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Year 2 > Ophthalmology anatomy > Flashcards

Ophthalmology anatomy Flashcards

1
Q

What bones contribute to the orbit?

A 
orbital plate of frontal
orbital plate of ethmoid
zygomatic
maxilla
sphenoid
lacramil
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2
Q

what passes through the infraorbital foramen?

A

infraorbital NVB

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3
Q

In what bone do the optic canal and superior orbital fissure lie?

A

sphenoid

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4
Q

what shape is the orbit?

A

pyramidal, optic canal forms the apex which lies quite medial

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5
Q

Name the 4 margins of the orbit

A

superior, inferior, medial and lateral. together form orbital ring

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6
Q

What is the function of the orbital ring?

A

anything larger in diameter than the orbital ring can’t cause direct trauma to the eye

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7
Q

What orbital bones are most likely to break?

A

floor and medial walls (maxillary, ethmoid, lacrimal)
This is a blowout fracture and orbital contents can become trapped and infraorbital NVB can be damaged (V2) resulting in general sensory deficit of the facial skin

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8
Q

If the zygoma fractures, which way does it usually rotate?

A

medially, towards the eye

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9
Q

which bone does the suspensory ligament of the eye attach to?

A

zygoma

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10
Q

What muscles makes up the external layer of the eyelid? What are its two parts?

A

Orbicularis oculi

orbital and palpebral parts

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11
Q

What nerve supplies the orbicularis oculi?

A

facial nerve CNVII

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12
Q

What are the dense bands of half moon shaped connective tissue on upper and lower eyelids called?

A

superior and inferior tarsus

give shape to the eyelid

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13
Q

What tendon attaches to the superior tarsus? What is its function?

A

tendon of levator palpebrae superioris

lifts the superior eyelid

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14
Q

What name is given to the connective tissue around the orbit that is continuous with the periosteum? What is its function?

A

orbital septum

barrier against infection

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15
Q

What is the function of the tarsal glands?

A

lipid secretion to prevent eyelids sticking together and overflow of lacrimal fluid

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16
Q

Is the cornea vascularised?

A

no

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17
Q

Where is the lacrimal fluid produced?

A

lacrimal gland

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18
Q

Where does the lacrimal fluid pass into?

A

inferior lacrimal puncta

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19
Q

Where does the conjunctiva cover?

A

the sclera, lower eyelid and upper eyelid, the conjunctival fornix is where the conjunctiva folds between the sclera and eyelid

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20
Q

What cranial nerve supplies the lacrimal gland?

A

parasympathetics from facial nerve

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21
Q

What is the average diameter of an eye?

A

25mm

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22
Q

What are the 3 main layers of the eye?

A 
fibrous outer layer
vascular layer (uvea)
inner layer (retina)
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23
Q

How much refractive power comes from the cornea?

A

2/3

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24
Q

What structures make up the uvea?

A

iris
cilliary body
choroid

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25
Q

Where does most nutrition and gas exchange take place in the eye?

A

Choroid

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26
Q

What segments make up the eye?

A

anterior and posterior

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27
Q

What chambers make up the anterior segment?

A

anterior and posterior

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28
Q

Where does the anterior chamber of the eye lie?

A

between iris and cornea

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29
Q

Where does the posterior chamber lie?

A

between the iris and suspensory ligaments

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30
Q

What liquid is contained in the chambers of the anterior segment?

A

aqueous humour

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31
Q

Where does the avascular cornea get its nutrition?

A

aqueous humour posteriorly and lacrimal fluid anteriorly

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32
Q

What fraction of the eye is contained in the posterior segment?

A

2/3 of the eye

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33
Q

What liquid is contained in the vitreous body of the posterior segment?

A

vitreous humour (more gel like)

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34
Q

What segment of the eye lies behind the lens?

A

Posterior segment

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35
Q

What part of the eye can be seen through a slit lamp?

A

anterior segment

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36
Q

Where do the cornea and sclera meet?

A

limbus/corneoscleral junction, seen as a greyish line around the iris

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37
Q

Where does the iridocorneal angle lie?

A

between the iris and cornea

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38
Q

Where is aqueous humour produced?

A

The cilliary body

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39
Q

What components make up the cilliary body?

A

smooth muscle and blood vessels

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40
Q

What name is given to the foldings of the cilliary body where the aqueous humour is produced?

A

cilliary processes

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41
Q

How does the aqueous humour pass from the posterior to anterior chamber to nourish the cornea?

A

through the pupil

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42
Q

Where does aqueous humour pass back into the venous system?

A

scleral venous sinus (Canal of Schlemm) at iridocorneal angle

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43
Q

Why is balance of secretion and reobstruction of aqueous humour important?

A

maintenance of intraorbital pressure

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44
Q

The ophthalmic arteriy is a branch of which branch of the common carotid?

A

internal carotid

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45
Q

Which artery passes inside the optic nerve?

A

Central artery of the retina. This is an end artery.

