, central retinal artery, and central retinal vein can be compressed and occluded.

81
Q

occlusion of the central retinal vein

A

papilledema (retinal edema)

82
Q

compression of the optic nerve

A

blindness

83
Q

retinal artery occlusion can cause what

A

blindness due to loss of blood supply to the retina

84
Q

what are the 6 movements of the eye

A

A. Adduction – movement of the pupil towards midline (toward nose)
B. Abduction – movement of pupil laterally (toward ear, vertical axis)
C. Elevation – movement of pupil superiorly.(transverse axis)
D. Depression – movement of pupil inferiorly
E. Extortion – superior pole of eyeball rotated laterally. (to ear)
F. Intortion – superior pole of eyeball rotated medially.(to nose)
No control of rotation of the eye !! that is vestibular control

85
Q

what are the 7 extraocular eyes muscles

A 
levator palpebrae superioris 
medial rectus
lateral rectus
superior rectus
inferior rectus
inferior oblique 
superior oblique
86
Q 
medial rectus 
origin
insertion
function
innervation
testing integrity
A
  1. Origin – common tendinous ring
  2. Insertion – medial surface of eyeball
  3. Function – adducts eye
  4. Innervation – CN III
  5. Testing integrity – eye held in abducted position; loss of adduction.
87
Q 
lateral rectus 
origin
insertion
function
innervation
testing integrity
A
  1. Origin – common tendinous ring.
  2. Insertion – lateral surface of the eyeball
  3. Function – abducts eye.
  4. Innervation – CN VI
  5. Testing integrity – eye held in adducted position; loss of abduction
88
Q 
Superior rectus 
origin
insertion
function
innervation
testing integrity
A
  1. Origin – common tendinous ring
  2. Insertion – superior surface of eyeball
  3. Function – elevates, adducts; intorsion
  4. Innervation – CN III
  5. Testing integrity – weakness of elevation; loss of elevation when eye is fully abducted.
89
Q 
inferior rectus
origin
insertion
function
innervation
testing integrity
A
  1. Origin – common tendinous ring
  2. Insertion – inferior surface of eyeball
  3. Function – depresses, adducts; extorsion
  4. Innervation – CN III
  5. Testing integrity – weakness of depression; loss of depression when eye is fully abducted.
90
Q 
inferior oblique 
origin
insertion
function
innervation
testing integrity
A
  1. Origin – anterior portion of floor of orbit
  2. Insertion – inferior surface of eyeball, posterior to the equator (vertical axis)
  3. Function – elevates, abducts; extorsion.
  4. Innervation – CN III
  5. Testing integrity – weakness of elevation; loss of elevation when eye is fully adducted.
91
Q 
superior oblique
origin
insertion
function
innervation
testing integrity
A
  1. Origin – common tendinous ring
  2. Insertion – superior surface of eyeball, posterior to the equator (vertical axis)
  3. This muscle passes through a trochea and changes its direction to attach to the eyeball.
  4. Function – depresses, abducts; intorsion.
  5. Innervation – CN IV

testing ability- weakness of depression; loss of depression when eye is fully adducted

92
Q

how do we look up?

A

superior rectus and inferior oblique

93
Q

how do we look down

A

superior oblique and inferior rectus

94
Q

go to eye website from funks lecture

A

do it
UC Davis?

also see funks slide 59-60

95
Q

are images depicting functions of EO muscles and how you test the clinically different?

A

yes

96
Q

testing lateral rectus clinically

A

have patient abduct their eye

97
Q

testing medial rectus clinically

A

have the patient adduct their eye

98
Q

testing superior rectus

A

Superior rectus – have patient abduct their eye and then elevate.

99
Q

testing inferior rectus

A

Inferior rectus – have patient abduct their eye and then depress.

this is because in this plane when the eye is abducted the only muscle that could depress the eye is the inferior rectus

100
Q

how do we test the superior oblique

A

Superior oblique – have patient adduct their eye and then depress.

101
Q

how do we test the inferior oblique

A

Inferior oblique – have patient adduct their eye and then elevate.

102
Q

what 6 of the CN’s are associated with the orbit

A

CNII SSA (optic canal)

through superior orbital fissure
CN III GSE, GVE-P
CN IV GSE
CN V1 GSA
CN VI GSE

CNVII SVE to orbicularis oculi

103
Q

LR6SO4R3

A

Lateral rectus CN VI
Superior oblique CN IV
All the rest CN III

104
Q

what three nerves are responsible for innervating the EO eye muscles

A

CN VI
CN IV
CN III

105
Q

CN III does what muscles

A

levator palpebrae superioris

medial, superior, inferior rectus

and inferior oblique

106
Q

CN IV

A

superior oblique

107
Q

CN VI

A

lateral rectus

Neuro Exam II (2 decks)

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