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Head and Neck > Orbit and Eye > Flashcards

Orbit and Eye Flashcards

1
Q

what happens to the orbit when there is blunt or penetrating trauma

A

blowout fracture- orbital floor and medial wall

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2
Q

what are the symptoms of a blowout fracture

A

swelling, bruising, ocular trauma, diplopia, decreased movement of eye, enophthalmos, facial anesthesia (impingement of infraorbital nerve)

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3
Q

what is the treatment for a blowout fracture

A

wait for swelling to subside, surgery for complex fractures, significant enophthalmos or entrapment of muscles

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4
Q

what is the common tendinous ring made out of

A

thickening of periorbita

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5
Q

which muscles do not originate in the annulus of zinn

A

obliques (superior and inferior) and levator palpebral superioris

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6
Q

what is the primary and secondary action of the levator palpebral superioris

A

primary: elevation of upper eyelid (no secondary)

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7
Q

what is the primary and secondary action of the superior rectus

A

primary: elevation, secondary: adduction and intorsion

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8
Q

what is the primary and secondary action of the inferior rectus

A

primary: depression, secondary: adduction and extorsion

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9
Q

what is the primary and secondary action of the medial rectus

A

primary: ADduction (no secondary)

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10
Q

what is the primary and secondary action of the lateral rectus

A

primary: ABduction (no secondary)

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11
Q

what is the primary and secondary action of the superior oblique

A

primary: depression and abduction, secondary: intorsion

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12
Q

what is the primary and secondary action of the inferior oblique

A

primary: elevation and abduction, secondary: extorsion

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13
Q

what direction are the axes of the eyes

A

anterior-posterior

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14
Q

what direction are the axes of the orbits

A

lateral-medial

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15
Q

what are the consequences of not having the axes of the eyes and orbits alined

A

actions of the superior and inferior recti and oblique muscles are complicated and to look straight ahead, the eyes must be slightly aDducted

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16
Q

what do the superior rectus and superior oblique do together

A

intort

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17
Q

what do the inferior rectus and inferior oblique do together

A

extort

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18
Q

what do the inferior oblique and superior rectus do together

A

elevate

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19
Q

what do the superior oblique and the inferior rectus do together

A

depress

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20
Q

what do the lateral rectus, inferior and superior oblique do together

A

aBduct

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21
Q

what do the medial rectus, inferior and superior rectus do together

A

aDduct

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22
Q

how do you test the inferior oblique muscle on the H test

A

have the patient look UP

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23
Q

how do you test the superior oblique muscle on the H test

A

have the patient look DOWN

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24
Q

when do the superior and inferior oblique muscles raise and lower the eye

A

when the eye is aDducted or aBducted: the muscle axis is lined up with the eye axis

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25
Q

what is the special afferent innervation to the orbit/eye

A

CN 2 optic nerve

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26
Q

what is the general afferent innervation to the orbit

A

V1- ophthalmic division of trigeminal nerve (orbit, orbital contents and superior part of face) also suspends the ciliary gangion

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27
Q

what are 3 general efferent innervations to the orbit/eye

A

CN 3: oculomotor (GE to most of EOM and VE preganglionic parasympathetic to smooth muscles of eye), CN 4 and CN 6

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28
Q

what are the symptoms of a CN 6 lesion/palsy

A

(loss of lateral rectus) eye is turned medially and diplopia

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29
Q

what are the symptoms of a CN 4 lesion/palsy

A

(loss of superior oblique) affected eye is higher and deviated medially, very subtle, may also see head tilt away from affected side to counteract extorsion (from IO), diplopia

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30
Q

what are the symptoms of a CN 3 lesion/palsy

A

(oculomotor palsy) loss of all but lateral rectus and superior oblique muscles (also sphincter and ciliary), eye is directed down and out, ptosis, pupillary dilation and poor near focus

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31
Q

what is the blood supply to the orbit

A

branches of the ophthalmic artery (internal carotid): lacrimal, central retina, long/short posterior ciliary, supraorbital and supratrochlear, anterior and posterior ethmoidal and dorsal nasal

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32
Q

what is the venous drainage for the orbit

A

drain into the superior and inferior opthalmic veins which go to cavernous sinus (inferior ophthalmic vein may also drain into pterygoid venous plexus)

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33
Q

what is a cavernous sinus thrombosis

A

blood clot in cavernous sinus caused by a late complication of midface infection

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34
Q

what are the symptoms of a cavernous sinus thrombosis

A

headache, orbital content swelling, lateral gaze palsy, ocular motor palsy, ptosis, dilation, exophthalmos and visual impairment

