Opthalmic surgery Flashcards
1
Q
orbit serves to protect, support and maximize the what of the eye? (F)
A
function
2
Q
what are the 7 orbit bones? (PLZ FEMS)
A
- palatine
- lacrimal
- zygomatic
- frontal
- ethmoid
- maxilla
- sphenoid
3
Q
What is the capsule name that is a thin membrane surrounding the eyeball and forms the eye “socket”? (TC)
A
Tenon’s capsule
4
Q
What is the AKA for Tenon’s capsule? (FB)
A
fascia bulbi
5
Q
what part of the eye controls the amount of light entry into the eye? (I)
A
Iris
6
Q
what part of the eye produces aqueous humor? (CB)
A
ciliary body
7
Q
what part of the eye is the outermost layer that is tough, fibrous and white? (S)
A
sclera
8
Q
what part of the eye is the most anterior layer? (C)
A
cornea
9
Q
what part of the eye is posterior and contain the blood supply? (C)
A
choroid
10
Q
what part of the eye is the innermost layer and produces the neuronal signals to the eye? (R)
A
retina
11
Q
What muscle fibers adjust the focus of the lens? CMF)
A
ciliary muscle fibers
12
Q
does the retina have direct blood supply?
A
no
13
Q
what muscle causes elevation/supraduction?
A
superior rectus
14
Q
what muscle causes depression/infraduction?
A
inferior rectus
15
Q
what muscle causes adduction?
A
medial rectus
16
Q
what muscle causes abduction?
A
lateral rectus
17
Q
what muscle causes intorsion (depression/adduction)?
A
superior oblique
18
Q
what muscle causes extorsion (elevation/abduction)?
A
inferior oblique
19
Q
what is the name of the fibrous member connecting the 4 rectus muscle sheaths? (IM)
A
intermuscular membrane
20
Q
what eyelid muscle closes the eyelid and promotes tear drainage? (OO)
A
orbicularis oculi
21
Q
what eyelid muscle raises the upper eyelid? (LPS)
A
levator palpebrae superioris
22
Q
orbital fossa doesn’t contain which extraocular muscle?
A
inferior oblique
23
Q
what is the approximate volume of the fossa in mL?
A
30 mL
24
Q
how many mL in the globe?
A
7 mL
25
Ophthalmic artery provides most of the blood supply to the orbital structures and originates from what artery?
internal carotid artery
26
what are the 4 branches of the ophthalmic artery? (CALS)
1. central retinal artery
2. anterior ciliary artery
3. long ciliary artery
4. short ciliary artery
27
what are the 4 veins of the eye? (VICS)
1. vortex
2. inferior ophthalmic
3. central retinal
4. superior ophthalmic
28
what sinus do the eye veins drain into? (CS)
cavernous sinus
29
```
What are these CNs functions?
CN 2
CN 3 (5)
CN 4
CN 5
CN 6
CN 7
```
CN 2 - transfer visual info from retina to vision centers
CN 3 - SR, IR, MR, IO, LPS
CN 4 - innervates superior oblique
CN 5 - touch and pain sensation around the eye
CN 6 - innervates the lateral rectus
CN 7 - innervates muscles around the eye
30
```
Are these CNs sensory, motor, or mixed?
CN 2
CN 3
CN 4
CN 5
CN 6
CN 7
```
```
CN 2 - sensory
CN 3 - motor
CN 4 - motor
CN 5 - sensory
CN 6 - motor
CN 7 - motor
```
31
Oculocardiac reflex:
1. afferent CN
2. efferent CN
1. CN 5
| 2. CN 10
32
```
What are the names of these CNs?
CN 2
CN 3
CN 4
CN 5
CN 6
CN 7
CN 10
```
```
CN 2 - optic
CN 3 - oculomotor
CN 4 - trochlear
CN 5 - trigeminal
CN 6 - abducens
CN 7 - facial
CN 10 - vagus
```
33
what are the 5 muscles CN 3 innervates? (SIMIL)
1. superior rectus
2. inferior rectus
3. medial rectus
4. inferior oblique
5. levator palpebrae superioris
34
LA block of what ganglion will produce a fixed, mid-dilated pupil? (CG)
Cilliar ganglion
35
What is the name of one of the muscles CN 7 innervates? (OO)
orbicularis occuli
36
what branch of CN 7 does the orbicularis occuli stem from?
zygomatic branch
37
LA of the orbicularis oculi and the zygomatic branch prevents what?
eye lid squeezing
38
what 4 things determine the volume in the eye? (AHP, AHD, ABF, VD)
1. aqueous humor production
2. aqueous humor drainage
3. arterial BF
4. venous drainage
39
Of all the forces that make up the intraocular pressure, which has the greatest impact?
venous drainage
40
what is normal IOP mmHg? (+/- 5 mmHg)
16 mmHg
41
coughing/straining can increase IOP by how many mmHg?
60 mmHg
42
what 3 meds increase IOP? (S,S,S)
steroids, succs, scopolamine patch
43
In general, anesthetic agents increase or decrease IOP?
decrease
44
Overdose of atropine eye drops can be treated with what? (P)
physostigmine
45
what are 4 SEs of atropine eye drops? (T, DS, F, A)
tachycardia, dry skin, fever, agitation
46
Does phenylephrine dilate or constrict the pupil?
dilate
47
what is an AE of systemic absorption of 10% phenylephrine? (SHC)
severe hypertensive crisis
48
BP day of surgery should be less that what SBP and what DBP?
