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My Ophthalmology > Week 1 - Important Anatomy > Flashcards

Week 1 - Important Anatomy Flashcards

1
Q

what are the 3 layers of the CNS meningeal layers - names, order from outer to inner, characteristics

A

order = DAP
Dura mater - thick dense connective tissue. Encloses dural venous sinuses.

Arachnoid mater - thin delicate tissue - lines longitunindal fissure. Has arachnoid granules that protrude into the dural venous sinuses.

subarachnoid space - contains CSF + blood vessels.

Pia mater - thin, fibrous, covers the brain + attached nerves + vessels

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2
Q

what are the 2 parts of the midbrain that are part of the pupillary sphincter reflex?

A
  1. Pretectal nucleus

2. EWN

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3
Q

where is the synapse of CN3 ?

A

in the ciliary ganglion

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4
Q

where are the choroid plexuses?

A

mostly in the lateral ventricles

also 3rd and 4th ventricles

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5
Q

what are the 3 parts of the trigeminal nerve CN 5 ?

A 
V1 = Ophthalmic 
V2 = maxillary 
V3 = mandibular
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6
Q

what does CN V1 cover?

A

Ophthalamic nerve

  • upper eyelid
  • eye
  • middle to tip of nose
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7
Q

what does CN V2 cover?

A

Maxillary

  • lower eyelid
  • maxillary area of face
  • side of nose
  • upper lip
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8
Q

what does CN V3 cover?

A

Mandibular

  • lower lip
  • jaw area
  • NOT the angle of the mandible
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9
Q

what 2 CNs are involved in the blink (corneal) reflex?

A 
CN V (V1) = afferent
(V1 --> trigeminal ganglion --> pons --> CN 7)
CN VII = efferent to eyelid of orbicular oculi
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10
Q

where do presynaptic Cervical sympathetic axons from the CNS synapse into post synaptic axons?

A

at the superior cervical sympathetic GANGLION

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11
Q

At what spinal level do pre-synaptic sympathetic axons leave the spinal cord?

A

T1

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12
Q

how do post-synaptic sympathetic axons travel to the head organs ?

A
  1. enter int/external carotid nerves
  2. these nerves are on surface of the int/external carotid arteries which do into the organs
  3. get to eyes on the ophthalmic artery branch
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13
Q

what 3 things in the head are supplied by oarasympathetic axons?

A

eyes
lacrimal glands
salivary glands

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14
Q

CN3 exit from the brain

  • what sinus?
  • what fissure?
A

cavernous sinus

superior orbital fissure

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15
Q

where do presynaptic parasympathetic axons of CN3 synapse?

A

in the ciliary ganglion

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16
Q

the post-sympathetic part of the CN3 is dividied in 2 parts - superior and inferior. what 2 muscles are superior + what 3 are inferior?

A

superior = superior rectus + LPS

inferior = medial rectus + inferior rectus + inferior oblique

remember that lateral rectus = CN6
and superior oblique is CN 4

LR6 SO4 AO3

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17
Q

ciliary nerves control iris diameter + refractive shape of lens

what part of autonomic control is are long ciliary nerves?

what are short ciliary nerves for?

A

long = sympathetic (and sensory - 1st part of blink reflex)

short = symp + parasympathetic

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18
Q

what does mydriatic mean?

A

enlarged pupil

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19
Q

what does miotic mean?

A

constricted pupil

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20
Q

terms for

  • enlarged pupil
  • constricted pupil
A 
enlarged = mydratic
constricted = miotic
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21
Q

what fibres allow dilation?

A

dilator pupillae

22
Q

what fibres allow constriction?

A

sphincter pupillae

23
Q

the pupillary light reflex involves which 2 cranial nerves?

A

2 (optic) - afferent

connections in the midbrain - pretectal + EWN

3 (oculomotor) - efferent

24
Q

what connects the lens and the ciliary body?

A

the suspensory ligament

25
Q

how do you achieve a “flat lens” for far vision?

A
  • ciliary muscle relaxes
  • suspensory ligament tightens
    (no parasympathetic control)
26
Q

how do you achieve a “round lens” for near vision?