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35
Q

what are the treatments for a cavernous sinus thrombosis

A

antibiotics, surgery to drain the sinus (morbidity is high and complete recovery is rare)

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36
Q

what is a carotid-cavernous sinus fistula

A

a rupture of internal carotid artery or its small dural branches in cavernous sinus caused by trauma or rupture of an aneurysm

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37
Q

what are the symptoms of a carotid-cavernous sinus fistula

A

trauma- marked swelling of orbital contents, pulsating exophthalmos, ocular motor palsy, vision impairment. Mild cases- diplopia and red, congested eye

38
Q

what are the treatments for a carotid-cavernous sinus fistula

A

trans-venous endovascular surgery for serious cases, usually not life-threatening

39
Q

what is the most common type of glaucoma

A

primary open angle glaucoma (OAG)- unknown cause

40
Q

what are the symptoms of primary OAG

A

gradual loss of peripheral vision, “tunnel vision”

41
Q

what are the treatments for primary OAG

A

usually a combination of drugs to lower IOP by increasing drainage or decreasing aqueous humor production

42
Q

what is acute angle closure glaucoma

A

emergency- caused by iris bulging forward through the sudden dilation of pupils (darkness, stress, or medications)

43
Q

what are the symptoms of acute angle closure glaucoma

A

severe, sudden eye pain, nausea and vomiting, halos, and blurred vision

44
Q

what are the treatments for acute angle closure glaucoma

A

medications, iridotomy

45
Q

what is secondary glaucoma

A

results in either primary open angle or acute angle-closure glaucoma, caused by eye injury, inflammation, tumor, diabetes, cataracts or steroids

46
Q

what does the outer fibrous layer consist of

A

sclera and cornea

47
Q

what does the middle layer (vascular/muscular) consist of

A

choroid: contains general afferents and vessels, ciliary body: smooth parasympathetic control, secretes aqueous humor, zonular fibers

48
Q

what does the inner (visual) layer consist of

A

retina: optic part, optic disc and fovea centralis

49
Q

what is the difference between a detached retina and a retinal tear

A

detached is an anterior displacement of vitreous that allows retina to pull away from choroid layer, tear is a hole in the retina and vitreous pools between it and choroid

50
Q

what causes a detached retina

A

PVD (usually older patients), trauma, weak area in retina/thin, glaucoma, cataract surgery (most common in people over age 50)

51
Q

what are the symptoms of a retinal detachment

A

flashes, sudden floaters, moving veil across vision

52
Q

what are some treatments for a retinal tear or detachment

A

tear: photocoagulation, cryopexy (freezing) detachment: pneumatic retinopexy (air bubble or gas), scleral buckle or vitrectomy

53
Q

what is another name for vortex veins

A

vorticose veins (4 large veins)

54
Q

what causes papilledema

A

tumors, problems with CSF production/absorption, encephalitis, medications

55
Q

what are symptoms of papilledema

A

headaches, blurry vision, diplopia

56
Q

what are some treatments for papilledema

A

depends on the cause

57
Q

what is the general afferent innervation to the cornea and sclera

A

ophthalmic nerve (V1)- nasociliary: long and short posterior ciliary branches

58
Q

what is the visceral efferent to the smooth muscle of the eye (parasympathetics)

A

oculomotor nerve (CN3) parasympathetics - ciliary ganglion - short posterior ciliary nerves- to ciliary muscle and sphincter puillary muscle

59
Q

what is the visceral efferent to the smooth muscle of the eye (sympathetics)

A

sympathetic plexus on internal carotid artery- through ciliary ganglion- long/short posterior ciliary nerves- dilator muscles

60
Q

which structures out of: the cornea, lens, aqueous humor, and vitreous humor, bends light the strongest

A

the cornea and lens (but only the lens changes shape)

61
Q

are the dilator pupillae fibers radial or circumferential

A

radial (sphincter pupillae are circumferential)

62
Q

what is the afferent pupilary light reflex pathway

A

light hits retina –> CN 2 optic nerve carries signal to the brain

63
Q

what is the efferent pathway for the pupilary light reflex

A

brainstem –> CN 3 oculomotor (inferior division) to parasympathetic root –> ciliary ganglion (synapse) then becomes the short posterior ciliary nerve which goes to sphincter pupilae muscle

