Visual System Flashcards
What forms the supraorbital margin?
Frontal bone (with supraorbital notch for the supraorbital nerve)
What forms the infraorbital margin?
- Zygomatic bone (laterally)
- Maxilla (medially)
What forms the roof of the orbit?
Frontal bone, lesser wing of sphenoid
What forms the floor of the orbit?
Maxilla, zygomatic, palatine
What forms the lateral wall of the orbit?
Zygomatic, lesser wing of sphenoid
What forms the medial wall of the orbit?
Maxilla, lacrimal bone, ethmoid, body of sphenoid
Where will blowout fractures to the orbit normally occur?
To the lacrimal bone or ethmoid bone, as they are extremely thin and fragile.
What proportion of the eyeball is sclera?
5/6th of the eyeball
What does the sclera do?
Maintains the shape of the globe, offering resistance to internal and external forces
What two characteristics make the sclera strong?
- Made of collagen
- Laid down in whirls
What does the sclera provide attachment for?
Extraocular eye muscles
What are the 3 layers to the eye?
- Sclera and cornea
- Vascular supply
- Neural part
What proportion of the eyeball is cornea?
1/6th
What is the principal refracting component of the eye?
Cornea
What makes the cornea optimum for vision?
Being avascular and transparent
Why is the cornea transparent?
Because the collagen fibrils are uniform in diameter, evenly spaced and run in bundles (lamellae) parallel to one another.
What does scleral opacity vary depending on?
- Composition of the stroma
- Hydration
- Size and distribution of collagen
What will happen to the order of collagen fibrils in the cornea if it is damaged?
The order will not necessarily return and can result in a scar
What is the anterior chamber of the eye?
Junction between iris and cornea
What happens at the anterior chamber of the eye?
Aqueous humour drains out of eye
What are the key structures of the anterior chamber of the eye?
- Cornea
- Trabecular meshwork
- Canal of Schlemm
- Aqueous humour drains into venous system via canal of Schlemm
- Ciliary body
What happens at the Canal of Schlemm?
Aqueous humour drains into the venous system
What forms the middle coat of the eye?
Uvea
What forms the middle layer of the eye?
Ciliary body, sclera and conjunctiva
What is the function of the ciliary body?
- Formation of aqueous humour (Ciliary epithelium)
- Tethers lens (Ciliary processes)
- Accommodation (Ciliary muscle)
What are the important structures within the ciliary body?
- Ciliary processes (Ciliary epithelium): form aqueous humour and form attachment for lens
- Ciliary muscle
What does the ciliary body produce?
Aqueous humour
What does the aqueous humour do?
- Important for maintaining the health of the lens and cornea.
- Creates intraocular pressure.
What structures does accommodation involve?
- Ciliary muscles
- Zonules to attach to lens
What are zonules?
Ligaments that attach between ciliary processes and lens.
Where is the ciliary muscle found?
Within the ciliary body
What is the ciliary muscle innervated by?
Parasympathetic NS
What kind of muscle is ciliary muscle?
Non-voluntary muscle (smooth muscle)
How does the ciliary muscle accommodate?
The circular fibres change the tension on the zonules, deforming the lens
What does relaxation of the ciliary muscle result in?
A thin lens that is deformed (distant objects)
What does contraction of the ciliary muscle result in?
A relaxed, fat lens (closer objects)
What is presbyopia?
- Amplitude of accommodation varies with age
- Prebyopia refers to the loss of accommodation with age.
- Caused by reduction in flexibility of the lens capsule and zonules
- Treated by the wearing of plus lenses
What is the iris?
Aperture of the eye
What two muscles comprise the iris?
- Sphincter pupillae: constricts pupil: innervated by parasympathetic NS
- Dilator pupillae: dilates pupil: innervated by sympathetic NS
What is the choroid?
3 layers of blood vessels underneath the retina that supply nutrients to the retina.
Which blood vessels in the choroid are the most important?
Most important is the choriocapillaris, which sits just below the retina.
What are the important components of the retina?
- Optic nerve/optic disc
- Fovea/foveola
- Macular
- Posterior pole
- Orra serrate
What are the 2 specialised regions of the retina?
Fovea and optic nerve
What is the fovea?
An avascular area of high visual acuity due to a high density of cones (no rods) where everything is shifted to the side except photoreceptors.
What forms the optic nerve?
