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OCULAR PHYSIOLOGY > EYELIDS > Flashcards

EYELIDS Flashcards

1
Q

What are the 6 layers of the eyelid

A

skin, subcutaneous layer, muscles, submuscular areolar layer, fibrous layer, palpebral conjunctiva

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2
Q

Skin is ______ and _______ and ______

A

thick; elastic; fat free

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3
Q

T/F the eyelid has fat

A

F; the eyelid is fat free

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4
Q

Blepharochalasis is what?

A

orbital fat herniation or edema

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5
Q

________ cell carcinoma is related to ______ exposure

A

Basal; ultraviolet radiation

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6
Q

T/F malignant growths are evenly distributed b/w upper and lower lids

A

F benign growths are evenly distributed and malignant tumors are 4 times more common in the lower then upper lid

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7
Q

Why are malignant tumors 4 times more common in the lower lid then the upper

A

Because the eyebrow protects the upper eyelid from the sun

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8
Q

Which muscle elevate the upper lids and which one closes it

A

the levator palpebral superioris; orbicularis oculi

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9
Q

Which muscle fibers modulate position of the open eye

A

Mueller muscle fibers (Tarsal plates)

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10
Q

A fold of skin separating the palpebral from the orbital portion of the lid marks insertion of the ______

A

levator palpebral superioris

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11
Q

When is the absence of the palpebral sulcus seen?

A

ptosis

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12
Q

What is the difference between congenital and acquired ptosis?

A

congenital - born with it; acquired - developed later in life

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13
Q

T/F Obicularis oculi is a striated and voluntary muscle

A

T

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14
Q

What does the orbicularis oculi do

A

helps hold the lid tightly against the eye, assistance spreading tears and flushing away waste products

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15
Q

Obicularis oculi is innervated by what cranial nerves?

A

CN 7

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16
Q

What can paralysis of the orbicularis oculi lead to?

A

dry eye and lagophthalomos

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17
Q

Levator is innervated by what cranial nerve

A

CN 3

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18
Q

Tarsal muscles superior and inferior are innervated sympathetically or parasympathetically

A

sympathetically

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19
Q

T/F Tarsal muscles keep the eye lid up

A

T

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20
Q

Which muscle gives a wide eye expression of fear

A

Tarsal muscles (Mueller)

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21
Q

Damage to the _______ innervation causes a _______ lid

A

sympathetic; droopy

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22
Q

_______ _______ tissues is loose connective tissues between muscle and tarsal plate

A

submuscular areolar layer

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23
Q

T/F submuscular areolar tissue is full of fat

A

false; it is fat free

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24
Q

The ______ layer is dense fibrous tissue that gives firmness and shape to eyelid

A

fibrous layer

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25
Q

T/F collagen is more develop in the upper lid than the lower lid which allows upper lid to be everted

A

T

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26
Q

What could be the causes of a floppy eyelid syndrom

A

decrease tarsal elastin and genetic abnormalities of collagen or elastin

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27
Q

What is floppy eyelid syndrome and why would you wake up in the morning with red eye

A

Upper eyelids are flaccid and easily everted; when you sleep you could be pulling the eyelid away and exposing your conjunctiva to the mattress therefore causing soreness or red eye dryness

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28
Q

Floppy eye syndrome can also be a ______ glad dysfunction

A

meibomian gland

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29
Q

T/F floppy eye syndrome can also cause an inadequate spreading of tear film

A

T; poor apposition of eyelid to globe

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30
Q

Floppy eyelid syndrom can often be associated with ____ ____

A

sleep apnea

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31
Q

What syndrome should not be confused with floppy eyelid syndrome

A

floppy iris syndrome

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32
Q 
the life span of cillia is \_\_\_\_\_\_ to \_\_\_\_\_\_ months 
A) 6-7
B)5-7
C) 3-5
D) 1-3
A

3; 5

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33
Q 
When cillia are forcibly removed from their follicles approximately how long does it take for new growth
A) 1 month
B) 3 months
C) 2 months
D) Never grows back
A

