Opthalmic and Dental Procedures Flashcards
(163 cards)
1
Q
Colored part of eye?
A
iris
2
Q
Tough, fibrous, white outermost layer of eye?
A
sclera
3
Q
Small, pink nodule in corner of eye; lacrimal duct?
A
caruncle
4
Q
Keeps objects from sliding behind eyeball?
A
conjunctiva
5
Q
Where topical opthalamic drugs are administered?
A
conjunctiva
6
Q
Part of the eye that forms the optic sheath encircling the optic nerve?
A
sclera
7
Q
3 out layers of the eye?
A
sclera, cornea, conjunctiva
8
Q
Tough outer layer of eye that is transparent and is the anterior part of the sclera
A
cornea
9
Q
Middle layers of eye?
A
uveal tract, (choroid, iris, ciliary body)
10
Q
Innermost layer of eye?
A
retina
11
Q
Layer that produces O2 for retina?
A
choroid
12
Q
Are there capillaries in retina?
A
no
13
Q
Part of eye that is a neurosensory membrane which converts light impulses to neural impulses via the optic nerve to the brain
A
retina
14
Q
This thick fluid is attached to blood vessels and optic nerve?
A
vitreous gel
15
Q
Major cause of vision loss?
A
retinal detachments from choroid layer
16
Q
3 layers of tissue which provides most of the nutrients to the eye?
A
uveal tract
17
Q
Part of the uveal tract which contains blood vessels, is posterior, and supports the retina?
A
choroid plexus
18
Q
Part of the uveal tract which controls light entry with muscle fibers and changes the pupil size?
A
iris
19
Q
Sympathetic nervous system control of the iris does what and parasympathetic does what?
A
SNS- dilate; PNS- constricts
20
Q
2 functions of the ciliary body?
A
secretes aqueous fluid and controls shape of the lens
21
Q
How do the ciliary muscles change the shape of the lens?
A
tension on the Zonule of Zinn
22
Q
Where is aqueous humor drained?
A
Schlems Canal
23
Q
Where is aqueous humor formed?
A
posterior chamber
24
Q
The 3 chambers of the eye ball?
A
anterior, posterior, viterous
25
IOP is determined by? And what should it be?
rate of aqueous humor formation to outflow; 25 or less
26
Which chamber is blocked in glaucoma?
anterior chamber
27
Schlemms canal is in which chamber?
anterior
28
Balance between production and elimination of aqueous humor formation maintains an average volume of what?
250 mL
29
IOP is usually between what and what?
10-22
30
Part of eye that is fibrous connective tissue from corneal limbus to behind the eye orbit?
Tenon capsule
31
Main function of Tenon capsule?
serves as cavity in which eye moves
32
Term for near sighted and far sighted?
myopia; hyperopia
33
Which type vision is elongated and the focal point is nearer to the lens?
myopia
34
Which type of vision is where the eye is short and the focal point is further from the lens?
hyperopia
35
Which type of vision is a concern with a retrobulbar block? And why?
myopia; bc the globe is elongated and the sclera is stretched thin so it is easier to puncture with a needle
36
What part of the eye turns the image in to the correct perspective?
optic nerve
37
The optic nerve is a direct connection to what?
occipital lobe
38
Which type of vision requires glasses for most of life?
myopia
39
An elongated globe is longer than __mm?
24
40
A short globe is shorter than __mm?
22
41
How many muscles are in the eye?
6
42
The rectus muscles originate from where and how many are there?
annulus of Zin; 4
43
This nerve controls the superior, inferior, and medial rectus muscles? And is it SNS or PNS innervation?
oculomotor nerve (III); PNS
44
Which way do the rectus muscles pull the eye?
in the direction of their attachment
45
Which nerve controls the lateral rectus muscle?
abducens (VI)
46
How many cranial nerves control the eye?
3
47
How many oblique muscles of the eye are there?
2
48
Which nerve controls the superior oblique muscle?
trochlear (IV)
49
Which nerve controls the inferior oblique muscle?
oculomotor (III)
50
Which muscle rotates the eye towards the nose or intorts?
superior oblique/trochlear nerve
51
Which muscle rotates the eye sideways/extorts/vertical gaze action?
inferior oblique/oculomotor
52
Where is the annulus of Zin? And which muscles originate there?
orbital apex; all ocular muscles except the obliques
53
CN that conveys visional info from retina to occipital lobe?
optic/II
54
CN that controls tears and closes the eye lids?
facial/VII
55
CN that is the efferent pathway for oculocardiac reflex -bradycardia and dysrythmias?
