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Head N Neck > Lecture 11 - Anatomy + Eye Conditions > Flashcards

Lecture 11 - Anatomy + Eye Conditions Flashcards

1
Q

What is the shape of the orbital cavity and how is it orientated?

A

Pyramidal
Apex pointing posteriorly
Base of pyramid superficial/anterior

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2
Q

Look at the last slide on image 8:

Label all the bones contributing to the bony orbit

A

1 = frontal
2 = sphenoid
3 = lacrimal
4 = ethmoid
5 = maxilla
6 = Zygomatic

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3
Q

What forms the medial wall of the orbital cavity?

A

Ethmoid
Lacrimal

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4
Q

What forms the lateral wall of the orbital cavity?

A

Zygomatic
Sphenoid

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5
Q

What forms the floor of the orbital cavity?

A

Maxillary bone
+
Zygomatic

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6
Q

What forms the roof of the orbital cavity?

A

Frontal bone

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7
Q

What are the 2 weakest parts of the orbital cavity?

A

Floor = maxillary + zygomatic

Medial wall = ETHMOID + lacrimal

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8
Q

Why can acute sinusitis involving the ethmoid sinus spread into the orbit?

A

The ethmoid is extremely thin

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9
Q

How can infection spread from the orbit out?

A

Tears drain via nasalacrimal duct from the orbit to the nasal cavity q

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10
Q

What sinus forms the floor of the orbit?

A

Maxillary air sinus

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11
Q

What is an orbital blow out fracture?

What causes it?

A

When there’s a sudden increase in Intra-orbital pressure from trauma to the eye/orbit

Fracture to the orbital floor (MAXILLA)

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12
Q

What is the most common part of the orbit to fracture in an orbital blowout fracture?

A

Maxilla (floor of orbit)

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13
Q

What is usually visible on a CT head of an orbital blow out fracture?

A

Orbital contents prolapse and bleed into maxillary sinus

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14
Q

Why do patients often have double vision worsened with upward gaze in orbital blowout fractures and periorbtal swelling?

Numbness over cheek, lower eye lid and upper lip on that side?

A

The muscles and soft tissues get stuck in fracture site preventing upward gaze

Numbness = infra orbital nerve can be damaged

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15
Q

What nerve does the infra-orbital nerve branch from?

Why can this be damaged in an orbital blow out fracture?

A

Maxillary division of the Trigeminal nerve (Vb)

Infraorbital nerve runs through the infraorbital Foramen of the maxillary bone

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16
Q

Look at the last slide and view the Head CT labelled 9:

What is this indicative of?
What can you see?

A

This is the anterior cranial fossa

This is a left sided orbital blowout fracture
Can be seen that the contents of the orbit have herniated into the maxillary sinus (since the black air isn’t visible)

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17
Q

What typically causes a orbital blowout fracture?

A

Punch/ball to face

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18
Q

How is orbital blowout fractures managed?

A

CT orbit
Avoid nose blowing, valsalva manoeuvres and driving till Diplopia gone

Surgical repair if symptoms persist after 2 weeks

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19
Q

What are the 3 main openings in the orbital cavity?

A

Optic canal
Superior orbital fissure
Inferior orbital fissure

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20
Q

What nerves run through the optic canal?

What blood vessels?

A

CN II (Optic nerve)

Artery = ophthalmic artery

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21
Q

What nerves run through the superior orbital fissure?

What blood vessels?

A

CN III, IV, Va and VI
(All the muscles moving the eye nerves and sensory of surface of eye Va)

Vein = superior ophthalmic vein which communicates with the cavernous sinus

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22
Q

What nerves run through the inferior orbital fissure?

Where does this nerve exit?

What blood vessels?

A

Infraorbital nerve which is a branch of the Maxillary division of Trigeminal (Vb)
Infraorbital then leaves orbit via Infraorbital Foramen

Vein = inferior opthalmic vein

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23
Q

What nerve is responsible for detecting pain from a wood chip hitting the eye?

A

Ophthalmic division of the Trigeminal nerve (Va)

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24
Q

What is the orbital septum?

A

Thin fibrous sheet of tissue that originates from the orbital rim that separates the Intra-orbital contents from muscle and subcutaneous tissue of eyelid

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25
Q

What is the important immune function of the orbital septum?

A

Acts as a barrier to stop infection spreading from the superficial eyelid area (pre-septal) into the orbital cavity proper

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26
Q

What is a pre-septal infection of the superfical eyelid region called?

