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Anatomy & Physiology 2 > Lids & Conjunctiva > Flashcards

Lids & Conjunctiva Flashcards

1
Q

What are the functions of the eyelid?

A
  1. Protection (from light entering the eye, direct trauma, air particles)
  2. Lubrication (distributes tear film, provides comfort, removes debris)
  3. Globe Position (maintains position in orbit with conjunctiva)
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2
Q

What are the layers of the eyelid?

A
  1. Skin
  2. Subcutaneous tissue (very little fat)
  3. Orbicularis oculi
  4. Orbital septum and tarsus
  5. Levator palpebrae superioris (upper lid only)
  6. Smooth muscle
  7. Conjunctiva

SSOOLSC

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3
Q

How many layers of the eyelid are there?

A

Seven

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4
Q

What is the grey line of the eyelids?

A

The gap between lamellae

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5
Q

What is the lamallae in contact with?

A

The palpebral conjunctiva

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6
Q

What conjunctiva is in contact with the eye?

A

The orbital conjunctiva is between the tarsal plate and the fornix

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7
Q

What is the lamellae?

A

A thin layer of the lid that’s separated into anterior and posterior by the grey line

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8
Q

What’s included in the anterior lamella?

A

Skin and Orbicularis

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9
Q

What’s included in the posterior lamella?

A

Tarsus and Conjunctiva

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10
Q

What’s the orbicularis oculi?

A

Concentric bands of striated muscle

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11
Q

What cranial nerve innervates the orbicularis oculi?

A

The facial nerve through the Temporal and Zygomatic branch

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12
Q

What is the orbicularis oculi responsible for?

A

Involuntary blinking, voluntary closing and tear drainage

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13
Q

What is the orbicularis oculi divided into?

A

Orbital, Palpebral and Lacrimal portions

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14
Q

What is the palpebral portion of the orbicularis oculi divided into?

A

Pre-septal and Pre-tarsal

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15
Q

What’s strongly attached to the orbicularis oculi?

A

Medial and lateral canthal tendons

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16
Q

What are the different portions of the orbicularis oculi responsible for?

A

Orbital - acts like purse string to strongly close the eye like in bright light

Palpebral - voluntary and involuntary closure of lids such as blinking and sleep

Lacrimal - draw lids and lacrimal papillae medially, dilate lacrimal sac during blinking

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17
Q

What is the orbital portion of the orbicularis oculi responsible for?

A

Orbital - acts like purse string to strongly close the eye like in bright light

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18
Q

What is the palpebral portion of the orbicularis oculi responsible for?

A

Palpebral - voluntary and involuntary closure of lids such as blinking and sleep

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19
Q

What is the lacrimal portion of the orbicularis oculi responsible for?

A

Lacrimal - draw lids and lacrimal papillae medially, dilate lacrimal sac during blinking

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20
Q

What’s the ciliary muscle in the orbicularis oculi also known as?

A

Muscle of Riolan

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21
Q

What’s the muscle of Riolan also known as?

A

Ciliary muscle (not the intra-ocular ciliary muscle)

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22
Q

What is the ciliary muscle / muscle of Riolan of the orbicularis oculi?

A

It’s at the lid margin consisting of a small group of very fine muscle fibres

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23
Q

What is the function of the ciliary muscle or muscle of Riolan?

A

To allow apposition and touching of the eyelids when we close our eye

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24
Q

What’s the orbital septum and extension of?

A

The orbital septum is an extension of the periosteum from orbital roof and orbital floor

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25
Q

What’s the function of the orbital septum?

A

To separate the lids from orbit, it’s clinically significant (pre-septal vs. orbital cellulitis). Very thin but has a huge protective function

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26
Q

What does the orbital septum separate?

A

The orbital septum separates the anterior and posterior lamellae

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27
Q

Where does the LPS originate?

A

Lesser wing of the Sphenoid

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28
Q

Where does the LPS insert?

A

Into the upper lid skin via aponeurosis

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29
Q

What’s the role of the LPS?

A

Elevation and retraction of the upper lid

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30
Q

What’s the anatomical site of where neurosis begins to form?

A

Whitnall ligament

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31
Q

What’s an aponeurosis?

A

An aponeurosis is a thin sheath of connective tissue that helps connect your muscles to your bones. Aponeuroses are similar to tendons. They support your muscles and give your body strength and stability. Tough tissue.

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32
Q

What is Whitnall’s ligament?

A

Whitnall’s ligament was first described in 1910 by Dr. Samuel Ernest Whitnall as a superior transverse ligament above the musculotendinous junction of the levator palpebrae superioris.[1][2] It is formed by a collection of muscle sheaths from the levator palpebrae superioris muscle that assemble into a ligament in the area where the levator palpebrae muscle becomes an aponeurosis.

