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Principles2 > Opthalmic surgery > Flashcards

Opthalmic surgery Flashcards

1
Q

orbit serves to protect, support and maximize the what of the eye? (F)

A

function

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2
Q

what are the 7 orbit bones? (PLZ FEMS)

A
  1. palatine
  2. lacrimal
  3. zygomatic
  4. frontal
  5. ethmoid
  6. maxilla
  7. sphenoid
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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

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4
Q

What is the AKA for Tenon’s capsule? (FB)

A

fascia bulbi

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5
Q

what part of the eye controls the amount of light entry into the eye? (I)

A

Iris

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6
Q

what part of the eye produces aqueous humor? (CB)

A

ciliary body

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7
Q

what part of the eye is the outermost layer that is tough, fibrous and white? (S)

A

sclera

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8
Q

what part of the eye is the most anterior layer? (C)

A

cornea

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9
Q

what part of the eye is posterior and contain the blood supply? (C)

A

choroid

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10
Q

what part of the eye is the innermost layer and produces the neuronal signals to the eye? (R)

A

retina

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11
Q

What muscle fibers adjust the focus of the lens? CMF)

A

ciliary muscle fibers

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12
Q

does the retina have direct blood supply?

A

no

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13
Q

what muscle causes elevation/supraduction?

A

superior rectus

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14
Q

what muscle causes depression/infraduction?

A

inferior rectus

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15
Q

what muscle causes adduction?

A

medial rectus

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16
Q

what muscle causes abduction?

A

lateral rectus

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17
Q

what muscle causes intorsion (depression/adduction)?

A

superior oblique

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18
Q

what muscle causes extorsion (elevation/abduction)?

A

inferior oblique

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19
Q

what is the name of the fibrous member connecting the 4 rectus muscle sheaths? (IM)

A

intermuscular membrane

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20
Q

what eyelid muscle closes the eyelid and promotes tear drainage? (OO)

A

orbicularis oculi

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21
Q

what eyelid muscle raises the upper eyelid? (LPS)

A

levator palpebrae superioris

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22
Q

orbital fossa doesn’t contain which extraocular muscle?

A

inferior oblique

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23
Q

what is the approximate volume of the fossa in mL?

A

30 mL

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24
Q

how many mL in the globe?

A

7 mL

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25
Q

Ophthalmic artery provides most of the blood supply to the orbital structures and originates from what artery?

A

internal carotid artery

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26
Q

what are the 4 branches of the ophthalmic artery? (CALS)

A
  1. central retinal artery
  2. anterior ciliary artery
  3. long ciliary artery
  4. short ciliary artery
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27
Q

what are the 4 veins of the eye? (VICS)

A
  1. vortex
  2. inferior ophthalmic
  3. central retinal
  4. superior ophthalmic
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28
Q

what sinus do the eye veins drain into? (CS)

A

cavernous sinus

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29
Q 
What are these CNs functions?
CN 2
CN 3 (5)
CN 4
CN 5
CN 6
CN 7
A

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

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30
Q 
Are these CNs sensory, motor, or mixed?
CN 2
CN 3
CN 4
CN 5
CN 6
CN 7
A 
CN 2 - sensory
CN 3 - motor
CN 4 - motor
CN 5 - sensory
CN 6 - motor
CN 7 - motor
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31
Q

Oculocardiac reflex:

  1. afferent CN
  2. efferent CN
A
  1. CN 5

2. CN 10

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32
Q 
What are the names of these CNs?
CN 2
CN 3
CN 4
CN 5
CN 6
CN 7
CN 10
A 
CN 2 - optic
CN 3 - oculomotor
CN 4 - trochlear 
CN 5 - trigeminal 
CN 6 - abducens
CN 7 - facial
CN 10 - vagus
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33
Q

what are the 5 muscles CN 3 innervates? (SIMIL)

A
  1. superior rectus
  2. inferior rectus
  3. medial rectus
  4. inferior oblique
  5. levator palpebrae superioris
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34
Q

LA block of what ganglion will produce a fixed, mid-dilated pupil? (CG)

A

Cilliar ganglion

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35
Q

What is the name of one of the muscles CN 7 innervates? (OO)

A

orbicularis occuli

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36
Q

what branch of CN 7 does the orbicularis occuli stem from?

A

zygomatic branch

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37
Q

LA of the orbicularis oculi and the zygomatic branch prevents what?

A

eye lid squeezing

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38
Q

what 4 things determine the volume in the eye? (AHP, AHD, ABF, VD)

A
  1. aqueous humor production
  2. aqueous humor drainage
  3. arterial BF
  4. venous drainage
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39
Q

Of all the forces that make up the intraocular pressure, which has the greatest impact?

A

venous drainage

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40
Q

what is normal IOP mmHg? (+/- 5 mmHg)

A

16 mmHg

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41
Q

coughing/straining can increase IOP by how many mmHg?

A

60 mmHg

42
Q

what 3 meds increase IOP? (S,S,S)

A

steroids, succs, scopolamine patch

43
Q

In general, anesthetic agents increase or decrease IOP?

A

decrease

44
Q

Overdose of atropine eye drops can be treated with what? (P)

A

physostigmine

45
Q

what are 4 SEs of atropine eye drops? (T, DS, F, A)

A

tachycardia, dry skin, fever, agitation

46
Q

Does phenylephrine dilate or constrict the pupil?

A

dilate

47
Q

what is an AE of systemic absorption of 10% phenylephrine? (SHC)

A

severe hypertensive crisis

48
Q

BP day of surgery should be less that what SBP and what DBP?

A

200/110

49
Q

are cataract surgeries okay to be performed while on an anticoagulant?

