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Y2 Ophthalmology Anatomy > Orbit and the Eye > Flashcards

Orbit and the Eye Flashcards

1
Q

List the components of the bony orbit, in terms of apex, roof, floor and base

A

APEX: optic canal
ROOF: frontal
FLOOR: maxilla
BASE: orbital rim

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2
Q

What is the main eye protection from direct blow?

A

Orbital margin/ rim

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3
Q

What is the most common presenting complaint in blowout fracture?

A

Pain on upgaze

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4
Q

Define what is meant by ‘blowout fracture’

A

Traumatic deformity of orbital floor/ medial wall usually from impact of a blunt object onto the eye socket

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5
Q

What is the function of the suspensory ligament of the eye?

A

Thick fascial sling that holds he eye above the floor of the orbit

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6
Q

What is the most vulnerable site for orbital trauma? What is the consequence of this?

A

Inferior wall of the orbit

Damage to infraorbital NVB in infraorbital foramen leading to general sensory deficit to the middle third of the face

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7
Q

What muscle of facial expression forms the external layer of the orbit? What is it’s nerve supply?

A

Orbicularis oculi

CNVII

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8
Q

List the two main parts of the orbicularis oculi muscle and give their function

A 
Orbital part - close eye tightly
Palpebral part (eyelid only) - blinking
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9
Q

What is the function of the orbital septum?

A

Helps prevent spread of infection into the deep tissues

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10
Q

The orbital septum is split by…

A

Medial and lateral palpebral ligament

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11
Q

What is the function of the tarsal glands?

A

Lipid secretion

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12
Q

Which muscle connects the superior tarsal gland to levator palpebrae superficialis?

A

Muller’s muscle

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13
Q

The orbital septum is located posterior to…

A

Orbicularis oculi

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14
Q

Which muscle(s) control eye opening? What is the nerve supply?

A

LPS with Muller’s muscle

CNIII

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15
Q

Which muscle(s) control eye closing? What is the nerve supply?

A

Orbicularis oculi

CNVII

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16
Q

The iris of th eye is covered by…

A

The cornea

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17
Q

The white sclera of the eye is covered by…

A

Conjunctiva

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18
Q

What is the ‘limbus’ of the eye?

A

The corneal limbus is the border of the cornea and the sclera (corneoscleral junction)

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19
Q

List the components of the lacrimal gland

A

Lacrimal lake
Inferior lacrimal papilla (swelling)
Inferior lacrimal punctum (opening)

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20
Q

What is the function of the conjunctiva of the eye?

A

Lines the lower eyelid and is a barrier to foreign bodies

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21
Q

What are the main parts of the conjunctiva of the eye?

A

Palpebral (inner eyelid)

Bulbar (eyeball)

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22
Q

How do you distinguish the limbus from the iridocorneal angle?

A

Grey clouding

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23
Q

Describe the spacing of fibres in the cornea vs. sclera respectively

A

Straight fibres

Meshwork

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24
Q

List the components of the uvea

A

Iris
CIliary body
Choroid

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25
Q

What is the ‘choroid’ of the eye?

A

Vascular tunic which supplies the outer layers of the retina and contains the ciliary vein

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26
Q

The production of lacrimal fluid from the lacrimal gland is controlled by which cranial nerve?

A

PS CNVII

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27
Q

Outline the route taken by lacrimal fluid or tears as it leaves the lacrimal gland

A 
Washes over eye -->
Pushed towards medial angle -->
Lacrimal puncta -->
Canalicu -->
Lacrimal sac -->
Nasolacrimal duct -->
Inferior meatus
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28
Q

What is fibrous outer layer of the eye composed of?

A

Sclera

Cornea

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29
Q

What is the vascular middle layer of the eye formed from?

A

Uvea

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30
Q

The iris of the uvea of the eye controls…

A

Pupil diameter

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31
Q

The ciliary body of the uvea of the eye controls…

A

Iris, lens shape, secretion of aqueous humour

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32
Q

The chorid of the uvea of the eye controls…

A

Nutrition and gas exchange

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33
Q

What is the photosensitive inner layer of the eye formed from?