2 months

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34
Q

What is the chief eyelid secretion

A

sebum

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35
Q

What gland secretes sebum

A

meibomian

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36
Q

Sebum forms ____layer over the _____ tear film which _____ evaporation of the aqueous component

A

superficial; precorneal; slows

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37
Q

There are approximately _______ meibomian gland in each tarsus

A

30

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38
Q

A _____ barrier is formed preventing tear spillage

A

hydrophobic

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39
Q

T/F meibomian glands are modified sebaceous glands

A

T

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40
Q

Little _____ leading to a ____ canal opens at the lid margin of meibomian glands

A

saccules; central

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41
Q

How many transverse arcades are there per eyelid

A

2

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42
Q

T/F arteries do not anastomose in the lid

A

F; they do anastomose in the lid

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43
Q

The facial system has arterial supply from the _____ carotid artery

A

external

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44
Q

The orbital system has arterial supply from the _____ carotid artery

A

internal

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45
Q

What two systems are there for the venous drainage

A

superficial (pre tarsal) system, deep (post tarsal) system

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46
Q

_____ and ______ are provided with lymphatics

A

lid and conjunctiva

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47
Q

What are the 2 lymphatics systems of the eyelid

A

superficial or pretarsal plexus; deep or post tarsal plexus

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48
Q

Paralysis of the cranial nerve ______ causes a brow to be lower on the affected side

A

7

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49
Q

What is the difference between ptosis and paralysis of CN 3

A

ptosis is a weakness of the upper eyelid; paralysis is a complete closure of the upper eyelid

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50
Q

Which EOMs are supplied with CN 3

A

MR, IR, SR, IO

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51
Q

Why wouldn’t a patient with 3rd nerve palsy have diplopia

A

They would have diplopia but the patient

52
Q

If there is complete paralysis from third nerve palsy would the patient complain of diplopia

A

no; because it is complete paralysis and the eyelid is completely closed

53
Q

If you were to manually open the upper eyelid of a third nerve palsy patient would they complain of diplopia

A

yes; because the EOMs are not working well

54
Q

______ paralysis causes minor ptosis in mueller’s muscles and is one of the components of _____ syndrome

A

sympathetic; Horner’s syndrome

55
Q

Weak solutions of ____ causes reversal of ptosis _____ to sympathetic paralysis

A

epinephrine; secondary

56
Q

T/F will epinephrine topical can work on a normal person

A

F; it can only work on a sympathetic paralysis which causes ptosis

57
Q

What three symptoms goes with Horner’s syndrome

A

Ptosis (droopy eyelids), miosis (state of pupillary constriction), anhydrosis (reduced facial sweating)

Usually Horner’s happens on one side of the face

58
Q

What does the corrugator supercilli do

A

pulls eyebrow together frown

59
Q

The _____ muscle raises brow in expression of surprise and is oriented _____ over the forehead

A

frontalis; radially

60
Q

______ muscles of the eyebrow has a ____ action and closes the eyelid

A

obicularis oculi and sphincter

61
Q

In Bell’s phenomenon the globe turns _____ as the eyelids are ____

A

upward; closed

62
Q

T/F bell’s phenomenon is found during reflex blinking

A

F

63
Q

If a patient does not have good bell’s phenomenon what can that cause

A

they will have exposure to the cornea and could cause drying of the cornea

64
Q

Reflex blinking is activated by what 4 things

A

touch, strong lights, approaching objects and loud noise, corneal, conjunctival or cilliary touch

65
Q

Which type of sensations activate reflex blinking

A

tactile, optic and auditory

66
Q

________ reflex and _______ reflex are common optically initiated blink reflexes

A

dazzle; menace

67
Q

_______ and ______ reflexes are tactile in origin

A

corneal and cilliary

68
Q

Dazzle and menace reflex are initiated by the perception of what?