200/110
49
are cataract surgeries okay to be performed while on an anticoagulant?
yes
50
systemic absorption of eye drops can be absorb via vessels in what 2 areas? (CS, NDM)
conjunctival sac, nasolacrimal duct mucosa
51
what 3 med classes decrease IOP? (CAI, OD, OA)
1. carbonic anhydrase inhibitor
2. osmotic diuretic
3. organophosphorus anticholinesterase
52
what 2 med classes decrease IOP in glaucoma pts? (BB, CS)
1. beta blocker
| 2. cholinergic stimulant
53
what 2 med class cause mydriasis for eye exams? (AAS, A)
1. alpha adrenergic stimulant
| 2. anticholinergic
54
what class of med are these drugs?
1. acetazolamide
2. mannitol, glycerol
3. timolol
4. phenylephrine
5. pilocarpine, acetylcholine
6. atropine, scopolamine
7. phospholine iodide (echothiophate), isoflurophate (floropryl)
1. carbonic anhydrase inhibitor
2. osmotic diuretic
3. beta blocker
4. alpha adrenergic stimulant
5. cholinergic stimulant
6. anticholinergic
7. organophosphorus anticholinesterase
55
topical/infiltration is appropriate for surgeries in what eye chamber? (AC)
anterior chamber
56
which of the two eye blocks provides excellent akinesia and analgesia?
retrobulbar block
57
which block penetrates the muscle cone?
retrobulbar
58
What are the 2 common LAs with % for retrobulbar blocks? (L, B)
1. lido 2%
| 2. bupivacaine 0.75%
59
what is the most common complication of a retrobulbar block? (RH)
retrobulbar hemorrhage
60
what can be performed if there is an elevated IOP? (C)
canthotomy
61
Direct injection of LA into where causes a total spinal block? (OS)
optic sheath
62
is a retrobulbar block performed with systemic anticoagulation?
no
63
can a peribulbar block be performed while a pt is anticoagulated safely?
yes
64
what are the 4 facial nerve blocks that prevent squinting during surgery? (N,O,V,A)
1. nadbath
2. o'brien
3. van lint
4. atkinson
65
which facial nerve block blocks the entire facial nerve? (N)
nadbath
66
which facial nerve block has the most complications? (N)
nadbath
67
can facial nerve blocks be used as a stand alone block for eye procedures?
no
68
what is the treatment for hemorrhage around the eye? (C)
canthotomy
69
myopic eyes have an increased risk of what eye complication? (GP)
globe puncture
70
depending on speed of injection, what can immediately result from an intra-arterial injection of LA? (S)
seizure
71
what are initial 5 CNS S/S of LAST? (PN, T, A, D, C)
perioral numbness, tinnitus, agitation, dysarthria, confusion
72
what are the 2 severe CNS S/S of LAST? (S, C)
seizure, coma
73
what are the 2 initial C/V S/S of LAST?
tachycardia, htn
74
what are the 2 later C/V S/S of LAST?
bradycardia, hypotension
75
oculocardiac reflex is most common in peds pts during what surgery? (SS)
strabismus surgery
76
Is PONV considered hi risk for all eye procedures?
yes
77
for GA, what is an important way to prevent increases in IOP? (SE)
smooth emergence
78
what dose of lidocaine can be given to attenuate IOP increases? (mg/kg)
1.5 mg/kg
79
what dose range of remi can be given to attenuate IOP increases? (mg/kg)
0.5-1 mg/kg
80
what are the 3 intraocular eye surgeries? (C, K, G)
cataract, keratoplasty, glaucoma
81
what are the 4 extraocular surgeries? (EM, RI, E, EUA)
eye muscle, radiation implantation, enucleation, examination under anesthesia
82
what is the one retinal eye surgery? (V)
vitrectomy
83
What are the other names for these procedures?
1. cataract surgery (P)
2. keratoplasty (CT)
3. glaucoma surgeries x2 (T, C)
4. eye muscle surgeries (SR)
5. enucleation (ER)
6. vitrectomy x2 (RD, SB)
1. phacoemulsification
2. corneal transplants
3. trabeculectomy, cyclophotocoagulation
4. strabismus repair
5. eye removal
6. retinal detachment, scleral buckle
84
what eye procedure uses ultrasound energy to fragment the lens allowing for aspiration of lens material? (P)
phacoemulsification
85
what is the most common complication of phacoemulsification? (PCR)
posterior capsule rupture
86
what eye procedure replaces portion of the cornea with tissue from a donor eye? (K)
keratoplasty
87
what eye procedure has open globe precautions half way through it? (K)
keratoplasty
88
what anesthetic technique is commonly used for eye exam under anesthesia?
GA with mask
89
what eye procedure removes the entire globe and portion of the optic nerve? (E)
enucleation
90
what eye procedure removes the vitreous to reduce traction on the retina, clears blood and debris and removes scar tissue? (V)
vitrectomy
91
what solution replaces the vitreous during a vitrectomy? (BSS)
balanced salt solution
92
if a gas bubble is used during a vitrectomy, N2O must be stopped at least how many minutes prior?
15 minutes
93
how are abx given for phacoemulsification and keratoplasty? (D)
as drops
94
how are abx given for enucleation? (I)
post op irritation of socket
95
what muscle does this to the eye lid:
1. opens it (LPS)
2. closes it and promotes tear drainage (OO)
1. levator palpebrae superioris
| 2. orbicularis oculi
96
phacoemulsification is performed to fix what? (C)
cataracts
97
keratoplasty is what type of transplant? (C)
corneal
98
what surgery is performed for a retinal detachment?
vitrectomy
99
what surgery is performed for a scleral buckle?
vitrectomy
100
what 2 surgeries can be performed for glaucoma? (T, C)
1. trabeculectomy
| 2. cyclophotocoagulation