A

Retina

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34
Q

List the three layers of the eye in order, from outer to inner

A

Fibrous outer layer
Vascular middle layer
Photosensitive inner layer

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35
Q

The anterior segment of the eye is split into two divisions what are they?

A 
Anterior chamber (cornea to iris)
Posterior chamber (suspensory ligament to iris)
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36
Q

The anterior chamber of the anterior segment of the eye secretes what type of fluid?

A

Aqueous humour

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37
Q

The posterior chamber of the anterior segment of the eye secretes what type of fluid?

A

Aqueous humour

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38
Q

List the two segments of the eye

A

Anterior (in front of lens)

Posterior (behind lens)

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39
Q

The posterior segment of the eye secretes what type of fluid?

A

Vitreous humour from the vitreous body

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40
Q

The vitreous body within the eye is a common site for what pathology?

A

Floaters

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41
Q

Outline the route taken by aqueous humour from production to drainage

A

Ciliary body –>
Posterior chamber (nourishes lens)–>
Anterior chamber (nourishes cornea)–>
Dural venous sinus (canal of shlemm)

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42
Q

What site of the eye is where aqueous humour is reabsorbed?

A

Iridocorneal angle

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43
Q

Abnormal absorption of aqueous humour results in what type of pathology?

A

Open or closed angle glaucoma

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44
Q

Outline arterial boody supply to the eye

A 
Ophthalmic artery (CCA-->ICA-->OA) which branches into ciliary arteries
Branches into nasal and scalp arteries
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45
Q

Which vessels are ‘end arteries’ in they eye? What is meant by the term ‘end artery’?

A

Central arteries of retina

No anastamosis if ischaemia - only blood supply to that area

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46
Q

Outline venous drainage of the eye

A

Little nasal and scalp veins –>
Superior and inferior ophthalmic veins –>
Cavernous sinuses

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47
Q

Which foramen allows ophthalmic veins to drain into cavernous sinuses?

A

Superior orbital fissure

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48
Q

What is meant by the ‘danger triangle of the face’?

A

Sinuses connect anteriorly to the valveless facial vein (drains triangle from upper lip to external nose)

Blood can flow bidirectionally, meaning blood from a spot/ cut can drain into the sinuses and cause intracranial infection

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49
Q

How is the optic nerve assessed on fundoscopy?

A

CONTOUR: crisp round edge? blurring?
COLOUR: white centre and pink rim like a rubber ring?
CUP: size (cup: disc ratio)

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50
Q

How might the optic nerve appear in the case of increased ICP? Name a pathology that can occur in this case

A

Swollen, explosion

Papilloedema

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51
Q

How is the optic nerve tested?

A 
Visual Acuity (inc. colour)
Visual Fields
Reflexes
Ophthalmoscope
AFRO
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52
Q

A problem with the nasal retina will affect the nasal/ temporal visual field and vice versa

A

Temporal

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53
Q

A lesion to the optic nerve will cause what visual field defect?

A

Ipsilateral monocular blindness

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54
Q

A lesion to the optic chiasm will cause what visual field defect? Why?

A

Bitemporal haemanopia

Nasal retina damaged as they cross at the chiasm causing a bilateral temporal field defect

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55
Q

A lesion to the optic tract will cause what visual field defect?

A

Left or right homonymous haemanopia (vision affected on same side of both eyes)
Described as if you’re looking face-on at the patient

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56
Q

Which lobe would be affected in a superior quadrantopia?

A

Temporal lobe

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57
Q

Which lobe would be affected in a inferior quadrantopia?

A

Parietal lobe

58
Q

A lesion to the occipital lobe would result in what visual field defect?

A

Homonymous haemanopia with macular sparing

59
Q

Which part of the eye is the posterior area where light is focused?