A

sudden motion in depth towards the eye

69
Q

What quantifies the corneal reflex

A

aesthesiometer

70
Q

T/F In CL wearers the tactile corneal reflex is not diminished slightly

A

F; it is diminished slightly

71
Q

Common clinical practice is to use a ______ filaments to touch the cornea without any associated optic stimulus

A

twisted wisp of sterile cotton (q-tip)

72
Q

What is reflex blinking versus blepharospasm

A

Reflex blinking - high speed response to tactile or propprioceptive (detects motion) stimuli;

Blepharospasm - slow sustained closure to nociceptive (pain) stimuli

73
Q

T/F Spontaneous blinking occurs on a regular basis with external stimulus

A

F; occurs on a regular basis without external stimulus

74
Q

What three things can spontaneous blinking change

A

level of visual acuity, emotional states and environmental conditions

75
Q

From a clinical point what can cause spontaneous blinking

A

computer users and any activity that involves increased attention (you have to remind yourself to blink)

76
Q

Spontaneous blinking is _____ or _______ in infants

A

extremely low; absent

77
Q

T/F spontaneous blinking is not present with blindness and is dependent on optic stimulation

A

F; spontaneous blinking is present despite blindness and does not depend on optic stimulation

78
Q

T/F During spontaneous blinking the lower lid moves

A

False; lower lid remains almost stationary most of movement by upper lid

79
Q

The palpebral fissure narrows in a _____ like motion ______ to _______

A

zipper; laterally; medially

80
Q

The tear strip moves towards what?

A

puncta

81
Q 
Spontaneous blink rate is \_\_\_\_\_\_\_ per min 
a) 15X
b)16X
C)17X
D)18X
A

15 x

82
Q 
Duration of a blink is \_\_\_\_ to \_\_\_\_\_\_ msec
a) 300-600
b)400-600
C)300-400
D)100-400
A

300; 400

83
Q 
Average time between blinks is \_\_\_\_\_
a) 3.0
b)2.8
C)2.6
D)2.5
A

2.8 sec

84
Q 
Obscuring visual input up to \_\_\_\_\_ msec is barely detectable 
a) 3.0
b)5
C)4
D)10
A

3; barely

85
Q 
Obscuring visual input for greater than \_\_\_\_\_\_ msec is \_\_\_\_\_\_ detectable 
a)10
b)20
C)15
D)30
A

30; easily

86
Q

Voluntary winking is _____ initiated closure of _____ eye

A

consciously; one

87
Q

Most people can wink freely with the _____ eye but not with the ______ eye.

What is that related to?

A

left; right

It is related to predominance of right handedness

88
Q

Blepharospasm is a _____ disorder of ______ control (obicularis muscle)

A

idiopathic; neuromuscular

89
Q

Blepharospasm results in

A

symmetrical, progressive, involuntary closure of both eyes

90
Q

Blepharospasm is dangerous during _____ procedure in which the globe is open.

Give two examples

A

Surgical;

1 .cataract extraction
2. corneal transplantation

91
Q

What is injected for temporary relief in blepharospasm patient

A

botox (botuliunum-A toxin) and is injected subcutaneously

92
Q

Blepharospasm ________ IOP

A

raises

93
Q

What is myokymia

A

fibrillary twitching of the eyelids

94
Q

Myokymia is aggravated by what 3 things

A

fatigue, thyrotoxicosis, psychological stress (most common)

95
Q

T/F Myokymia is not related to the more severe dystonias

A

T

96
Q

What is dystonias

A

invlountary muscle contraction and slow repetitive movement

97
Q

What is lagophthalmos

A

incomplete closure of the eye during sleep

98
Q

Lagophthalmos results in _____ and ______ exposure of the _____ portions of the cornea

A

desiccation; excessive; lower

99
Q

What is desiccation

A

state of extreme dryness

100
Q

T/F lagophthalmos can happen in a normal person or a common consequence of some diseases