A

Periorbital/preseptal cellulitis

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27
Q

What is a post-septal infection of the orbital cavity proper called?

A

Post-septal cellulitis

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28
Q

What is an infection called that is anterior to the orbital septum?

A

Pre-septal/Periorbital cellulitis

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29
Q

What is an infection called that is poster to the orbital septum?

A

Post-septal/orbital cellulitis

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30
Q

What can cause peri-orbital cellulitis?

A

Secondary to superficial infections from bites or wounds

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31
Q

How does Periorbital cellulitis present?

A

Around eye can be swollen
Painful

BUT ocular function (eye movements and vision are FINE)

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32
Q

How does orbital (post-septal) cellulitis present?

A

Proptosis/exophthalmous (eye pushed towards in orbital cavity)

Reduced and painful eye movements
Reduced visual acuity

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33
Q

Why do patients with orbital cellulitis have painful eye movements and/or reduced visual acuity?

A

The exudate fluid/inflammation increases the Intra-orbital pressure compressing the optic nerve since the infection is postseptal/ in the orbit

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34
Q

Where can an orbital cellulitis spread to which is dangerous?

A

Can spread intracranially:
-cavernous sinus (then cause thrombosis)
-meningitis

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35
Q

What makes up the eye lids?

A

Skin
Subcutaneous tissue
Muscles
Tarsal plate

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36
Q

What are the 2 key muscles that run in the eyelid?

A

Orbicularis oculi (Palpebral part)

Levator Palpebrae superioris

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37
Q

What is the innervation and function of orbicularis oculi?

A

CN VII

Closes the eyelid

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38
Q

What is the innervation and function of Levator palpebrae superioris?

A

Retracts eyelid

CN III (occulomotor) and sympathetic fibres (smooth muscle part)

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39
Q

What does the levator palpebrae superioris insert into?

A

Tarsal plate and orbital septum

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40
Q

Go to the last slide and label image 1:

A

1 = Orbicularis oculi
2 = levator palpebrae superioris
3 = tarsal plate

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41
Q

What are the 2 types of glands located int he eye lids?

A

Meibomian glands

Glands associated with lash follicle

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42
Q

Where are meibomian glands located in the eyelids?

Go to last slide and label image 2:

A

In the tarsal plate

1 = meibomian glands in tarsal plate
2 = glands associated with hair follicle

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43
Q

What is the function of the Meibomian glands?

A

Modified sebaceous gland

Provide lipid layer of tear film
Preventing tear evaporation and spillage over lid

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44
Q

What is the function of the glands associated with lash follicles?

A

Sebaceous secreting oily substance

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45
Q

What are the 2 types of eyelid lumps?

A

Stye
Meibomian cyst

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46
Q

What structure of the eyelid is normally involved in a Stye?

A

Glands associated with the hair follicles

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47
Q

How does a Stye present?

A

Outer margin of eyelid

PAINFUL

Red with white punctum

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48
Q

What is usually the cause of a Stye ?

What is the treatment?

A

Infection of glands associated with hair follicles (staphylococcus)

Warm compress / oral abx

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49
Q

What is a Meibomian cyst?

A

Blockage of Meibomian gland (NON INFECTIVE CAUSE)

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50
Q

How does a Meibomian cyst present?

A

PAINLESS

Gradually enlarging firm lump

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51
Q

How is a Meibomian cyst treated?

A

1/3 solve spontaneously

Surgical incision if needed

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52
Q

What is a good differential between a Stye and meibomian cyst?

A

Stye = Painful lump on edge of eyelid

Meibomian cyst = PAINLESS lumb deeper in the eyelid

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53
Q

What is Blepharitis?

A

Inflammation of the whole eyelid margin

54
Q

How does blepharitis present?

A

Dry, crusty, itch swollen and red eyelids

55
Q

What can cause Blepharitis?

A

Staphylococcus infection of glands
Meibomian gland dysfunction

56
Q

How is Blepharitis treated?

A

Warm compress
Lid hygiene

57
Q

Go to the last slide and label image 3:

A

1 = lacrimal gland
2 = optic nerve
3 = ophthalmic nerve
4 = ophthalmic vein

58
Q

What are the 3 layers of tear film?

A

Oily
Water
Mucus

59
Q

What produces the oily component of the tear film?

A

Meibomian glands

60
Q

What produces the watery component of the tear film?

A

Lacrimal Gland

61
Q

What produces the mucus component of the tear film?

A

Conjunctiva (goblet cells)

62
Q

What 3 apparatus form the tear film?