It attaches to the superior rectus muscle tendon sheath, the medial side of the trochlea, and to the lateral orbital margin

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33
Q

What is Whitnalls ligament also known as?

A

Superior Transverse Ligament

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34
Q

What does the Superior Transverse Ligament/Whitnalls ligament form?

A

Aponeurosis

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35
Q

What division of CN III is the LPS part of?

A

Superior Division

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36
Q

What is blood to the LPS supplied by?

A

Ophthalmic and supraorbital arteries supply the LPS

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37
Q

What’s the superior tarsal muscle also called?

A

Muller’s Muscle

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38
Q

What is Muller’s Muscle also known as?

A

The Superior Tarsal Muscle

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39
Q

Where does Muller’s Muscle originate?

A

From the LPS at the level of Whitnall’s ligament

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40
Q

Where does the Superior Tarsal Muscle insert?

A

Into the tarsal plate

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41
Q

What’s the role of Muller’s Muscle?

A

Elevates the upper lid

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42
Q

What is Muller’s Muscle muscle type?

A

Smooth muscle

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43
Q

Is Muller’s Muscle under sympathetic and parasympathetic innervation?

A

Sympathetic

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44
Q

What is the inferior tarsal muscle analogous with?

A

Muller Muscle but it’s in lower lid

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45
Q

What’s the major bulk of posterior lamellae?

A

Tarsal plates. Thick but thinner and rounded towards the end of the eyelid

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46
Q

What glands do the tarsal plates contain?

A

Meibomian glands that open at lid margin for oil secretion

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47
Q

What are the mm of the tarsal plates?

A

Upper = 10mm
Lower = 5mm (has fewer glands)

48
Q

How do the tarsal plates attach?

A

Skin moves freely over anterior surface, conjunctiva is densely adherent to posterior surface

Form the medial and lateral canthal ligaments which attach to maxilla and zygoma, respectively

49
Q

How big is the lid margin?

A

30mm x 2mm

50
Q

What is the lid margin separated into?

A

2 sections by lacrimal puncta:
Lateral - 5/6th square edged
Medial - 1/6th round edged without lashes. Water collects medially in the corner at the lacrimal lake.

51
Q

How is the lid margin organised from anterior to posterior?

A

Anterior to posterior:
Skin
Lashes (out of the anterior lamellae)
Grey line
Meibomian gland orifices
Mucocutaneous junction (anchoring point of the palpebral conjunctiva to the eyelid)
Conjunctiva

52
Q

What is epiphora?

A

Watery eyes (would be like a waterfall if the inferior puncta is blocked or not working).
This can irritate the skin which affects lower eyelids and cheekbones but also comprises vision.

53
Q

What is the role of the lashes?

A

Protection from debris and prevent film evaporation as a secondary function.
The tertiary function is glands that open to the eyelash and keep it supple being the Glands of Zeis and the Glands of Moll

54
Q

What are Meibomian glands?

A

Type of sebaceous gland in tarsal gland

55
Q

How many meibomian glands are there?

A

30 in the upper lid, fewer in the lower lid

56
Q

What do the meibomian glands secrete?

A

Meibum

57
Q

What is the function of meibomian glands?

A

To prevent evaporation of aqueous tear film

58
Q

What do blocked meibomian glands cause?

A

Chalazions & Hordealum

Chalazions = blocked meibomian glands that are not infective (so not tender or painful but can affect the skin on the eyelids).

If they’re infected then they become a stye (hordealum)

59
Q

How do you treat a stye or chalazion?

A

Stye = antibiotics
Need to tell them to have eyelid hygiene (how to clean them) and do a warm compress to the eye to relax the openings of the meibomian glands to allow evacuation of the content in them

60
Q

What are the Glands of Moll?

A

Modified apocrine sweat glands that help keep lashes supple

61
Q

What are the Glands of Zeis?

A

Sebaceous glands to lash follicles that also maintain quality of lashes (they open into hair follicles)

62
Q

What’s the corneal reflex?

A

When something touches the eye, we blink

63
Q

What is the receptor, afferent pathway, first synapse, second synapse, efferent pathway and effector muscle of the Corneal Reflex?

A

Receptor - Sensory ending in corneal epithelium

Afferent Pathway - Long ciliary nerves, nasociliary nerve, ophthalmic nerve

First synapse - Spinal nucleus of trigeminal

Second synapse - Facial nucleus

Efferent pathway - Temporal and zygomatic branches of facial nerve

Effector muscle - Orbicularis oculi

64
Q

What is the receptor, afferent pathway, first synapse, second synapse, efferent pathway and effector muscle of the ‘Blinking to light’ or fast-approaching object’?