A

T

101
Q

What is ectropion

A

a falling away of the lower lid away from the globe

102
Q

Ectropion is caused by _______ of the obicularis

A

weakness

103
Q

What can result from ectropion

A

epiphora (overflow of tears) and poor blink closure

104
Q

Describe senile ectropion

A

lower lid may sag away from the eye as the inferior portion of the obicularis loose tone

105
Q

loss of tone and loss of orbital fat deep to the eye due to age can cause what

A

senile ectropion

106
Q

What is the difference entropion and ectropion

A

Entropion is an anatomic defect; turning in of the eyelid

Ectropion is a pathologic condition; turning outward of the eyelid

107
Q

T/F Snap test can check the muscle tone of the lower lid

A

T

108
Q

Ectropion of the lower lid is commonly caused by flaccid paralysis of the ______ muscle in the CN ______ weakness of _______

A

obicularis; 7; bell’s palsy

109
Q

What is cicatrical entropion and why does it happen

A

caused by or related to scar tissue; happens because of trichiasis

110
Q

What is trichiasis

A

misdirected upper or lower eyelashes that turn inward towards the eyeball may scratch the cornea

111
Q

What disease may have entropion as a result of it

A

trachoma (chlamydia infection) and ocular pemphigoid (chronic blisterring and scarring of eyes)

112
Q 
The palpebral fissure vertically is \_\_\_\_\_\_ to \_\_\_\_\_\_\_ mm and \_\_\_\_\_\_\_ to \_\_\_\_\_\_ horizontally 
a) 8 -11, 27-30
b)2-9, 27-30
C)8-11, 40-50
D)2-9, 40-50
A

8- 11; 27-30;

113
Q

If there is forward displacement of the globe then _______ of palpebral fissure

A

widening

114
Q

large eye with shallow orbit is _____ globe with a _____ fissure

A

prominent; wider

115
Q

Abnormal recession of the globe into the orbit results in what

A

narrowing of the palpebral fissure

116
Q

T/F Any process that results in proptosis or forward movement of the globe within the orbit will produce widening of the palpebral fissure on that side

A

T

117
Q 
In exophthalmos the palpebral fissure measurements measured from \_\_\_\_ to \_\_\_\_ is obtained in normal subjects with a mean of \_\_\_\_\_\_ mm
a) 12-21 , 16
b)12-21, 17
C)9-10, 16
D)9-10, 17
The palpebral fissure measurements in thyroid eye disease have values ranging from \_\_\_\_\_ to \_\_\_\_\_ with a mean of \_\_\_\_\_\_ mm 
a) 12-24, 18
b)12-24, 19
C)12-21, 16
D)12-21, 17
Measurements of greater then \_\_\_\_\_ was found in only \_\_\_\_\_\_ % of normals while \_\_\_\_\_% of those with thyroid eye disease fell above this level 
a) 19, 5-32
b)19, 10-15
C) 21, 5-32
D)21, 10-15
A

A)12; 21; 16

B)12; 24; 19

19; 5; 32

118
Q

What is the principal component in the apparent exophthalomos of eye disease

A

the degree lid retraction

119
Q

In what disease is exophthalmos seen

A

thyroid

120
Q

T/F exophthalmometry measurements are not similar to normal patients

A

F; they are similar to normal patients

121
Q

What type of fissure measurements are better in exophthalmos patients

A

vertical

122
Q

retraction of the ___ eyelid causes a _____ palpebral fissure

A

upper; widening

123
Q

What is thyrotoxicosis

A

means an excess of thyroid hormone in the body

124
Q

What two clinical signs signal hypothyroidism?

A

Collier’s sign - retraction of the upper lid

Von Grafe’s sign - delay of movement of the upper lid when shifting gaze from up to down causes a staring expression

125
Q
  1. True of False: In Thyrotoxicosis, Collier’s Sign is the delay of movement of the upper lid when shifting gaze from up to down, causing a widening of the palpebral fissure & a staring expression.
A

F , Von’s grafes sign

OCULAR PHYSIOLOGY (13 decks)

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