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Advanced Principles B (Summer '24) > Head & Neck Surgery: Eyes (Exam II) > Flashcards

Head & Neck Surgery: Eyes (Exam II) Flashcards

1
Q

Eye Anatomy placeholder

A
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2
Q

What produces the aqueous humor?

A

Ciliary body

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3
Q

What artery perfuses the majority of the orbital structures?
Where does this artery branch off from?

A

Opthalmic artery (branches off the internal carotid).

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4
Q

Where does the opthalmic vein drain?

A

Cavernous sinus

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5
Q

Which CN transmits neural signals from the retina?

A

Optic Nerve (CN II)

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6
Q

Which cranial nerves control extraocular muscle movement?

A
  • III (Oculomotor)
  • IV (Trochlear)
  • VI (Abducens)
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7
Q

Which CN transmits pain and touch sensations of the eye?

A

Trigeminal (V)

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8
Q

Which CN innervates the orbicularis muscle via its zygomatic branch?

A

VII (Facial)

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9
Q

Blockade of the facial nerve would prevent what?

A

Accurate TOF assessment of the orbicularis oculi

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10
Q

What provides sensation to the upper and lower eyelids?

A
  • Upper - frontal branch of ophthalmic nerve
  • Lower - maxillary nerve
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11
Q

What is normal intraocular pressure?

A

10 - 20 mmHg

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12
Q

> ____ mmHg is a pathological intraocular pressure.

A

> 25 mmHg

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13
Q

Quantity of _____ fluid and ______ blood volume help regular IOP.

A

aqueous fluid : choroidal blood volume

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14
Q

Which two anesthesia “things” have the greatest effect on IOP?

A
  • Laryngoscopy
  • Emergence
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15
Q

Coughing, straining, and vomiting can result in a _______ mmHg increase in IOP.

A

30 - 40 mmHg

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16
Q

How will CO₂ affect IOP?

A

Hypercapnia = ↑IOP via choroidal congestion

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17
Q

Hypoxia and hypertension will ↓IOP. T/F?

A

True

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18
Q

What common anesthetic drugs are known intraocular pressure increasing drugs?

A
  • Succinylcholine
  • Neostigmine
  • Atropine
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19
Q

How much does IOP increase with sugammadex?

A

Trick question. Sugammadex does not increase IOP.

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20
Q

Ocular blocks will increase IOP by 5 - 10 mmHg. Which block will cause the greatest increase?

A

Peribulbar blocks

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21
Q

A forceful squeeze of our eyelids can increase IOP by _____ mmHg.

A

> 70 mmHg!

Normal blink is 10 mmHg.

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22
Q

What common anesthetic drugs decrease IOP?

A
  • VAA
  • IV anesthetics
  • Short-acting opioids
  • Mannitol

Depression of CNS ocular centers = relaxation of extraocular tone.

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23
Q

What effect do midazolam, nitrous oxide, and non-depolarizing neuromuscular blockers have on IOP?

A

No change

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24
Q

What is another name for the oculocardiac reflex?

A

Trigeminovagal Reflex

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25
Q

What are the triggers for the oculocardiac reflex?

A
  • Traction on the extraocular muscles. Especially the medial rectus.
  • Pressure on the globe
  • Retrobulbar block
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26
Q

What surgery is the oculocardiac reflex seen in most frequently?

A

Strabismus repair of pediatric patients.

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27
Q

What are non-pharmacologic treatments of the oculocardiac reflex?

A
  • STOP surgery
  • Correct hypercapnia and/or hypoxia
  • Prevention/pretreatment
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28
Q

What are the pharmacologic treatments for oculocardiac reflex?

A
  • Atropine 7-10 mcg/kg IV
  • Glycopyrrolate 0.2 mg IV
  • LA in the rectus muscle
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29
Q

Open Angle Glaucoma is a ______ condition.

A

chronic

30
Q

_____ _____ _____ causes chronic pressure elevation and development of open angle glaucoma.

A

Trabecular meshwork sclerosis

31
Q

How painful is the development of open angle glaucoma?

A

Gradual and painless

32
Q

What are the treatment goals of open angle glaucoma?

A
  • ↓ IOP
  • ↓ aqueous humor production
  • Trabeculectomy/trabeculoplasty
33
Q

Acute dilation of the iris with obstruction of aqueous drainage is…

A

Closed angle glaucoma

Very painful.

34
Q

What is the treatment for closed angle glaucoma?

A

Iridotomy

35
Q

How quickly must iridotomy be performed for closed angle glaucoma?

