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Anatomy Flashcards

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1
Q

What are the retina and the optic nerve outgrowths of?

A

The brain

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2
Q

What are the 3 coats of the eye?

A
  1. Outer fibrous layer
  2. Middle vascular layer (uveal tract)
  3. Inner nervous layer (retina)
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3
Q

What are the 3 parts of the outer fibrous layer of the eye?

A
  1. Cornea
  2. Sclera
  3. Lamina cribrosa
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4
Q

What are the 3 parts of the middle vascular layer of the eye (uveal tract)?

A
  1. Iris
  2. Ciliary body - consisting of the pars plicata and pars plana
  3. Choroid
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5
Q

What are the 3 layers of the inner nervous layer of the eye?

A
  1. Pigment epithelium of the retina
  2. Retinal photoreceptors
  3. Retinal neurones
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6
Q

What are the 3 compartments of the eye?

A
  1. Anterior chamber
  2. Posterior chamber
  3. Vitrous chamber
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7
Q

What are the boundaries of the anterior chamber?

A

The space between the cornea and the iris

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8
Q

What are the boundaries of the posterior chamber (3)?

A

The triangular space (on either side of the pupil, when viewed in cross-section) between the iris anteriorly

The lens and zonule posteriorly

The ciliary body laterally

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9
Q

What are the boundaries of the vitrous chamber?

A

The space behind the lens and zonule

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10
Q

What are the 3 intraocular fluids?

A
  1. Aqueous humour
  2. Vitrous humour
  3. Blood
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11
Q

What is aqueous humour?

A

A watery, optically clear solution of water and electrolytes similar to tissue fluids

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12
Q

What is vitreous humour?

A

A transparent gel

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13
Q

What is the role of blood in the eye in addition to its usual functions?

A

Contributes to the maintenance of intraocular pressure

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14
Q

What layer of the eye contains most of the blood?

A

Choroid

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15
Q

What are the 2 functions of the choroidal vasculature?

A
  1. Retinal nutrition

2. Heat-exchanger for the retina

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16
Q

What is the function of the retina?

A

It absorbs light energy as light strikes the retinal pigment epithelium and converts it to nerve impulses

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17
Q

How is the eye clinically separated into 2 compartments?

A
  1. Anterior segment - all structures from (and including) the lens forward
  2. Posterior segment - all structures posterior to the lens
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18
Q

Where is the cornea?

A

Forms the anterior 1/6th of the outer coat of the eye

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19
Q

What forms the 5/6ths outer coat of the eye?

A

Sclera and lamina cribrosa

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20
Q

What are the 5 layers of the cornea from anterior to posterior?

A
  1. Epithelium and its basement membrane
  2. Bowman’s layer
  3. Stroma
  4. Descemet’s membrane
  5. Endothelium
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21
Q

What type of cells is the epithelium of the cornea made of?

A

Stratified squamous type of epithelium with 5-6 cell layers of regular arrangement

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22
Q

What is the Bowman’s layer made of?

A

Homogenous sheet of modified stroma

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23
Q

Which part of the cornea makes up 90% of the total corneal thickness?

A

Stroma

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24
Q

What does the stroma of the cornea consist of (3)?