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46
Q

The cilliary arteries are branches of which artery?

A

Ophthalmic artery

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47
Q

Which is the only vein draining the retina?

A

central retinal vein

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48
Q

How does venous drainage leave the orbit?

A

Superior and inferior ophthalmic veins. These join before draining into the cavernous sinus. The orbit also drains anteriorly into the facial vein and towards the jugulars. Blood flow in this area is not always unidirectional.

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49
Q

What are the areas of the fundus called?

A

optic disc
macula
fovea

50
Q

What name is given to the posterior section of the retina?

A

Fundus

51
Q

Why is the optic disc known as the blind spot?

A

no photoreceptors here

52
Q

What structure forms the optic disc?

A

Optic nerve

53
Q

What structures enter the eyeball at the optic disc?

A

central artery and vein

54
Q

What is special about the macula?

A

Acute vision, lots of cones. The central area of the macula is called the fovea, where the most acute vision occurs

55
Q

What are the layers of the retina? (posterior to anterior)

A

Photoreceptors
Ganglion cells
Axons
Branches of retinal arteries and veins

56
Q

What layer of the retina forms the optic nerve?

A

Axons

57
Q

Which is more nasal, the macula or optic disc?

A

optic disc

58
Q

Where does the left visual field hit the retinae?

A

nasal retina in the left eye, temporal retina of the right eye.

59
Q

Which parts of the vision cross at the optic chiasma?

A

nasal retinal images

60
Q

Where in the brain is the right visual field processed?

A

Left visual cortex?

61
Q

What 7 extraoccular skeletal muscles control eyeball movement?

A 
superior rectus
inferior rectus
medial rectus
lateral rectus
superior oblique
inferior oblique
levator palpebrae superioris
62
Q

Where do the rectus muscles originate from?

A

common tendinous ring

63
Q

What bone does the superior oblique originate from?

A

sphenoid bone

64
Q

What is the name given to sling that the superior oblique passes through?

A

trochlea

65
Q

describe somatic motor innervation of extraocular muscles

A

LR6 SO4 AO3
Lateral rectus= anducent (only job)
Superior oblique= trochlear (only job)
All others= oculomotor

66
Q

What names are given to the axes of the eyeball?

A

vertical
transverse
anteroposterior

67
Q

What is movement around the vertical axis?

A

adduct and abduct

68
Q

What is movement around the transverse axis?

A

elevation and depression

69
Q

What is movement around the anteroposterior axis?

A

intorsion and extorsion

70
Q

How must the eyeball be aligned to test muscle function and nerve supply?

A

Aligned along plane of muscle

71
Q

Describe clinical testing of the extraocular muscles and their primary movements

A

lateral rectus= abduct (ABDUCent)
superior rectus= elevation (when abducted)
inferior rectus= depression (when abducted)
medial rectus= adduction
inferior oblique= elevation (when adducted)
superior oblique= depression (when adducted

72
Q

Describe the muscles needed for pure elevation of the eye

A

superior rectus and inferior oblique, both want to elevate and cancel each other out in terms of rotation (superior=medial, inferior=lateral). Here they work as both synergists and antagonists

73
Q

What cranial nerve gives sensation to the face?

A

Trigeminal

74
Q

What branch of the trigeminal nerve gives sensation to the upper eyelid, cornea, conjunctiva and the skin of the root, bridge and tip on the nose?

A

Ophthalmic branch (CNV1)

75
Q

What branch of the trigeminal nerve supplies the skin of the lower eyelid, skin of the maxilla, skin of the ala, skin and mucosa of the upper lip?

A

Maxillary nerve (CNV2)

76
Q

Which branch of the trigeminal nerve gives off the infraorbital nerve?

A

Maxillary nerve (CNV2)

77
Q

What nerves are involved in the blink reflex?

A

sensory afferent limb-Action potentials from the cornea via ophthalmic nerve to the trigeminal ganglion, then along trigeminal nerve to the pons.

Central CNS connections between trigeminal and facial nerves.

motor efferent limb- action potentials conducted via the facial nerve to the palpebral part of the orbicularis oculi

78
Q

Why is the blink reflex important?

A

Prevents dessication of the eye, nourishes the cornea and helps wash away any foreign bodies

79
Q

From what spinal levels do the sympathetic fibres exit?

A

T1-L2 and travel to the sympathetic trunks. They then pass into all spinal nerves (anterior and posterior rami)

80
Q

Describe the cervical part of the sympathetic axis.

A

Axons exit at T1 then pass into the sympathetic chain and head up to the three cervical ganglia (superior, middle and inferior). They synapse at superior cervical ganglia. Post-synaptic axons pass onto the surfaces of the external and internal carotid arteries and become internal and external carotid nerves. This is a periarterial sympathetic plexus. The nerves follow the arteries in order to reach the organs. Sympathetic axons follow the internal carotid up the the ophthalmic artery and then into the eye.

