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2nd Year Medicine > Opthalmology Anatomy > Flashcards

Opthalmology Anatomy Flashcards

1
Q
A

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2
Q
A

Orbital rim

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3
Q

Thin part of orbital rim?

What are they at risk of?

Complicatons of this?

A

Medial wall + orbital floor

* affected by orbital blowout fracture

* Comps: paraesthesia of skin of the face

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4
Q

How do eyelids protect the eyes? (4)

What do they contain? (4)

A

* Protect eyes: outer skin, inner conjunctiva, eyelashes, glands

* Contain: tarsal plate (maintains shape), meibomian glands (secrete lipids), obicularis oculi (CN7), levator palpabrie superioris (CN3, elevates upper eyelid)

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5
Q
A

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6
Q

Lacrimal gland innervation?

Function?

A

CN7 (parasympathetic)

* produces tears

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7
Q

Lacrimal apparatus?

A

* Lacrimal gland produces tears

* Pushed towards medial triangle

* drains through lacrimal puncta

* eventually reaches inferior meatus of nasal cavity

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8
Q
A

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9
Q

Layers of the eye? (3)

A

Fibrous - outer layer

* Sclera - white, fibrous

* Cornea - refraction

Uvea (vascular layer) - middle

* Iris

* Ciliary body - controls iris, shape of lens + aqueous humor secretion

* choroid - nutrition and gas exchange

Retina (photosensitive) - inner layer

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10
Q

Where is anterior segment of the eye?

Divided into? (2)

A

In front of lens

* anterior chamber = between cornea and iris, contains squeous humor

* Posterior chamber = between iris and suspensory ligaments, contaisn aqueous humor

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11
Q

Function of ciliary body of the eye? (3)

Where is it found?

A

Function

* controls iris

* shape of lens

* aqueous humor secretion

Found in uvea (middle layer)

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12
Q

Posterior segment of the eye?

Function?

A

Posterior segment is behind the lens, and makes up 2/3rds of the eye

* contrains vitreous body which secretes virteous humor (common place for “floaters”)

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13
Q

Describe circulation of aqueous fluid (4)

A

1) ciliary body

* secrete aqueous humor

2) aqueous circulates within posterior chamber and nourishes lens
3) squeous passes through pupil into anterior chamber, nourishes cornea
4) aqueous reabsorbed into scleral venous sinus (canal of Schlemm) at irodocorneal angle

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14
Q

Arterial supply to eye?

A

Opthalmic artery from internal carotid artery

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15
Q

What does the opthalmic artery divide into? (2)

Complication?

A

* Ciliary arteries + central artery of the retina

It is an end artery - cannot maintain tissue if occlusion occurs

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16
Q

Venous drainage of the eye? (2)

A

* Superior opthalmic vein drains into cavernous sinusvia superior orbital fissure

* Inferior opthalmic vein drains into superior opthalmic vein

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17
Q

Danger triangle of the face?

A

Infection in this area of the face can drain back into cavernous sinus and cause cavernous sinus thrombosis

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18
Q

Parts of the retina? (4)

A

Fundus

*posterior area where light is focused

Optic disc

* point of CN 2 formation

* only point of entry/exit of blood vessels + axons of CN2

* blind spot!!

Macula

* greatest density of cones

Fovea

* centre of macula

* area of most cute vision

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19
Q

Layers of the retina (from posterior to anterior)? (3)

Where do they retinal veins and arteries lie?

A

1) photoreceptors
2) ganglion cells
3) axons of ganglion cells

Retinal veins and arteries lie aterior to retina

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20
Q

Where is the blind spot of the eye?

Why?

A

Optic disc

* there are no photoreceptors in the optic disc

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21
Q
A

…

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22
Q

What does interruption of flow in retinal artery branch/vein cause?

What about interruption of flow in central artery (end artery)?

A

* loss of an area of visual field corresponding to area of ischaemia

* monocular blindness

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23
Q

Where is light from objects in the right visual field processed?

Lower visual field?