A
  1. Lamellae of collagen
  2. Cells
  3. Ground substance
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25
What is the Descemet's membrane?
The basement membrane of the endothelium
26
What is the location of the iris?
It is the anterior-most part of the uvea
27
Where is the sensory innervation of the eyelids? 1. Upper 2. Lower
1. Upper - ophthalmic division of the trigeminal (V) nerve | 2. Lower - maxillary division of the trigeminal (V) nerve
28
What nerve innervates the orbicularis oculi?
Facial (VIIth) nerve
29
What happens to the lower eyelid with a facial nerve palsy? | What does it not cause?
Ectropion Not ptosis
30
What innervates the levator palpebral muscle in the upper eyelid?
Oculomotor (III) nerve
31
What are the 2 major arteries that give off branches that supply the eye? Where do the branches travel?
1. External carotid artery via the face | 2. Internal carotid artery via the orbit
32
What are properties of the sclera (5)?
1. Collagenous 2. Avascular (apart from some vessels on its surface) 3. Relatively acellular 4. Tough but thin 5. Gives attachment to the extraocular muscles
33
What are properties of the cornea (3)?
1. Sensitive to touch 2. Avascular 3. Transparent
34
What are the 2 functions of the cornea?
1. Protection of invasion of microorganisms into the eye | 2. Transmission and focusing (refraction) of the light
35
Where does the cornea derive its nutrition from (3)?
1. Diffusion from blood vessels at the limbus 2. From aqueous humour 3. From the tear film
36
Where is the lacrimal gland? What is its function? What is its innervation?
Superotemporal part of anterior orbit Secretes most of the aqueous component of the tear film Innervated by parasympathetic fibres carried by the facial nerve
37
What is the function of blinking?
Spread of tears across the ocular surfaces
38
Where do tears drain?
Superior and inferior puncta at the nasal end of the eyelids
39
What is the pathway of the drainage of tears after the punta?
The tears go into the punctum, which drains into a single canaliculi, which unite in a common canaliculus, which finally ends in the lacrimal sac. The tears then go from the lacrimal sac to the lasolacrimal duct, then drain into the inferior meatus to the nasopharyngeal cavity
40
What is the primary function of the internal ocular structures of the eye?
To refine the image formed by the cornea, and to convert light energy into electrical energy for image formation by the brain
41
What does the iris consist of?
Connective tissue containing muscle fibres, blood vessels and pigment cells
42
What are the 2 main functions of the iris?
1. Control light entry to the retina | 2. Reduce intraocular light scatter (by its pigment)
43
How does the pupil dilate? | What is it innervated by?
Contraction of dilator pupillae muscle (radial smooth muscles fibres), innervated by the sympathetic nervous system
44
How does the pupil constrict? | What is it innervated by?
Contraction of the iris sphincter muscle (ring of smooth muscle fibres) Innervated by the parasympathetic nervous system (oculomotor nerve)
45
What is the ciliary body and its function (3)?
1. Unites the iris with the choroid 2. Makes aqueous humour 3. Anchors the lens via the zonules, through which it modulates lens convexity
46
What is the innervation of accommodation?
Controlled by parasympathetic fibres in the oculomotor nerve
47
How does accommodation occur?
Muscle fibres in the ciliary body contract, causing its inner circumference to reduce This relaxes the zonules, so that the lens becomes convex (fat) to focus on near objects.
48
What does the choroid consist of (3)? *************
1. Bruch's membrane, consisting of: - basement membrane of RPE cells - basement membrane of choriocapillaries 2. Choriocapillaries (capillaries that supply RPE and outer retina) 3. Layer of larger choroidal bv external to choriocapillaries 4. Pigmented cells scattered in choroid external to choriocapillaries (in order of external surface of RPE to outside i.e. towards sclera)
49
Where is the choroid? | What is its function?
Between the retina and the sclera | Gives oxygen and nutrition to the outer retinal layers
50
What is the circulation of aqueous humour?
Aqueous circulates from the posterior to the anterior chamber through the pupil, leaving the eye through the trabecular meshwork. finally, it drains into the veins.
51
Where is the trabecular meshwork?
Anterior chamber angle between the iris and the cornea
52
At which points are the vitrous adherent to the retina (3)?
1. Optic disc 2. Ora serrata 3. Fovea
53
What type of vision does the macula provide?
Central vision
54
What cells make up the majority of the fovea? What type of vision does the fovea provide (2)?
Cones 1. High quality vision 2. Central, colour vision
55
What vision does the majority of the retina provide?
Peripheral vision
56
What are the layers of the retina from outside in (9)? *************8
1. Retinal pigment epithelium (RPE) 2. Rods and cones (photoreceptors) 3. External limiting membrane 4. Outer nuclear layer (nuclei of rods and cones with bipolar cells) 5. Inner nuclear layer (nuclei of bipolar cells) 6. Inner plexiform layer (synapse of bipolar cells with ganglion cells) 7. Ganglion cell layer 8. Nerve fibre layer 9. Internal limiting membrane
57
What are the function of cones?
Fine vision (acquity) and colour appreciation
58
What are the function of rods?
Vision in low light levels and detection of movement
59
What type of cells are concentrated in the macula?
Cones
60
What is the function of the retinal pigment epithelial cells (4)?
1. Recycle vitamin A for the formation of photopigments 2. Transport water and metabolites 3. Renew photoreceptors 4. Help to reduce damage by scattered light