64
Q

what is the afferent pupilary dark reflex pathway

A

no light on retina –> CN 2 optic nerve –> brain

65
Q

what is the efferent pupilary dark reflex pathway

A

brain –> spinal cord –> cervical sympathetic chain –> superior cervical ganglion (synapse) –> internal carotid plexus:

a) sympathetic root to ciliary ganglion (no synapse) to short posterior ciliary nerve to dilator pupilae muscle
b) V1 –> nasociliary nerve –> long ciliary nerve –> dilator pupilae muscle

66
Q

what is the afferent pathway for the corneal touch reflex

A

short/long ciliary nerve –> ciliary ganglion (no synapse) –> nasociliary nerve –> V1 –> semilunar ganglion –> CN V –> brainstem

67
Q

what is the efferent pathway for the corneal touch reflex

A

brainstem –> CN 7 –> temporal/zygomatic branches –> orbicularis occuli muscle

68
Q

what happens if there are lesions on each CN 3, superior cervical ganglion or V1 of Trigeminal

A

dilated pupil/near focus problems = absence of pupil constriction, constricted pupil (miosis) = absence of pupil dilation, loss of corneal touch reflex

69
Q

what is a stye (hordeolum)

A

acute, local inflammation from blockage of sebaceous and tarsal glands

70
Q

what is a chalazion

A

chronic form of stye, can occur on skin, lid margin or tarsal side (more painful), usually bacterial

71
Q

what are some treatments for a chalazion

A

warm compresses, antibiotics, steroids, incision and drainage

72
Q

what is conjunctival hyperemia

A

(blood shot eyes) conjunctival blood vessels become engorged (local irritation)

73
Q

what is conjunctivitis

A

“pink eye” infection of conjunctiva, usually bacterial or viral, can also be allergies

74
Q

what are symptoms and treatment for conjunctivitis

A

redness, itchiness, discharge, treatment varies

75
Q

what are the general afferents to the eyelid

A

V1 ophthalmic division of trigeminal nerve (lacrimal, supraorbital, supratrochlear, infratrochlear) and V2 infraorbital

76
Q

what does a lesion of the general afferents to the eyelid cause

A

anesthesia of eyelid

77
Q

what is the general efferent to the eyelid

A

CN 7 facial (temporal and zygomatic branches to orbicularis oculi)

78
Q

what would a lesion to the general efferents of the eyelid cause

A

bells palsy or a cranial injury/cavernous sinus problem = complete upper eyelid ptosis

79
Q

what is the visceral efferent to the eyelid

A

sympathetics to mullers muscle

80
Q

what would a lesion to the visceral efferent of the eyelid cause

A

Horners syndrome

81
Q

what is the general afferent to the lacrimal system

A

V1 ophthalmic division of Trigeminal nerve 5

82
Q

what is the visceral efferent parasympathetic to the lacrimal system

A

secretomotor: preganglionics from CN 7 in greater petrosal nerve and nerve of the pterygoid canal to the pterygopalatine ganglion (synapse) –> postganglionics in zygomatic nerve and communicating branch to lacrimal gland

83
Q

what is the visceral efferent sympathetic to the lacrimal system

A

inhibits secretion or change the viscosity of tears: preganglionics from T1-2 synapse in superior cervical ganglion –> postganglionics in internal carotid nerve and plexus to deep petrosal nerve and nerve of pterygoid canal to the pterygopalatine ganglion (no synapse) zygomatic nerve and communicating branch to lacrimal nerve

84
Q

what is the blood supply to the lacrimal gland

A

ophthalmic artery branches

85
Q

what is the venous drainage to the lacrimal gland

A

ophthalmic veins –> cavernous sinus

86
Q

what are 3 types of tears

A

basal, reflex, and emotional

87
Q

what are basal tears

A

lubrication, cleaning, removal of bacteria (normal parasympathetic stimulation)

88
Q

what are reflex tears

A

from irritation, wash irritants from the cornea (afferent= trigeminal, efferent = facial)

89
Q

what are emotional tears

A

from emotional stress, cause is unknown

90
Q

what happens to tearing with a lesion in CN 5

A

reflex lacrimation is lost but emotional and basal lacrimation are retained

91
Q

what happens to tearing with a CN 7 lesion- proximal to the geniculate ganglion

A

all lacrimation is lost, but tarsal, sebaceous and conjunctival glands can sometimes keep eye lubricated (i.e. basal tears)

Head and Neck (10 decks)

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