A

Fundus

60
Q

The optic disc represents the area of…

A

CNII formation

Entry/ exit for blood vessels

61
Q

Clinically, the blind spot in a person’s vision refers to what?

A

The absence of photoreceptors in the optic disc

62
Q

Which part of the eye has the greatest density of cones, and therefore, the most acute vision?

A

Macula (specifically, the fovea at the centre of the macula)

63
Q

List the layers of the retina from anterior to posterior

A

Photoreceptors
Ganglion cells
Axons of ganglion cells

64
Q

How will complete interruption in blood flow to a retinal artery branch affect vision?

A

Loss of an area of visual field depending on area of ischaemia

65
Q

How will complete interruption in blood flow to a central retinal artery affect vision?

A

Monocular blindness in the affected eye

66
Q

How are the quadrants of the eye described?

A

Upper and lower nasal and temporal

67
Q

Outline the route taken by light as it hits the eye to the retinal layers

A 
Tear film -->
Cornea -->
Aqueous humour of anterior chamber -->
Pupil -->
Aqueous humour of posterior chamber -->
Lens -->
Vitreous body and humour -->
Retinal artery/ vein branches -->
GANGLION CELL AXONS -->
GANGLION CELLS -->
PHOTORECEPTORS
68
Q

Light hits the retinal layers of the eye from anterior to posterior. True/ False?

A

False

From posterior to anterior, ending with photoreceptors

69
Q

Outline the optic pathway from visual field to primary visual cortex

A 
Right and left visual field -->
Temporal retina continues ipsilaterally and nasal retina crosses at chiasm -->
Optic nerve -->
Optic chiasm -->
Layer geniculate nucleus -->
Primary visual cortex
70
Q

Light from objects in the right visual field processed by left/right primary visual cortex.

A

Left

71
Q

Light from objects in lower visual field processed by upper/ lower primary visual cortex.

A

Upper

72
Q

List the seven extraocular muscles, grouping them into types

A

RECTUS: superior, inferior, medial, lateral
OBLIQUE: superior, inferior
LEVATOR PALPEBRAE SUPERFICIALIS

73
Q

Where do the rectus muscles of the eye originate from?

A

Common tendinous ring

74
Q

What is the function of LPS, an extraocular eye muscle?

A

Lifts the upper eyelid

75
Q

Outline the innervation of the extraocular muscles of the eye

A 
SOMATIC MOTOR
LR6, SO4, AO3
Lateral rectus: CNVI
Superior oblique: CNIV
All others: CNIII
76
Q

List the three axis of the eye, and what movement each control

A

Vertical: ABD, ADD
Transverse: ELEVATION, DEPRESSION
AP: INTORSION, EXTORSION

77
Q

Which eye movement is controlled by lateral rectus muscle?

A

Abduction

78
Q

Which eye movement is controlled by superior rectus muscle?

A

Elevation in abduction

79
Q

Which eye movement is controlled by inferior rectus muscle?

A

Depression in abduction

80
Q

Which eye movement is controlled by medial rectus muscle?

A

Adduction

81
Q

Which eye movement is controlled by inferior oblique muscle?

A

Elevation in adduction

82
Q

Which eye movement is controlled by superior oblique muscle?

A

Depression in adduction

83
Q

Which two extraocular muscles control pure depression of the eye?

A

Superior oblique

Inferior rectus

84
Q

Which two extraocular muscles control pure elevation of the eye?

A

Superior rectus

Inferior oblique

85
Q

Sensory innervation of the face is controlled by which CN?

A

Branches of CNV

86
Q

List the areas of the face in which sensation is controlled by CNV1

A

Upper eyelid
Cornea
Conjunctiva
Skin of root/bridge/ nose tip

87
Q

List the areas of the face in which sensation is controlled by CNV2

A

Lower eyelid
Maxilla
Ala of nose
Upper lip

88
Q

List the areas of the face in which sensation is controlled by CNV3

A 
Mandible
TMJ 
Lower lip
Chin
(except angle of mandible)
89
Q

Sensation to the angle of the mandible is controlled by…

A

C2/3 spinal nerves

90
Q

What term refers to a skin lesion at tip, side or root of the nose? What is a common cause of this?