The axons of ganglion cells as they exit the retina to pass visual information to higher cortical areas.
What is the lamina cribrosa?
A band of 3-10 sheets of dense connective tissue that forms a sieve at where the optic nerve exits the eye through which axons must pass. Disease can damage this area and push on axons traversing it.
If a patient notices a “curtain come down” over their vision, what is a potential reason?
Arterial occlusion
Which artery supplies the inner retina?
Central retinal artery (branch of ophthalmic artery)
What are the ciliary arteries?
- Long posterior ciliary
- Short posterior ciliary
- Anterior ciliary
Do the anterior ciliary arteries pierce the globe?
No. They supply structures at the front of the eyeball.
What do the posterior arteries travel in?
The choroid
Which artery supplies the outer retina?
Posterior ciliary artery
Which artery supplies the photoreceptors?
Posterior ciliary artery
What do the short posterior arteries supply?
Photoreceptors closer to optic nerve and nerve itself
What do the long posterior arteries supply?
Photoreceptors all the way around the retina
What are the eyelids comprised of?
- Skin
- Glands and eyelashes
- Conjunctiva
- Muscles:
- Orbicularis oculi
- Levator palpebrae superiosis
- Lacrimal apparatus:
- Lacrimal gland and ducts
- Nasolacrimal sac and duct
What are the muscles of the orbit?
- Orbicularis oculi
- Levator palpebrae superiosis
What does levator palpebrae superiosis do?
Elevates the upper lid
What type of muscle is levator palpebrae superiosis?
Striated muscle
What is levator palpebrae superiosis innervated by?
CNIII (oculomotor)
What does orbicularis oculi do?
Depresses upper lid (sphincter muscle)
What type of muscle is orbicularis oculi?
Striated muscle
What is orbicularis oculi innervated by?
CNVII (facial)
Do levator palpebrae superiosis and orbicularis oculi work together?
No. NEVER!
What are the 3 basic layers to the eyeball? What is their function?
- Outer coat: cornea and sclera
- Function: strength
- Middle coat: uvea
- Function: nutrition
- Inner coat: retina
- Function: vision
What fundamentally limits visual acuity?
- Neural factors
- Optical factors
What is visual acuity?
Ability to resolve fine detail.
How is visual acuity tested?
By recognition of letters on a Snellen or LogMAR chart.
What result on a visual acuity test is considered legally blind?
6/60
What optical factors affect visual acuity?
- Pupil size
- Clarity of optical media
- Cataracts, corneal opacities…
- Refractive errors → blur
- Myopia, hypermetropia, astigmatism, presbyopia
What is the best visual acuity at phototopic levels?
6/6
What type of photoreceptors are present at the fovea?
Cones
How far away from the fovea is demonstrable visual acuity loss?
5 minutes of arc away from fovea.
What is the best visual acuity at scotopic levels?
6/60
Where are rods (and rod pathways) found in the retina?
Between 5-15˚ away from the fovea
Where is the best peripheral vision in the retina?
At approx. 8 degrees off centre of the fovea.
What is visual acuity in the fovea determined by?
Number of cones
What are the 6 neurons of the retina?
Rods, cones, horizontal cells, bipolar cells, amacrine cells and ganglion cells.
What are the 2 synaptic layers of the retina?
- Outer plexiform layer
- Inner plexiform layer
What does light pass through before hitting photoreceptors?
All retinal layers
What are the properties of rods?
- Night vision
- Scotopic
- Very sensitive
- One type only
- No colour vision
- 100 million
- Absent from fovea
What are the properties of cones?
- Day vision
- Photopic
- Less sensitive
- Three types (RGB)
- Allow colour vision
- 5 million
- Densest in fovea
What is needed for the finest detail to be resolved?
- A good optical system
- Small, closely packed detectors
What is the “through” pathway?
Photoreceptors → bipolar cells → ganglion cells → optic nerve
What provides lateral interactions and modulations to the through pathway?
- Horizontal cells
- Amacrine cells
What are the first, second and third order neurons in the through pathway?
- Photoreceptor
- Bipolar cell
- Ganglion cell
What are the 10 different types of bipolar cells?
- 1x rod bipolar cell
- 9x cone-bipolar cells
What are bipolar cells important for?
Spatial vision & colour vision
What are OFF bipolar cells?
Bipolar cells that hyperpolarise when light falls on the retina.