A

yes

50
Q

systemic absorption of eye drops can be absorb via vessels in what 2 areas? (CS, NDM)

A

conjunctival sac, nasolacrimal duct mucosa

51
Q

what 3 med classes decrease IOP? (CAI, OD, OA)

A
  1. carbonic anhydrase inhibitor
  2. osmotic diuretic
  3. organophosphorus anticholinesterase
52
Q

what 2 med classes decrease IOP in glaucoma pts? (BB, CS)

A
  1. beta blocker

2. cholinergic stimulant

53
Q

what 2 med class cause mydriasis for eye exams? (AAS, A)

A
  1. alpha adrenergic stimulant

2. anticholinergic

54
Q

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)
A
  1. carbonic anhydrase inhibitor
  2. osmotic diuretic
  3. beta blocker
  4. alpha adrenergic stimulant
  5. cholinergic stimulant
  6. anticholinergic
  7. organophosphorus anticholinesterase
55
Q

topical/infiltration is appropriate for surgeries in what eye chamber? (AC)

A

anterior chamber

56
Q

which of the two eye blocks provides excellent akinesia and analgesia?

A

retrobulbar block

57
Q

which block penetrates the muscle cone?

A

retrobulbar

58
Q

What are the 2 common LAs with % for retrobulbar blocks? (L, B)

A
  1. lido 2%

2. bupivacaine 0.75%

59
Q

what is the most common complication of a retrobulbar block? (RH)

A

retrobulbar hemorrhage

60
Q

what can be performed if there is an elevated IOP? (C)

A

canthotomy

61
Q

Direct injection of LA into where causes a total spinal block? (OS)

A

optic sheath

62
Q

is a retrobulbar block performed with systemic anticoagulation?

A

no

63
Q

can a peribulbar block be performed while a pt is anticoagulated safely?

A

yes

64
Q

what are the 4 facial nerve blocks that prevent squinting during surgery? (N,O,V,A)

A
  1. nadbath
  2. o’brien
  3. van lint
  4. atkinson
65
Q

which facial nerve block blocks the entire facial nerve? (N)

A

nadbath

66
Q

which facial nerve block has the most complications? (N)

A

nadbath

67
Q

can facial nerve blocks be used as a stand alone block for eye procedures?

A

no

68
Q

what is the treatment for hemorrhage around the eye? (C)

A

canthotomy

69
Q

myopic eyes have an increased risk of what eye complication? (GP)

A

globe puncture

70
Q

depending on speed of injection, what can immediately result from an intra-arterial injection of LA? (S)

A

seizure

71
Q

what are initial 5 CNS S/S of LAST? (PN, T, A, D, C)

A

perioral numbness, tinnitus, agitation, dysarthria, confusion

72
Q

what are the 2 severe CNS S/S of LAST? (S, C)

A

seizure, coma

73
Q

what are the 2 initial C/V S/S of LAST?

A

tachycardia, htn

74
Q

what are the 2 later C/V S/S of LAST?

A

bradycardia, hypotension

75
Q

oculocardiac reflex is most common in peds pts during what surgery? (SS)

A

strabismus surgery

76
Q

Is PONV considered hi risk for all eye procedures?

A

yes

77
Q

for GA, what is an important way to prevent increases in IOP? (SE)

A

smooth emergence

78
Q

what dose of lidocaine can be given to attenuate IOP increases? (mg/kg)

A

1.5 mg/kg

79
Q

what dose range of remi can be given to attenuate IOP increases? (mg/kg)

A

0.5-1 mg/kg

80
Q

what are the 3 intraocular eye surgeries? (C, K, G)

A

cataract, keratoplasty, glaucoma

81
Q

what are the 4 extraocular surgeries? (EM, RI, E, EUA)

A

eye muscle, radiation implantation, enucleation, examination under anesthesia

82
Q

what is the one retinal eye surgery? (V)

A

vitrectomy

83
Q

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)
A
  1. phacoemulsification
  2. corneal transplants
  3. trabeculectomy, cyclophotocoagulation
  4. strabismus repair
  5. eye removal
  6. retinal detachment, scleral buckle
84
Q

what eye procedure uses ultrasound energy to fragment the lens allowing for aspiration of lens material? (P)

A

phacoemulsification

85
Q

what is the most common complication of phacoemulsification? (PCR)

A

posterior capsule rupture

86
Q

what eye procedure replaces portion of the cornea with tissue from a donor eye? (K)

A

keratoplasty

87
Q

what eye procedure has open globe precautions half way through it? (K)

A

keratoplasty

88
Q

what anesthetic technique is commonly used for eye exam under anesthesia?

A

GA with mask

89
Q

what eye procedure removes the entire globe and portion of the optic nerve? (E)

A

enucleation

90
Q

what eye procedure removes the vitreous to reduce traction on the retina, clears blood and debris and removes scar tissue? (V)

A

vitrectomy

91
Q

what solution replaces the vitreous during a vitrectomy? (BSS)

A

balanced salt solution

92
Q

if a gas bubble is used during a vitrectomy, N2O must be stopped at least how many minutes prior?

A

15 minutes

93
Q

how are abx given for phacoemulsification and keratoplasty? (D)

A

as drops

94
Q

how are abx given for enucleation? (I)

A

post op irritation of socket

95
Q

what muscle does this to the eye lid:

  1. opens it (LPS)
  2. closes it and promotes tear drainage (OO)
A
  1. levator palpebrae superioris

2. orbicularis oculi

96
Q

phacoemulsification is performed to fix what? (C)

A

cataracts

97
Q

keratoplasty is what type of transplant? (C)

A

corneal

98
Q

what surgery is performed for a retinal detachment?

A

vitrectomy

99
Q

what surgery is performed for a scleral buckle?

A

vitrectomy

100
Q

what 2 surgeries can be performed for glaucoma? (T, C)

A
  1. trabeculectomy

2. cyclophotocoagulation

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