Ocular exam 2 Flashcards
What of the iris can be seen anteriorly?
The collarette
what is the collarette?
It’s the thickest part of the iris. It is a zigzag circular ridge of collagenous remains of vessels and some active vessels. it divides into pupillary and ciliary zones
What is the ciliary zone of the collarette? What structures are here?
small peripheral crypts, middle furrowed subzone, Fuch’s crypts, and radial streaks
what are small peripheral crypts?
in the ciliary zone of the collarette, they are pits where there is no surface layer of the iris
what is the middle furrowed subzone?
in the ciliary zone of the collarette, it has concentric wrinkles that are individual-specific
what are Fuch’s crypts?
They are pits where there is no surface layer of the iris, it can be on the ciliary zone or pupillary zone of the collarette
What are radial streaks?
in the ciliary zone of the collarette, these are white columns that run throughout the ciliary zone
What’s the pupillary zone of the collarette? What parts are there?
Radial streaks (finer than ciliary zone) and Fuch’s crypts
How does a blue eye appear blue?
the body or stroma of the iris absorbs long wavelengths and the pigmented epithelium of the iris reflects the short wavelength light back.
How does a brown eye appear brown?
the body or stroma of the iris absorbs few wavelengths and the pigmented epithelium of the iris reflects both long and short wavelength light back.
What makes up the posterior surface of the iris?
It has Schwalbe’s structural furrows, circular contraction furrows, Schwalbe’s radial contraction furrows
What is the pigment frill?
the epithelium that curves around to appear at the anterior surface
the furrows at the pigment frill are the continuation of what?
The continuation of the posterior radial contraction furrows of Schwalbe
What are the layers of the iris?
The anterior border layer, Iris stroma, and pigmented iris epithelium
what is the anterior border layer of the iris?
it is composed of widely spaced fibroblasts with collagen fibrils, making it porous to aqueous. more posterior are layers of melanocytes.
What are iris processes?
They come of the anterior border layer of the iris and travel to the trabecular meshwork. Extension made up of fibroblasts and melanocytes and collagen
What is the Iris stroma? What does it contain?
the second layer of the iris. It is loose connective tissue of collagen. it has aqueous, fibroblasts, melanocytes, lymphocytes, macrophages, mast cells, clump cells, ground substance, vessels, nerves and iris sphincter smooth muscle cells. note that lymphocytes and macrophages are from the blood
Why is it hard to tell the difference between an iris artery and vein?
Vessel walls are thick from fibroblasts, melanocytes, and collagen.
What has a blood-aqueous barrier? What is it made of?
The iris capillaries have a blood-aqueous barrier of zonula occludens.
What are clump cells? what is the most common type of clump cell?
They are found in the iris stroma where they clump around the iris sphincter. Macrophages are the most common clump cell type.
What is the iris sphincter? where is it found? What kind of muscle?
It is in the stroma of the iris. it is anchored into the pupillary dilator muscle by the spurs of the dilator. Para-ANS smooth muscle
What is the Pigmented iris epithelium? what is it an extension of?
It is the third layer of the iris, made up of the anterior and posterior iris epithelium. It’s an extension of the retinal tunic
What is the anterior epithelium (iris)?
The first layer of the pigmented iris epithelium (which is the 3rd layer of the iris). pigmented ciliary epithelium of ciliary body turns into pigmented anterior epithelium. It sends muscular processes (spurs) to anchor into the stroma of the iris root. It is myoepithelial except near the pupil.
What is the posterior epithelium (iris)?
The second layer of the pigmented iris epithelium (which is the 3rd layer of the iris). before the iris root, the nonpigmented ciliary epithelium of ciliary body becomes the posterior epithelium
what does the pigmented ciliary epithelium of the ciliary body turn into?
The anterior epithelium of the iris
what does the nonpigmented ciliary epithelium of the ciliary body turn into?
The posterior epithelium of the iris
How is the pigmented iris epithelium arranged?
apex to apex.
What composes the iris dilator muscle? What kind of innervation is it?
myoepithelial cells from the anterior epithelium, from the iris root to the midpoint of the sphincter. It is Symp-ANS.
what is the classic viewpoint of blood supply to the iris?
the two long posterior ciliary arteries anastomose with the anterior ciliary arteries in the loose connective tissue of the ciliary body near the root of the iris, forming the major circle of the iris.
what is the major circle of the iris?
the blood supply made when the anterior and posterior ciliary arteries anastomose near the root of the iris. (classic viewpoint)
what is the modern viewpoint of the blood supply of the iris?
the two long posterior ciliary arteries for the circle major circle of the iris. The secen anterior ciliary arteries anastomose to form the intramuscular circle.
what is the minor arterial circle of the iris?
radial arteries come together at the collarette.
what are the veins of the iris?
radial veins drain to ciliary body veins, then choroidal veins, and then out the eye through the vortex veins.
What does Cocain 10% do?