A

Meibomian glands
Lacrimal glands
Conjunctiva

63
Q

Why is blinking useful?

A

Distributes tear film across surface of eye rinsing and lubrication the conjunctivae and cornea

64
Q

Where are the lacrimal glands located?

A

Top lateral side of each eye

65
Q

Describe the movement of tear film :

A

Made by lacrimal gland
Moves across eye, drained into a hole called the Lacrimal Punctum
Hole leads to Lacrmial canaliculi which drain into the lacrimal sac and down the NASOLACRIMAL DUCT

66
Q

What structures hold the eyeball in place?

A

Suspensory ligament
6 extra ocular muscles
Orbital fat

67
Q

What is a common sign that a retrobulbar/retro orbital pathology has occured?

What is the medical term for this?

A

Globe/eyeball displaces anteriorly

Proptosis/exophthalmos

68
Q

What is the difference between Proptosis and exophthalmos?

A

Proptosis = anterior displacement of an organ

Exophthalmos = anterior displacement of eye ball

69
Q

What part of the eye is affect by autoantibodies in Graves’ disease causing Proptosis of the eye (exophthalmos)?

A

Retroorbital tissues

70
Q

What is the transparent membrane called that covers the entire surface of the eye except for over the cornea?

A

Conjunctiva

71
Q

What is the conjunctiva?

A

Mucus membrane that has blood vessels within it

72
Q

How are the conjunctiva structured?

A

Reflects onto inner surface of the eyelids stopping you losing contact lenses behind your eye

73
Q

What is the junction between the sclera and the cornea called?

A

Limbus

74
Q

What are the 2 types of painless causes of a red eye?

A

Conjunctivitis

Subconjunctival haemorrhage

75
Q

What is conjunctivitis?

A

Uncomfortable gritty PAINLESS feeling of the eye making it RED

Usually accompanied by a watery discharge

76
Q

What is the main cause of conjunctivitis?

What are some other causes?

A

Virus infection

Bacterial infection
Allergic

77
Q

How does conjunctivitis caused by a virus present differently to a bacterial infective conjunctivitis?

A

Virus = water discharge

Bacteria = thick purulent discharge

78
Q

How is conjunctivitis managed?

A

Self limiting

Don’t share towels and wash hands since Very contagious

79
Q

What is a subconjunctival haemorrhage and how does it present?

A

Small bleed between conjunctiva and sclera

Bloody eye
Painless

80
Q

Go to the last slide and fill out the condition seen in image 4:

A

Sub conjunctival haemorrhage

81
Q

How many layers does the eyeball have?

A

3 layers

82
Q

What makes up the 3 main layers of the eye?
Outermost to innermost

A

Sclera
Choroid
Retina

83
Q

What is the sclera?

A

The white of the eye that is continuous with the dura (meningeal layer) of the optic nerve

84
Q

What structure does the sclera become as it moves anteriorly of the eyeball?

A

Transparent CORNEA

85
Q

What is the choroid of the eye?

A

The vascular layer of the eye

86
Q

What structures are continous with the choroid?

A

Ciliary body
Iris

87
Q

What is the term given to the collective of the choroid + ciliary body + iris?

A

Uveal tract

88
Q

What suspends the lens?

A

Suspensory ligaments

89
Q

How do the central retinal artery and vein reach the eye?

A

The run through the middle of the optic nerve to supply the Retina

90
Q

What is the optic disc?

A

Area where there are no photoreceptors

91
Q

What is the retina?

A

Region with photoreceptors

Is continuos with the optic nerve

92
Q

Go to the last slide and label image 5:

A

1 = sclera
2 = choroid
3 = retina
4 = ciliary body
5 = iris
6 = pupil
7 = suspensory ligaments
8 = macula
9 = optic disc
10 = central retinal artery and vein
11 = optic nerve

93
Q

What are some condition causing PAINFUL acute red eye?

A

Acute closed angle glaucoma
Scleritis
Keratitis
Corneal injury (abrasion, ulcer)
Uveitis

94
Q

How can a corneal ulcer be seen?

A

Add Fluor in dye then view under blue light
Defect appears in green

95
Q

What is Keratitis?

A

Inflammation (infective or non infective cause) of cornea

96
Q

What is Scleritis?

A

Inflammation of sclera

INTENSE PAIN

97
Q

What is Uveitis?

A

Inflammation of the iris

98
Q

How is uveitis normally treated?

A

Anti inflammatories
Steroids

99
Q

When is pain with uveitis worse?