81
Q

What cranial nerves does parasympathetic innervation originate from?

A

CN III, VII, IX and X and sacral spinal nerves

82
Q

What name is given to the parasympathetic ganglion in the head that supplies the eye?

A

ciliary ganglion in the orbit

83
Q

What cranial nerve supplies presynaptic axons to the ciliary ganglion?

A

Oculomotor

84
Q

What types of nerves pass through they ciliary ganglion?

A

sensory somatic
sympathetic
parasympathetics

85
Q

What types of nerves pass through they ciliary ganglion?

A

sensory somatic (CNV1)
sympathetic
parasympathetics

86
Q

What nerve, involved in the blink reflex, follows the path of the ophthalmic artery around the eyeball?

A

long ciliary nerve

87
Q

Describe vestibulo-ocular reflex.

A

turns eyes in the opposite direction to head movement to stabilise gaze. CNS connections betweem CN VIII and CN III, IV and VI

88
Q

Describe the oculocardiac reflex.

A

reflex bradycardia in response to tension on the extraocular muscles or pressure on the eye. Connections between CN V1 and CN X

89
Q

Describe the action of sympathetic stimulation on the eye.

A

opens eyes wider
gets more light into the eyes
focus on far objects

90
Q

Describe the action of parasympathetic stimulation on the eye.

A

allows orbicularis oculi to work
gets less light into eyes
focus on near objects
reflex lacrimation

91
Q

what 2 sets of muscles surround the pupil?

A

dilator pupillae fibres

92
Q

what 2 sets of muscles surround the pupil?

A

dilator pupillae fibres

sphincter pupillae fibres

93
Q

What name is given to a non-physiologically constricted pupil? When may it be seen?

A

miotic

Horner’s syndrome

94
Q

What muscle is at fault in fixed pin point and fixed dilated pupils?

A

sphincter pupillae fibres

95
Q

What nerve give parasympathetic control to the sphincter pupillae fibres?

A

Oculomotor nerve

96
Q

What is the affernet limb in pupillary light reflex?

A

Optic nerve

97
Q

What is the efferent nerve of the pupillary light reflex?

A

oculomotor nerve

98
Q

What happens in the other when when you stimulate one eye by shining light directly into it?

A

constriction of the pupil

99
Q

How many neurones are involved in the pupillary light reflex?

A

4 neurone chain

100
Q

Describe the 4 neurone chain in the pupillary light reflex.

A

1st neurones=retinal ganglion cells pass via the ipsilateral optic nerve to dessucate in the optic chiasm. They synapse in the pretectal nucleus in the midbrain.

FINISH SLIDE 21

101
Q

Suspensory ligaments attach which structure to the lens?

A

Ciliary body

102
Q

When is the ciliary muscle relaxed? What shape is the lens?

A

far vision

Lens becomes longer and flatter

103
Q

When is the ciliary muscle contracted? What shape is the lens?

A

Near vision

lens becomes shorter and fatter

104
Q

What 3 components are clinically assessed in the accomodation reflex? (bringing finger towards tip of nose)

A

Bilateral pupillary constriction
Bilateral convergence of both eyes towards the midline
Bilateral relaxation of the lens

105
Q

What 3 components are clinically assessed in the accommodation reflex? (bringing finger towards tip of nose)

A

Bilateral pupillary constriction
Bilateral convergence of both eyes towards the midline
Bilateral relaxation of the lens

106
Q

What nerve is tested in the accommodation reflex? (bringing finger tip towards nose)

A

Oculomotor

107
Q

What is the afferent limb in lacrimation reflex?

A

Ophthalmic nerve

108
Q

What is the efferent limb in lacrimation reflex?

A

Parasympathetic axons from facial nerve

109
Q

Where does the common tendinous ring attach to the sphenoid bone?

A

around the orbital opening of the optic canal

110
Q

What is the Monro-Kellie hypothesis?

A

You cannot change the pressure within the intracranial cavity without altering the brain size, blood volume, CSF as intracranial volume is constant

111
Q

What name is given to the space between the arachnoid and pia?

A

Subarachnoid space

112
Q

What are the layers of meninges covering the optic nerve?

A

Dura
Arachnoid
Pia

113
Q

Which layer of the meninges has sensation? What nerve supplies this?

A

Dura

Trigeminal

114
Q

Where does the CSF drain into the venous system?

A

Arachnoid granulations occuring at the superior sagital sinus

115
Q

At what spinal level would you take a lumbar puncture?

A

L3/4 or L4/6

116
Q

At what level does the spinal cord end?

A

L2

117
Q

At what level does the CSF end?

A

S2

118
Q

Where is the CSF produced?

A

Choroid plexus of the ventricles

119
Q

Through which 4 foramina can the CSF exit the 4th ventricle from?

A

2x Lateral foramina
Medial foramina
Spinal canal

120
Q

What direction can the eye not move in in trochlear nerve palsy?

A

Inferomedially

Year 2 (6 decks)

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