Normal response is dilation, Horner’s response is reduced pupil dilation because there is litttle NE for reuptake in affected eye.
What does Apraclonidine 0.5% do?
it directly excites the sympathetic receptors of the iris dilator muscle to cause dilation. Normal response is dilation. Horner’s pupil will have marked dilation because affected pupil is very sensitive to NE.
What does hydroxy-amphetamine 1% do?
It helps narrow down which type of Horners syndrome. The normal response is dilation. If the affected pupil dialates less than good pupil, then it’s 3rd order Horner’s syndrome. If they dialate equally, then it’s 2nd or 1st order Horner’s.
What is Iopidine?
it’s the same thing as Apraclonidine
What is horner’s syndrome?
The affected eye has issues with the sympathetic innervation in Hypothalamus, Anterior gray horn, or in the cervical ganglion. This causes the pupil to have miosis because it struggles with dilating. The pupilary fissure is also narrowed
What is the clinical importance of the pupil? 5
It can indicate brainstem TBI (RAPD), level of wakefulness (as in narcolepsy), sphincter damage, photophobia. certain eye surgeries need the pupil big.
What is the parasympathetic loop for iris control?
Optic nerve > Optic tract > Pretecum nucleus >Edinger-westphal nucleus > CN III > Ciliary ganglion > Optic nerve > iris. This is the only instance where Para-ANS constricts
Miosis happens through what ANS feature to what muscle?
Para-ANS to sphincter muscle
Mydriasis happens through what ANS feature to what muscle?
Symp-ANS to dilator muscle
Is pupillary dilator lateral or medial to the pupilarry sphincter?
The dilator is lateral to the sphincter. The sphincter is near the edge
How can type 1 diabetes affect the pupil?
It causes a loss of parasympathetic fibers, causing mydriasis.
Is the ciliary body inner or outer the sclera?
it is inner
What is posterior the ciliary body?
The choroid
What makes the aqueous of the eye?
The ciliary body
What is the ora serrata?
it is the junction between the retina and the ciliary body
what is the pars plana?
It’s the posterior, flat, 4mm part of the ciliary body that ends when you get to ciliary process. It borders the pars plicata and the ora serrata.
what is the pars plicata?
It’s the anterior, 2mm part of the ciliary body after the pars plana. its ends at the scleral spur.
What is a denate process?
it’s the ciliary body in between oral bays.
What are oral bays?
its the small gaps in between the dentate processes of the ora serrata
Going from posterior to anterior, what is before, during, and after the ciliary body?
Before is the retina,ora serrata,pars plana, pars plicata (major ciliary processes: tail, head), after is zonule
What does the head of the major ciliary process do?
being free of zonules, they secrete aqueous
how does the length of the head and tail of the major ciliary process compare with the length of the pars plicata?
they are the same length.
where are the minor ciliary processes located?
in the valleys in between major ciliary processes
what are the borders of the inner side of the ciliary body?
the lens zonules, posterior chamber, and the vitreous
what are the borders of the outer side of the ciliary body?
the sclera except in the anterior pars plicata where the ciliary muscle strongly connects to the scleral spur
what are the different layers of the ciliary body? outer to inner
supraciliary layer, ciliary muscle layer, Stroma, Bruch’s membrane, and ciliary epithelium
what is the supraciliary layer? what is it’s anterior boundary? what is it composed of?
it is the loose connective tissue junction between the sclera and the ciliary body. it’s the most outer part of the ciliary body. It’s continuous with the suprachoroid. It is sealed off at the scleral spur. It’s composed of collagenous fibers, melanocytes, and fibroblasts.
What is the ciliary muscle layer? what happens to drainage during accommodation? How does it compare to other smooth muscle?
2nd outer layer.it’s the largest intrinic eye muscle, inner to the supraciliary layer. It inserts into the scleral spur with it’s tendon. The trabecular meshwork opens up when accomodating to increase drainage. It has more actin, myosi, and mitochonrdiathan other smooth muscle
What are the different divisions of the ciliary muscle fibers?
Longitudinal (meridional): attach at scleral spur anteriorly and end posteriorly at muscle stars in suprailiary layer of pars plana (and suprachoroid of anterior choroid). They are more outer.Radial: start at spur and end at pars plicata.and circular fibers: run perpandicular around the lens. ALL smooth muscle and all turn on to cause accommodation.
Where do muscle stars attach?
they connect with choroidal blood vessels and Bruch’s membrane (in the pars plana)
What are the two drain pathways and when do they function the most? what does accommodation do to drainage rate?
uveoscleral pathway (during relaxation through ciliary muscles) and trabecular meshwork (during contraction) 90% drainage through here. Accommodation increases draiange becaue it opens up trabecular meshwork
what is the Stroma of the ciliary body?
3rd outer layer. This has more vessels in the pars plicata and is thicker. The blood vessels are fenestrated (“holed” but not really) because it’s they are to produce aqueous (plasma but not RBC enters the stroma)