A

* Left primary visual cortext

* upper part of visual cortext

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24
Q

Extrinsic muscles of the eye? (6)

A
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25
Q

What is different about the superior oblique muscle of the eye?

A

It passes through a pulley (the trochlear)

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26
Q

Functions of the external muscles of the eye? (6)

A

* Lateral rectus = laterally

* Medial rectus = medially

* Superior rectus = up and in

* Inferior rectus - down and in

* Superior oblique = down and out

* inferior oblique = up and out

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27
Q

Innervation of extrinsic muscles of the eye? (3)

A

* Lateral rectus = abducent nerve

* Superior oblique = troclear nerve

* All others = CN III (occulomotor)

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28
Q

Sensory innervation of the eye?

A

Trigeminal nerve

CN V1 (opthalmic) = upper eyelid, cornea, conjunctiva, tip + bridge of nose

CN V2 (maxillary) = lower eyelid, maxilla, ala of the nose, upper lip

CN V3 (mandibular) = mandible (except ridge of mandible, which is supplied by C2, 3)

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29
Q

Explain the blink (corneal) reflex? (4)

A

* AP’s conducted from cornea via CN V1 branches to trigeminal ganglion

* Then along CN V to pons

* CNS connections between CN V and CN VII

* AP’s conducted via CN VII to obicularis oculi

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30
Q

Route of sympathetic axons? (4)

A

* Originate from autonomic centres in brain

* Exit spinal cord with T1 - L2 spinal nerves (thoracolumbar outflow)

* Pass into sypathetic chains + all spinal nerves

* Pass into splanchnic nerves to supply organs

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31
Q

Function of splanchnic nerves?

Types? (2)

A

Relay sympathetic nerves to organs

* Cardiopulmonary splanchnic nerves - heart + lungs

* Abdominopelvic= abdominal and pelvic organs

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32
Q

How are sympathetics relayed to the eyes?

A

3 cervical ganglia = superior, middle and inferior

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33
Q

How are sympathetic nerves carried to the eyes?

A

* Travel from sympathetic trunk and synapse in superior cervical sympathetic ganglion

* Post-synaptic axons enter internal and external carotid nerves

* pass onto surface of internal and external carotid arteries

* carried to organs of the head

* opthalmic artery carries sympathetic axons to orbit

(no splanchnic nerves involved)

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34
Q

Parasympathetic outflow to eye?

A

Craniosacral outflow

* CN3 + 7

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35
Q

Route of CN III (occulomotor)?

What does it supply? (3)

A

Connects with CNS between midline and pons

* passes thru cavernous sinus

* exits via superior orbital fissure

Supplies

* somatic motor to superior, medial, inferior rectus + inferior oblique

* somatic motor to levator palpebrae superioris

* presynaptic parasympathetic axons to ciliary ganglion

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36
Q

Divisions of occulomotor nerve?

A

Suprior division = SR and LPS

Inferior division = MR, IR, IO and ciliary ganglion

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37
Q

Function of ciliary nerves?

Types? (2)

Function of long ciliary nerves?

A

Supply autonomic axons to control diameter of iris and shape of lens

* Long ciliary nerves = sympathetic, somatic sensory

* Short ciliary nerves = sympathetic, parasympathetic

Long ciliary nerves form first part of blink reflex

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38
Q

CN 3

A

…

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39
Q
A

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40
Q

Autonomic reflexes of the eye? (6)

A

* Wide eye opening of fight or flight

* Pupil dilation/constriction (light reflex)

* focusing lens far + near vision (accommodation reflex)

* Lacrimation (tera production)

* vestibulo-ocular reflex (stabilises gaze on object during head movement)

* Oculocardiac reflex - reflex bradycardia in respode to pressure on eye or extraocular muscle tension

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41
Q

Sympathetic vs parasympathetic functions of the eye? (4)

A

Sympathetic

* open eyes wider

* pupil dilation

* focus on far objects

* emotional lacrimation

Parasympathetic

* pupil constriction

* focus on near objects

* reflex lacrimation (wash foreign body)

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42
Q

How can we blink consciously but also as a reflex?