A

Hutchinson’s sign

Ophthalmic herpes zoster

91
Q

Which cranial nerve controls the afferent limb of the blink reflex? (Be specific)

A

Nasociliary branch of CNV1

92
Q

Which cranial nerve controls the efferent limb of the blink reflex?

A

CNVII

93
Q

Outline the route taken by sympathetic axons to the head and neck, specifically the orbit

A

Presynaptic axons (cranial nerves) –>
Exit spinal cord at T1–>
Ascend in sympathetic trunk–>
Synapse in superior cervical sympathetic ganglion –>

Postsynaptic sympathetic axons –>
Enter internal and external carotid nerves –>
Pass onto surface of internal and external carotid arteries –>
Organs of head and neck –>
Ophthalmic artery –>
Orbit

94
Q

Outline the route taken by sympathetic axons to organs of the body

A

Autonomic centres in brain –>
Exit spinal cord at T1-L2 –>
Sympathetic chains on vertebral column –>
Spinal nerves (anterior and posterior ramii) –>
Splanchic nerves to organs

95
Q

Outline the route taken by parasympathetic axons to organs of body

A

All leave via CNs III, VII, IX, X and sacral spinal nerves (craniosacral outflow)

96
Q

How do parasympathetic axons reach the eye, lacrimal and salivary glands?

A

Via parasympathetic ganglia in the head

97
Q

How do parasympathetic axons reach the neck, chest and abdomen (as far as the midgut)?

A

Vagus nerve

98
Q

How do parasympathetic axons reach the hindgut, pelvis and perineum?

A

Sacral spinal nerves

99
Q

The oculomotor nerve connects with the CNS at…

A

Junction between midline and pons

100
Q

The oculomotor nerve passes through which anatomical structure?

A

Cavernous sinus

101
Q

The oculomotor nerve passes through which foramen?

A

Superior orbital fissure

102
Q

The oculomotor nerve supplies which muscles, and with which modality?

A

SOMATIC MOTOR: SR, MR, IR, IO, LPS

PS: ciliary ganglion

103
Q

Describe how the eye would appear in complete CNIII palsy

A

Eye positioned down and out with ptosis

104
Q

What is the function of the ciliary ganglion?

A

Autonomic axons to control iris diameter and refractive shape of lens

105
Q

Which fibres are contained by the long ciliary nerve?

A

Sympathetic

Somatic sensory

106
Q

Which fibres are contained by the short ciliary nerve?

A

Sympathetic

Parasympathetic

107
Q

Which of the long and short ciliary nerves forms the first part of the blink reflex?

A

Long ciliary nerve (somatic sensory)

108
Q

The short ciliary nerve eventually becomes part of which cranial nerve?

A

CNV (nasociliary branch)

109
Q

What is the fight or flight response of the eye? Which muscle controls this action? What is it’s nerve supply?

A

Maximal eyelid elevation/ wide eye opening
Levator palpebrae superficialis
CN III

110
Q

What is the function of the pupillary light reflex?

A

Pupillary dilatation/ constriction adjusting to light entry

111
Q

Dilatation of the pupil is controlled by…

A

Sympathetics

112
Q

List common situations where the pupil would typically dilate

A

Dim light
Fight/ flight response
Sickness
Mydriatic pupil

113
Q

Which pupillary fibres control dilatation and constriction of the eye respectively?

A

Dilatory pupillae fibres

Syphincter pupillae fibres

114
Q

Constriction of the pupil is controlled by…

A

Parasympathetics

115
Q

List common situations where the pupil would typically constrict

A

Bright light
Rest and digest response
Miotic pupil e.g. in Horners

116
Q

Name a pathological cause of a fixed pin point pupil

A

Opiate drugs

117
Q

Name a pathological causes of a fixed blown pupil

A

CNIII paralysis

118
Q

List the two main types of pupillary light reflex

A

Direct (stimulated eye)

Consensual (non-stimulated eye)

119
Q

The afferent limb of the pupillary light reflex is controlled by which CN?