A

Receptor - Retina

Afferent Pathway - Optic nerve

First synapse - Superior Colliculus

Second synapse - Facial nucleus

Efferent pathway - Temporal and zygomatic branches of facial nerve

Effector muscle - Orbicularis oculi

65
Q

What is the receptor, afferent pathway, first synapse, second synapse, efferent pathway and effector muscle of the ‘Blinking to noise’?

A

Receptor - Cochlea

Afferent Pathway - Vestibulocochlear Nerve

First synapse - Inferior Colliculus

Second synapse - Facial nucleus

Efferent pathway - Temporal and zygomatic branches of facial nerve

Effector muscle - Orbicularis oculi

66
Q

What causes blinking?

A

Autonomic control, variable frequency and speed, no clear stimulus

67
Q

What is Bells Palsy?

A

Facial nerve palsy with movement issues of the face. This can cause the cornea to dry out and perforate. If they have lagophthalmos (inability to close the eye) then they can lose vision

68
Q

What is Lagophthalmos?

A

An inability to close the eye

69
Q

How does Bells Palsy occur?

A

Facial nerve starts at the Pons, contralateral. Fibres cross into facial nerve nucleus which innervate facial muscles. However, uniquely, the facial nerve is ipsilateral and contralateral. A lower motor neurone lesion will affect the forehead but an upper motor neuron issue will not affect the forehead because the forehead has supply from both the contralateral and ipsilateral side. Part that controls forehead has info from both parts of the lower cortex (lower motor neurons). If someone presents with issues like this, first thing to do is to ask them to raise their forehead.

70
Q

What is Ectropion?

A

It’s an evolution outwards of the lower eyelid. Tear film is exposed to need surgery to correct for the tear film. It’s paralytic, cicatricial, mechanical and congenital causing tear film insufficiency, dryness and pain.

71
Q

What is Entropion?

A

Involution of the lower eyelid. Involution means age related. It’s spastic, cicatrical and congenital. It causes foreign body sensation, irritation, redness and may damage the cornea. Causes damage to the cornea every time you blink and can cause blindness. Look more up about this.

Cicatricial = can cause sparring due to mechanical rub and the eyelashes can rub against and introduce foreign bodies into the eye

72
Q

What’s Cicatricial?

A

Cicatricial = can cause sparring due to mechanical rub and the eyelashes can rub against and introduce foreign bodies into the eye

73
Q

What is the arterial blood supply pre and post-tarsal?

A

Pre-tarsal = superficial temporal and facial arteries (branches of external carotid artery)

Post-tarsal = Branches of ophthalmic arteries (branch of the internal carotid artery)

74
Q

What is the venous supply to the medial and lateral part of the eyelids?

A

Medial = Ophthalmic and angular veins

Lateral = Superficial temporal veins

75
Q

What are the lymphatics of the eyelid?

A

Follow venous drainage
Medial aspect = submandibular nodes
Lateral aspect = preauricular nodes

76
Q

Where does sensory innervation to the upper lid come from?

A

CN V - Ophthalmic

77
Q

Where does sensory innervation to the medial lower lid come from?

A

CN V - Ophthalmic

78
Q

Where does sensory innervation to the lateral lower lid come from?

A

CN V - Maxillary

79
Q

Where does sensory innervation from the lower lid come from?

A

Medial = Ophthalmic Nerve of CN V

Lateral = Maxillary Nerve of CN V

80
Q

What is the conjunctiva?

A

A thin, translucent membrane that attaches globe to lids.
Epithelium is continuous from the mucocutaneous junction all the way to the corneal limbus

81
Q

What are the functions of the conjunctiva?

A

Lubrication - contributes mucous part of the tear film

Reduces Friction - allows free movement of the lids

Immune Defense - contributes to protection of the eye

82
Q

What is the conjunctival anatomy?

A

Palpebral Conjunctiva -
Adherent to tarsal plate

Forniceal Conjunctiva -
Contains some lacrimal ducts

Bulbar Conjunctiva -
Overlies anterior globe and EOMs

Caruncula Lacrimalis -
Modified skin with volumes of accessory lacrimal and sebaceous glands

Plica Semilunaris -
Fold of conjunctiva rich in Goblet and Immune cells that may facilitate lateral movement

83
Q

Where is the conjunctiva stratified squamous and stratified columnar?

A

Epithelium varies by location and contains non-keratinized stratified squamous on palpebral part and is stratified columnar on the bulbar part

84
Q

How many cells are in the conjuctiva and what cells are in the conjuctiva?