A

levator palpabrae superioris contaisn skeletal and smooth muscle

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43
Q

Explain the reflex of opening eyes wider

A

Postsynaptic sympathetic fibres reach levator palpebrae superioris via:

* superior cervical sympathetic ganglion

* internal carotid nerve

* internal carotid plexus

* carried on opthalmic artery

* to orbit

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44
Q

What is a non-physiologically nlarged pupil called?

Ax?

A

Mydriatic pupil

* mydriatic drugs

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45
Q

How are dilator pupillae fibres arranged?

A

* originate around external circumference of iris - fixed

* insert around internal cicrumference of iris - mobile

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46
Q

What is responsible for dilating the pupil?

Constricting the pupil?

A

* dilate = sympathetics

* constrict = parasympathetics

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47
Q

what is a non-physiologically constricted pupil?

Ax?

A

miotic pupil

* horner’s syndrome

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48
Q

what is a ficed “pin point” pupil indicative of?

Fixed dilated pupil?

A

* Serious pathological sign - e.g. opiate drugs

* serious pathological sign e.g. CN III pathology

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49
Q

Which muscle contricts the pupil?

A

Sphincter pupillae fibrs - around internal circumference of iris

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50
Q

Pupillary light reflex? (3)

A

* 1st neurones = retinal ganglion cells pass via optic nerve to optic chiasm then midbrain

* 2nd neurones (bilateral) = synapse in midbrain

* 3rd neurones (bilateral) = CN III to ciliary ganglion

* 4th neurones = short ciliary nerve to sphincter pupillae muscles

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51
Q

What connects ciliary body to lens?

What is the autonomic supply to ciliary muscles that control the lens?

A

Suspensory ligaments of lens

* parasympathetics (no sympathetics)

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52
Q

Explain control of lens?

A

Ciliary muscle relaxes in “far vision”

* no parasympathetic signal

* ligament tightens and lens flattens to focus on object in the distance

Ciliary muscle contracts in “near vision”

* parasympathetic

* ligament relaxes and lens becomes spherical to focus on near objects

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53
Q

3 components of the accommodation reflex? (3)

A

1) bilteral pupillary constriction (CN III)
2) bilateral convergence (medial rotation of both eyes) - CN III
3) bilateral relaxation of the lens (CN III)

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54
Q

What are basal tears? (3)

A

* important in corneal health

* clean, nourish and hydrate the avascular cornea

* contain lysozyme

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55
Q

What are reflex tears?

A

* In response to mechanical or chemical stimulation

* Sensory = CN VI (cornea)

* motor = CN VII

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56
Q

What is horner’s syndrome?

Ax? (5)

S/s? (4)

A

Impaired sympathetic innervation to head and neck

Ax

* neck trauma

* carotid dissection

* internal jugular vein engorgement

* cervical node metastasis

* pancoast tumour

S/s

* miosis

* ptosis

* reduced sweating (anhydrosis)

* increased warmth and redness

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57
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A

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58
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A

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59
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A

…

60
Q
A

…

61
Q
A

…

62
Q
A

…

63
Q
A

…

64
Q
A

…

65
Q
A

optic tract as has not split into quadrants yet

Left hemanopia

Vertical so inter-nuclear disease

66
Q
A

stroke causing occipital infarct (back of head)

Cortex pathology

67
Q
A

Hyphaemia - blood in anterior chamber

68
Q
A

dislocated lens - zonules torn

69
Q
A

retinal detachment

70
Q
A

choroidal tear (white line)

71
Q
A

commotio retinae - “bruised retina”

72
Q
A

optic nerve avulsion

73
Q
A

severe intra-ocular disruption (can’t see iris or pupil)

74
Q
A

conjunctival foreign body

75
Q
A

corneal foreign body

76
Q
A

intra-lentricular foreign body

77
Q
A

limbal ischaemia caused by alkali burn - look at china white appearance!! No vascularity

78
Q
A

vortex neuropahy (associated with amiodarone use)

79
Q
A

maculopathy (associated with chloroquine use)

80
Q
A

optic neuropathy (associated with ethambutol)

81
Q
A

…

82
Q
A

Viral conjunctivitis caused by herpe ssimplex!