A

< 24 hours

36
Q

_______ drugs MUST be avoided in closed angle glaucoma patients.

A

Anticholinergic Drugs

  • Scopolamine
  • Antihistamines
  • Decongestants
  • Antidepressants
  • Benzodiazepines
  • Ipatropium bromide
37
Q

What carbonic anhydrase inhibitor is used for the treatment of chronic glaucoma?

A

Acetazolamide

38
Q

What two common side effects are seen from acetazolamide?

A
  • Hypokalemia
  • PONV
39
Q

What type of drug is Echothiophate?
What condition does it treat & how?

A
  • Anticholinesterase inhibitor
  • Treats glaucoma by maintaining miosis
40
Q

Excess echothiophate can result in what?

A
  • Systemic plasma cholinesterase inhibition

Caution with succinylcholine and ester LA’s

41
Q

Phenylephrine using topically on the eye does what?

A

Dilates the eye

2.5% vs 10%

42
Q

What drugs are used intraoperatively after lens extraction to induce pupillary constriction?

A
  • Pilocarpine
  • Acetylcholine
43
Q

What is timolol used for?

A

Glaucoma via ↓ aqueous humor production

non-selective β1 blocker.

44
Q

What possible side effects does timolol have?

A
  • ↓ HR
  • Bronchospasm
  • CHF exacerbation
45
Q

What type of drug is netarsudil?

A

Rho Kinase inhibitor

Treats glaucoma.

46
Q

What is a cataract?

A

Opacity of the lens of the eye

47
Q

What type of anesthesia is used for cataracts?

A
  • Topical
  • Regional
  • Minimal/No IV anesthesia
48
Q

What procedure is defined by the replacement of an infected/traumatized or poorly optical cornea?

A

Keratoplasty

49
Q

How is a low and stable IOP maintained with a keratoplasty?

A

Mannitol (used because of lasting effects, 5-6 hours)

50
Q

Is topical anesthesia an option for keratoplasty?

A

No.

  • GETA typically
51
Q

What are the advantages to regional anesthesia for keratoplasty’s?

A
  • Perioperative analgesia
  • Akinesia
  • No oculocardiac reflex
  • ↓ PONV
52
Q
A

Succinylcholine

Echothiophate causes plasma cholinesterase inhibition.

53
Q

What is a trabeculectomy performed for?

A

Refractory glaucoma

Excision of trabecula to increase drainage of aqueous humor & ↓IOP.

54
Q

What two drugs are used in a trabeculectomy to prevent flap scarring and increase surgical success?

A
  • Mitomycin-C
  • 5-FU
55
Q

What is surfer’s eye?

A

Ptyergium = triangular piece of fibrovascular tissue

56
Q

________ is used to prevent recurrence after ptyergium excision.

A

Mitomycin-C

57
Q

What is Ectropion?

A
58
Q

What is Entropion?

A

Eyelid turning inward

59
Q

What is blepharoplasty?

A

Correction of defect, deformity, or disfiguration of eyelids

60
Q

What is ptosis?

A

Drooping upper eyelid

61
Q

What is strabismus?

A

Misalignment of visual axis
- Double vision (Diplopia)

62
Q

What conditions is strabismus associated with?

A
  • Trisomy 21
  • Cerebral Palsy
  • Hydrocephalus
  • Malignant Hyperthermia
  • Myotonic Dystrophy
63
Q

Describe the postoperative pain and nausea/vomiting after strabismus repair.

A
  • No severe post-operative pain
  • PONV is significant (50 - 80%)
64
Q

What pain control strategies are used for strabismus repair?

A
  • Ketorolac (minimize opioids)
65
Q

What drug is added to local anesthetic injectate to prevent damage to the extraocular muscles?

A

hyaluronidase

66
Q

What block provides akinesia of the CN II, III, and VI and a sensory block of the conjunctiva and cornea?

A

Retrobulbar block

67
Q

What are possible complications of retrobulbar block?

A
  • Hematoma
  • Optic nerve injury
  • Globe perforation
68
Q

Which cranial nerves are blocked with a peribulbar block?

A
  • CN III & CN VI
  • CN II is not blocked.
69
Q

What complication is avoided with a peribulbar block vs a retrobulbar block?

A

Retrobulbar hemorrhage

70
Q

What topical anesthetic is used for eye surgeries?

A

0.5% proparacaine

71
Q

What is blocked (and not blocked) with topical proparacaine?

A

Blocked:
- Conjunctive, cornea, and sclera

Not Blocked:
- Iris & ciliary body

Advanced Principles B (Summer '24) (8 decks)

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