A

3;
Goblet Cells
Immune Cells
Melanocytes

85
Q

What are the features of goblet cells?

A

Unicellular
Most in fornices and plica semilunaris
Produce majority of conjunctival mucins

86
Q

What are the features of immune cells?

A

Langerhans cells help prime immune response (antigen-presenting)
Lymphocytes

87
Q

What are the features of melanocytes?

A

Vary depending on race, contribute to pigmentation like light scattering in the eye. They can cause melanoma’s = skin cancer on and in the eye

88
Q

How is the conjunctiva supplied with blood?

A

Rich vascular network within stroma, similar to lids

Additionally some supply from anterior ciliary arteries

89
Q

How is the conjunctiva sensory innervated?

A

Palpebral part = mostly from CN V1

Inferomedial fornix and palpebral part = CN V2

Bulbar = long ciliary nerves

90
Q

What are the 2 types of glands in the conjunctiva?

A

Accessory lacrimal glands and mucus-secreting glands

91
Q

What are the names and locations of the accessory lacrimal glands of the conjunctiva?

A

Glands of Krause - in the superior fornix

Glands of Wolfring - in the superior tarsus

92
Q

What are the names and locations of the mucus-secreting glands of the conjunctiva?

A

Glands of Henle - scattered throughout the conjunctiva

93
Q

What divides the Lacrimal gland into palpebral and orbital?

A

Aponeurosis of the LPS

94
Q

What type of gland is the lacrimal gland?

A

Exocrine lobulated gland

95
Q

What artery supplies the lacrimal gland? Which vein drains it?

A

Lacrimal Artery & Superior Ophthalmic Vein

96
Q

Does the Lacrimal gland receive autonomic or sympathetic fibres?

A

Both

97
Q

Which nerve supplies sensation to the face?

A

Trigeminal Nerve

98
Q

Which nerve supplies movement to the face?

A

Facial Nerve

99
Q

What is the pterygopalatine ganglion?

A

Landmark of the lacrimal gland, becomes efferent fibres at the pterygopalatine ganglion of the parasympathetic pathway to the lacrimal gland. The nerves move together and damage to these nerves = dry eyes

100
Q

How do parasympathetic fibres reach the pterygopalatine ganglion via?

A

Lacrimal Nucleus –> Facial Nerve –> Greater petrosal nerve

101
Q

What is the parasympathetic supply to the lacrimal gland?

A

From facial nerve in the lacrimal nucleus/superior salivatory nucleus. Pre-ganglionic fibres are carried by the greater petrosal nerve and then the nerve of pterygoid canal to reach the pterygopalatine ganglion

102
Q

What is the “secretomotor” of the parasym supply of the lacrimal nerve?

A

Forms the efferent pathway of the lacrimal reflex (parasym supply is of “greater” importance than sympathetic = “Greater Petrosal Nerve”)

103
Q

How do post-ganglionic fibres leave the pterygopalatine ganglion?

A

Leave and piggyback on the maxillary nerve along the zygomatic branch and then reaches the lacrimal gland with the lacrimal nerve

104
Q

Where does the sympathetic supply of the lacrimal gland originate?

A

Superior cervical ganglion in the sympathetic chain

105
Q

In sympathetic nervous system which fibres are long and which are short?

A

Pre = Short
Post = Long

106
Q

Where do the post-ganglionic fibres of the sympathetic supply of the lacrimal nerve travel?

A

Deep petrosal nerve and then follow the same course

107
Q

Which gland is the responsible for baseline tear production?

A

Accessory Lacrimal Glands

108
Q

Which glands produce lipid layer of tears?

A

Meibomian, Zeis and Moll

109
Q

Which lubricates and aids in even distribution of tears?

A

Conjunctival Goblet Cells

110
Q

Which glands constantly produce aqueous?

A

The Accessory Lacrimal Glands

111
Q

What is the purpose of aqueous in tears?

A

Nourishes and hydrates and for immune defense

112
Q

What glands produce aqueous in tears?

A

Lacrimal and accessory lacrimal glands

113
Q

Which layers of tears are the most implicated in dry eye?

A

Lipid & Aqueous

114
Q

What can lipid layer dysfunction be secondary to?

A

Blepharitis (inflamed eyelid), aging or idiopathic = dry eyes

115
Q

What can cause Aqueous layer dysfunction?

A

Medications, allergies, trauma (chemical injuries), disease to lacrimal glands, Sjogren’s disease, rheumatoid disease of lacrimal and accessory glands (last two are both autoimmune exocrine disorders)

116
Q

Where does the conjunctiva end?

A

At the limbus

Anatomy & Physiology 2 (12 decks)

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