83
Q
A

Viral conjunctivitis caued by herpes zoster!

84
Q
A

herpes zoster opthalmicus

85
Q
A

chlamydia conjunctivitis = see follicles

86
Q
A

chlamydia conjunctivitis leading to subtarsal scarring

87
Q
A

bacterial keratitis with hypopyon

(leukocytic exudate, seen in the anterior chamber)

88
Q
A

diabetic retinopathy - dots are man-made with laser

89
Q
A

diabetic retinopathy - see blot haemorrhages, exudate, abnormalities of venous calibre (bottom = lumen is not consistent)

90
Q
A

incompitent aneurysm - look at all that exudate mate!!

91
Q
A

…

92
Q
A

Vessels grow on optic nerve - much worse prognosis than NVE

93
Q
A

NVE - ischaemia is local to blood vessel production

94
Q
A

rubeosis iridis

95
Q
A

central retinal artery occlusion!!

First pic = cattle tracking (blood vessels all broken up)

Bottom left = white retina

Bottom right = patch of oedema

96
Q
A

central retinal vein occlusion = can be mistaken for diabetic retinopathy

97
Q
A

rubeotic eye

note: capillary arcade - vessels spreading across iris

98
Q
A

branch vein occlusion

* top half looks normal

* bottom half see exudate and haemorrhage

99
Q
A

sarcoid (uveitis)

100
Q
A

thyroid eye disease

101
Q
A

Marfan’s syndrome!

Lens dislocation - normally when lens dislocates it travels downwards

However, in Marfans, it travels upwards (remember: M for marfans, M for moon (up))

102
Q
A

…

103
Q
A

adenoviral keratitis = subepithelial infiltrates

104
Q
A

fungal keratitis

105
Q
A

orbital ceullitis

106
Q
A

endophthalmitis

107
Q
A

endophthalmitis

108
Q
A

haemorrhagic CMV retinitis in AIDS

109
Q
A

toxoplasma

110
Q
A

toxoplasmosis

111
Q
A

toxocara

112
Q
A

dacrocystitis

113
Q
A

subconjunctival haemorrhage

114
Q
A

orbital cellulitis

115
Q
A

Staphylococcal anterior blepharitis

116
Q
A

meibomian cyst

117
Q
A

acne rosacea corneal ulcer

118
Q
A

Follicular conjunctivitis secondary to molluscum contagiosum

`* redness maximal at periphery

* looks like grains of rice

119
Q
A

Follicular conjunctivitis due to
chlamydial infection

120
Q
A

H simplex conjunctivitis

121
Q
A

Herpes Zoster Ophthalmicus

122
Q
A

Chemosis = conjunctival oedema

123
Q
A

Bacterial corneal ulcer

124
Q
A

Auto-immune corneal ulcer

* immune complexes deposited at limbus

125
Q
A

anterior uveitis

126
Q
A

anterior uveitis

127
Q
A

anterior uveitis

128
Q
A

‘Synechiae’ causing irregular pupil

129
Q
A

episcleritis

130
Q
A

scleritis

131
Q
A

ac angle closure glaucoma

Hazy and blue - due to corneal oedema

132
Q
A

CRAO - cherry spot

Pale retina

Thin vessels

133
Q
A

branch retinal artery occlusion

134
Q
A

central retinal vein occlusion

135
Q
A

branch retinal vein occlusion

136
Q
A

…

137
Q
A

ION = pale, swollen disc

138
Q
A

retinal detachment

* floaters, visual loss

139
Q
A

wet ARMD

140
Q
A

…

141
Q
A

christmas tree cataract (polychromatic cataract)

142
Q
A

congenital cataract

143
Q
A

dry ARMD

* drusen

* decline in central vision

144
Q
A

glaucoma

145
Q
A

chronic disc swelling, resulting in optic disc atrophy

2nd Year Medicine (24 decks)

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