A
  • ciliary muscle contracts
  • suspensory ligament relaxes
    under CN3 !!! parasympathetic control = near vision more important than far in parasympathetic states
27
Q

what is needed for the accommodation reflex? (3)

A

parasympathetic control:

round lens (near vision) = so CN3

convergence = CN3 causes medial rotation of eyes

pupillary constriction = CN3 also

28
Q

compression of WHAT causes horners?

A

compression of the cervical parts of the sympathetic trunk - impairs sympathetic innervation
eg. ptosis instead of wide opened eyelids
eg. miosis instead of dilated
eg reduced steating

29
Q

could add lacrimilisation nerve Qs

A

??

30
Q

what spinal levels is lumbar puncture done at ?

A

either L3/4

or L4/5

31
Q

how does CSF get from the subarachnoid space back into the brain?

A

subarachnoid –> arachnoid –> arachnoid granules –> dural venous sinuses

32
Q

what happens when the optic nerve is compressed by high ICP?

A
  1. compression of the central vein and artery of the retina too
  2. papilloedema - optic disc swelling
33
Q

what specifically damages CN 3 when there is raised ICP?

A

Tentorial herniation - herniation of the medial temporal lobe through the tentorial notch. likely to compress CN3

34
Q

what happens to the eye when CN3 is compressed by high ICP?

A
  1. paralysis of eyelid = PTOSIS
  2. paralysis of SR + IO + IR + MR = TURNED DOWN AND OUT
  3. paralysis of parasympathetic pupillary control = DILATED PUPIL
35
Q

What eye movement is restricted when CN 4 is compressed ?

A

Trochlear nerve = SO paralysis

The eye cant move inferomedially

36
Q

what eye movement is restricted when CN6 is compresed

A

Abducens = Lateral rectus
Eye cant move horizontal + lateral
stuck in medial

37
Q

afferent and efferent in the blink reflex?

A 
afferent = V1 (ophthalmic - nasociliary branch)
efferent = CN 7
38
Q

what is cupping?

what are the clinical signs of cupping?

A

Cupping is progressive thinning of the neuroretinal rim – increasing cup size.

Progressive loss of peripheral vision before central. Happens in glaucoma - raised IOP for some reason.

39
Q

what 2 eye nerve conditions are common in MS?

A

optic neuritis

intranuclear opthalmoplegia

40
Q

most common + other causes of CN6 palsy?

A 
#1 is microvascular
temporal injury
raised ICP - petrous tip impingement
tumour 
congenital
41
Q

signs of CN 4 palsy

A

Can’t turn “down and in”
head tilting if chronic
vertical double vision

42
Q

most common + other causes of CN 4 palsy?

A

1 is congenital

microvascular
tumour
trauma

43
Q

Signs of a CN3 palsy

A

ptosis
dilated pupil
turned down and in

44
Q

describe inter-nuclear ophthalmoplegia + its effect

A

damage to the connection between CN4 + 6 in the medial longitudinal fasciculatus in the brainstem

affects connection between eyes that allow both to look right / left simultaneously at the same time + speed

45
Q

2 systemic conditions that predispose to internuclear opthalmoplegia

A
  1. MS

2. Vascular eg. stroke

46
Q

what visual field defect is caused by lesion at the occipital visual cortex?

A

Contralateral homonymous hemianopia +/- macular sparing

47
Q

where is the right upper visual field processed?

A

left temporal lobe

48
Q

where is the left lower visual field processed?

A

right parietal lobe

49
Q

what visual field defect is caused by an optic nerve lesion?

A

Ipsilateral monocular visual loss

50
Q

what nerve problem is caused by GCA? describe it..

A

ION = ischaemic optic neuropathy

Obstructution / stenosis of the posterior ciliary arteries which supply the head of the optic nerve.

ischaemia causes irreversible vision loss.

51
Q

describe optic neuritis

A

progressive visual loss getting worse for 2 weeks. colour vision inc. Pain behind eye + worse on movement.

may have scotoma (central)

common in MS

52
Q

what slow growing tumour can affect the optic chiams?

A

Meningioma

Becase slow growing it doesn’t cause increased ICP

My Ophthalmology (7 decks)

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