61
What is the blood supply to the retina (2)?
1. Central retinal artery and vein | 2. And from the choroid
62
Where do the retinal vessels enter and leave the eye? Where do they run in?
They enter and leave the eye through the optic nerve and run in the nerve fibre layer.
63
What is the blind spot?
Optic disc which has no photoreceptors
64
What bones form the bony walls of the orbit (6)?
1. Frontal 2. Maxillary 3. Zygomatic 4. Ethmoid 5. Lacrimal 6. Sphenoid bones
65
What are the clinical implications of the fact that the medial wall and floor of the orbit are thin (2)?
1. A forceful blow to the eyes forces the eye back into the orbit and decompression through fracture of the floor or medial wall minimises damage to the eyeball 2. Infection in the maxillary or ethmoid sinus can easily spread to the orbit
66
What 2 structures pass through the optic foramen at the apex of the eye socket?
1. Optic nerve | 2. Ophthalmic artery
67
What 7 structures pass through the superior orbital fissure?
1. Lacrimal nerve 2. Frontal nerve 3. Nasociliary nerves (ophthalmic division of the trigeminal (V) nerve) 4. Oculomotor (III) nerve 5. Trochlear (IV) nerve 6. Abducent (VI) nerve 7. SUperior ophthalmic vein
68
What 2 structures pass through the inferior orbital fissure?
1. Inferior ophthalmic vein | 2. Maxillary division of the trigeminal (V) nerve
69
What are the 7 extraocular muscles?
1. Medial rectus 2. Lateral rectus 3. Superior rectus 4. Inferior rectus 5. Superior oblique 6. Inferior oblique 7. Levator muscle
70
How do the 4 extraocular rectus muscles attach to the eyeball anteriorly and posteriorly?
1. Anteriorly on the sclera | 2. Posteriorly, they have a common attachment to a ring of connective tissue which surrounds the optic foramen
71
What are the clinical implications of compression at the orbital apex and why?
May lead to loss of corneal sensation, reduced ocular movement and impaired visual function, and displacement of the globe forwards (proptosis) This is because the 4 extraocular rectus muscles form a cone within which are the sensory and autonomic nerves and arteries to the eyeball, including the optic nerve and the motor nerves to all the extraocular muscles including the levator but excluding the superior oblique
72
What is the memory aid to remember what nerves innervate what extraocular muscles?
LR6 SO4 Lateral rectus - VI abducens Superior oblique - IV trochlear All others (including levator) - III oculomotor
73
What is the action of the medial rectus muscle?
Adduction of the eye (medially)
74
What is the action of the lateral rectus muscle?
Abduction of the eye (laterally)
75
What is the action of the superior rectus muscle? 1. Primary action 2. Secondary action 3. Tertiary action
1. Elevation 2. Intorsion 3. Adduction
76
What is the action of the inferior rectus muscle? 1. Primary action 2. Secondary action 3. Tertiary action
1. Depression 2. Extorsion 3. Adduction
77
What is the action of the superior oblique muscle? 1. Primary action 2. Secondary action 3. Tertiary action
1. Intorsion 2. Depression 3. Abduction
78
What is the action of the interior oblique muscle? 1. Primary action 2. Secondary action 3. Tertiary action
1. Extorsion 2. Elevation 3. Abduction
79
Which is the chief sensory nerve of the eye?
Optic nerve
80
What is the blood supply to the optic nerve?
Branches of the ophthalmic artery
81
What are the sensory nerves of the eyeball, conjunctiva and skin of eyelids extending up across the forehead and back towards the occiput?
Branches of the ophthalmic division of the trigeminal (V) nerve
82
What is the clinical significance of having branches of the trigeminal nerve sensory to the eye?
Shingles of the eye can also cause a rash in that dermatome
83
What is the innervation leading to accomodation?
Parasympathetiic nerve fibres to the ciliary body
84
What substances are given for pupil dilation (2)?
1. Topical inhibitor of the parasympathetic system e.g. tropicamide 2. Sympathetic agonist e.g. phenylephrine
85
Describe the visual pathways (4)?
1. The 2 optic nerves unite at the optic chiasm above the sella turcica of the sphenoid bone 2. Nerve fibres from the nasal retinal (temporal vision) cross to the opp side of the chiasm (so post-chiasmal fibres on the left subserve the field of vision on the right) 3. The optic tracts extend from the chiasm to the lateral geniculate body 4. The nerves, which began as fibres on the surface of the retina, form synapses with neurones passing through the optic radiation to reach the visual cortex in the occipital lobes
86
What type of visual loss does a pituitary tumour pressing on the optic chiasm cause?
Bitemporal hemaniopia
87
What visual loss would a unilateral lesion behind the chiasm cause?
Hemaniopia on the opp side
88
What supplies the optic tract and radiations?
Branches of the middle cerebral artery
89
What supplies the visual cortex?
Posterior cerebral artery
90
What supplies the macula?
Dual blood supply from the middle and posterior cerebral arteries
91
What are the clinical implications of an occulsion of the arterial supply to the visual cortex?
Would cause bilateral field loss which spares central vision (macular sparing) because the macula as a dual blood supply
92
What is visual acuity?
Measure of the ability of the eye to see that two closely positioned objects are separate
93
What nerves provide innervation of the cornea?
Ophthalmic nerve (CN V1)
94
Why does damage to the cornea cause a lot of pain?
Nerve endings are exposed
95
When looking through the ophthalmoscope, is the optic disc placed nasally or temporally?
Nasally

Ophthalmology (12 decks)

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