A

Reading or bright light

100
Q

When a patients looks up with scleritis why can you see a blue patch in the sclera?

A

Thin sclera exposes choroid

101
Q

What are the 2 substances that fill the eye?

A

Aqueous humor = watery

Vitreous Humor = firm jelly like

102
Q

Where is aqueous humor (watery) located?

A

Between lens and cornea

103
Q

Where is vitreous (jelly like) humor located??

A

Posterior to lens in contact with the retina

104
Q

There are 2 chambers where aqueous humor is located, where are these 2 chambers?

A

Anterior chamber = between cornea and iris

Posterior chamber = between iris and lens

105
Q

Where is aqueous humor produced?

A

In the posterior chamber by the ciliary bodies

106
Q

Where does the aqueous humor drain?

A

At a canal at the iridocorneal angle
Angle between the iris and the cornea

107
Q

Describe the movement of aqueous humor from production to drainage:

A

Made by ciliary body
Moves from posterior chamber to anterior chamber
Goes to iridocorneal angle
Drains into trabecular mesh work in the canal of schlemm

108
Q

What is Glaucoma?

A

Damage to the optic nerve (CN II) due to raised Intra-ocular pressure

109
Q

What causes Acute Glaucoma?

A

Acute closed angle Glaucoma

When there’s an acute narrowing of the iridocorneal angle
Leads to intraoccular rapidly rising

110
Q

How does Acute closed angle glaucoma present?

A

Older patients

Acutely PAINFUL RED eye with BLURRED vision

Irregular oval shaped fixed pupil (iris pushed forward)

Nausea and vomiting (happens with IOP)

111
Q

Why is acute angle closure glaucoma an ophthalmological emergency?

A

Its sight threatening
If not treated with either drugs or surgery rapidly will have irreversible sight loss

112
Q

What causes chronic glaucoma?

A

Where the trabecular mesh work leading into the canal of schlemm gets slowly degraded with age

This leads to aqueous humor building up in eye very slowly so IOPP raises very slowly

113
Q

How does chronic glaucoma present?

A

Gradual loss of peripheral vision since the IOP slowly rises since the iridocorneal angle is still open but the trabecular meshwork is slowly degenerating

114
Q

What is the optic cup?

A

The bright light seen in the eye within the optic disc

115
Q

What is an indicator w.r.t the optic cup of GLaucoma?

A

Increased optic cup:disc ratio on fundoscopy

116
Q

What is the point on the retina with the point of highest visual acuity/central vision?

A

Macula (+fovea)

117
Q

What is the fovea?

A

Area within the macula that is the thinnest layer of the retina where there are lots of cones present

118
Q

What are the 2 types of photoreceptors in the retina?

A

Rods
Cones

119
Q

How are cones and rods and retinal ganglion cells structured in the retina?

A

Retinal ganglion cells nearest to vitreous humor which are the axons of the optic nerve

Rods and cones deepens layer

120
Q

Go the last slide and label the fundoscopic image labelled 6:

A

1 = macula densa
2 = optic disc
3 = retinal artery
4 = retinal vein

121
Q

What is the most common cause of blindness in the UK?

A

Macula degeneration

122
Q

What is macula degeneration?

A

Bilateral degeneration of the macula (thins and atrophy’s)

Leads to gradual but noticeable loss of central vision

123
Q

What is the main artery supplying the orbit and eye?

What branch of this sublimes the retina?

A

Ophthalmic artery

Central retinal artery

124
Q

What structure does the central retinal artery run through?

A

Optic nerve

Had to penetrate through meningeal layers

125
Q

What 2 blood supplies does the retina need in order to function?

A

Central retinal artery

Underlying vascular choroid layer (fed by ciliary arteries)

126
Q

How does Central Retinal Artery Occlusion present?

What causes it?

A

Sudden painless loss of visions in one eye

Caused by embolus blocking central retinal artery

127
Q

How can Central Retinal Artery Occlusion be detected on Fundoscopy?

A

The retina is pale due to ischaemia

Causes RED CHERRY SPOT MACULA (very obvious due to paler ischaemic retina)

128
Q

What is the main venous drainage of the orbit and the eye?

A

Ophthalmic veins (superior and inferior)

129
Q

Where do t he superior and inferior ophthalmic veins drain too and why is this a concern with orbital infections?

A

Cavernous sinus

Means orbital infections can spread intracranially

130
Q

Go the last slide and label the image labelled 7:

A

1 = superior ophthalmic vein
2 = inferior ophthalmic vein
3 = to cavernous sinus)
4 = facial vein

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