A

Ipsilateral optic nerve

120
Q

The efferent limb of the pupillary light reflex is controlled by which CN?

A

Bilateral oculomotor nerve

121
Q

The two limbs of the pupillary light reflex connect with the CNS at the…

A

Midbrain

122
Q

Outline the 4 parts of the neurone chain controlling the pupillary light reflex

A

1, Retinal ganglions are transmittedvia CNII to the optic chiasm and synapse at the pretectal nucleus in the midbrain

  1. Synapse at EW nucleus (site of CNIII PS axons and cell bodies exist)
  2. Pass via CNIII to the inferior division of the eye and synapse in the ciliary ganglion
  3. Pass in short ciliary nerves to the sphincter pupillae muscles
123
Q

What connects the circumference of the lens and the ciliary body?

A

Suspensory ligament of the lens

124
Q

Describe the structure of the ciliary body

A

SM like a sphincter around the lens circumference

125
Q

Describe the action of the ciliary body, and thus the change in lens shape in ‘far’ vision

A

No parasympathetics, ligament tightens (cilary body relaxes) and lens flattens to focus on object in distance

126
Q

Describe the action of the ciliary body, and thus the change in lens shape in ‘near’ vision

A

Parasympathetics cause ligament to relax (cilary body contracts) and lens becomes spherical to focus on near objects

127
Q

Name the two parts of the lens of the eye

A

Outer: cortex
Inner: nucleus

128
Q

How does the lens change with age?

A

Becomes less flexible, can’t focus as easily

129
Q

What is the function of the accommodation reflex?

A

Response to ‘near’ vision - allows the eye to focus on two points

130
Q

Outline the main three components of the accommodation reflex, and the muscle used in each

A
  1. Bilateral pupillary constriction via sphincter pupillae
  2. Bilateral convergence of both eyes to midline via medial rectus
  3. Bilateral relaxation of lens via ciliary muscle contraction
131
Q

The three components of the accommodation reflex are innervated by which CN?

A

CNIII

132
Q

What pH does the lacrimation reflex keep tears at?

A

7.6

133
Q

What type of tears are involved in corneal cleaning, hydration and nourishment?

A

Basal tears

134
Q

What type of tears are involved in response to chemical/ mechanical stimuli?

A

Reflex tears

135
Q

What type of tears are involved in reaction to happy/ sad/ frightened feeling?

A

Emotional tears

136
Q

Outline the neurone root, supplying innervation to the lacrimal gland

A

CNVII motor axons to muscles of facial expression –>
Stylomastoid foramen –>
Internal acoustic meatus –>
Chorda tympani, motor to stapedius, PS to submandibular/ sublingual glands –>
Branch of V2 –>
V1 –> Axons to lacrimal gland

137
Q

List the symptoms present in Horner’s syndrome

A

Miosis
Ptosis
Ipsilateral reduced anhydrosis
Increased warmth and redness

138
Q

Outline the anatomy affected in Horner’s syndrome

A

Impaired sympathetic innervation to head and neck due to compression of cervical sympathetic trunk

139
Q

Which muscle is comprised, due to compression of it’s sympathetic innervation in Horner’s, which leads to ptosis?

A

Muller’s muscle controlling LPS

140
Q

List causes of Horner’s syndrome

A 
Root of neck trauma
Carotid dissection
IJV engorgement
Deep cervical node metastases
Pancoast tumour at lung apex
141
Q

What is the vestibulo-ocular reflex?

A

Turns eyes in opposite direction to head movement allowing eyes to stabilise gaze on an object

142
Q

What is the oculo-cardiac reflex?

A

Reflex bradycardia due to tension on extraocular muscles/ pressure on the eye

Y2 Ophthalmology Anatomy (2 decks)

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