X/vagus
56
Why is an injection in to the optic nerve sheath basically an injection in to the CNS?
it is covered by meninges
57
2 branches of the facial nerve (CN VII)?
temporal and zygomatic
58
Why do you sometimes block the facial nerve with an eye block?
because the branches control the opening and closing of the eye
59
How many bones and what are they that form the eye orbit?
7; frontal, sphenoid, lacrimal, ethmoid, maxillary, palatine, zygomatic
60
How is each eye orbit shaped?
like a pear and has 4 sided pyramid
61
Where is the blood supply to the rectus muscles from? And where is it primarily from?
1st branch of internal carotid artery, primarily from opthalmic artery
62
Medial muscular branch is?
medial rectus, inferior rectus, inferior oblique (MII)
63
The lateral muscular branch is?
lateral rectus, superior rectus, and superior oblique (LSS)
64
Ciliary artery branches in to (2)?
short posterior and long posterior
65
This artery supplies the globe, choroid, optic nerve head, and external part of retina?
short posterior
66
This artery of the ciliary artery gives rise to the 7 anterior ciliary vessels and supplies the anterior eye?
long posterior
67
Each rectus muscles has __ anterior ciliary vessels except the ______ rectus muscle has 1?
2; lateral
68
Topical opthalmic medications can have systemic absorption thru (2)?
conjunctiva and lacrimal duct because it goes in to the nasal mucosa
69
If a block or GA not used for cataract, what 4 things are given?
tetracaine, dilator, steroid, abx
70
How quickly are eye drops absorbed?
slower than IV, but faster than SQ
71
Suxxs contraindicated with taking with what eye drop? Why?
echothipate- may prolong the effects of Suxxs w plasma cholinesterase 3-7 weeks after d/c
72
What class of drug is echothiopate?
IRREVERSIBLE cholinesterase inhibitor
73
What does echothipate produce in the eye?
miosis
74
How do carbonic anhydrase inhibitors work as eye drops?
reduce aqueous humor production (glaucoma)
75
What does miosis do to the pupils?
constricts
76
Mydriasis does what to pupils?
dilates
77
Central anticholinergic syndrome is and which drug do you have to be careful about that with?
mad as a hatter, hot as a hare, dry as a bone; atropine
78
Why is atropine used as an eye drop?
it dilates the pupils; mydriasis; opthalmic capillary decongestion
79
What do phenylephrine and epinephrine do to the pupil?
mydriasis
80
What gas do you have to avoid with sulfur hexafluoride (SF6)?
N20
81
Metallic taste after eye drop can be a sign of toxicity but is often d/t?
LA passing thru nasal mucosa
82
What can you do after eye drop administration to reduce systemic absorption (3)?
close eyes for 60 seconds, avoid blinking, block tear outflow canal with index finger (with eye closed)
83
This topical anesthetic med stings on administration?
tetracaine
84
What does alkalizing a solution with sodium bicarb do to the absorption?
decreases the onset time
85
A protein enzyme that speeds onset of eye drops by promoting the even spread of the local anesthetic, especially in the peribulbar technique?
hyaluronidase
86
This type of anesthesia is used for ocular procedures if need suppresion of oculocardio reflex, akinsia, and analgesia?
regional
87
3 types of regional anesthesia for ocular procedures?
retrobulbar block, peribulbar techniques, sub tenon block
88
A synonym for retrobulbar block?
intraconal block
89
Which block is not very common any more?
sub tenons
90
Why is a sub tenons block contraindicated in glaucoma?
it raises the IOP
91
This block is better for anticoagulated patients at risk for retrobulbar hemorrhage?
sub tenons
92
Volume of orbit and volume of globe in mL?
30 mL, 7mL
93
In this type of block, the tip of the needle is inserted behind the globe?
retrobulbar
94
What type of block is sometimes required to go along with retrobulbar block?
facial
95
This type of block limits eyelid squinting?
orbicularis occuli
96
2 types of approaches for retrobulbar block?
transcutaneously or transconjunctivally
97
This type of eye block includes an injection outside of the cone?
peribulbar block
98
Some differences between retrobulbar and peribulbar blocks (5)?
retro: intraconal, deep needle placement w/in orbit, small volume 2-4 mL, fast onset 2 min, may need facial nerve block or eye lid block; extraconal: extraconal, needle away from optic nerve, larger volume 10-12 mL, latency of onset-10 minutes
99
Even pressure should be placed on the eye post block in order to (3)?
diffuse LA, reduce IOP, soften the eye
100
Honan device applies how much pressure and for how long?
30-40 mm Hg; 5 minutes
101
How should a digital massage after an eye block be done?
30 sec on, 5 sec off
102
Best block as far as pain on injection goes?
peribulbar
103
Best block for blocking surgical pain?
sub tenons
104
Best block to cause eye akinesia?
retrobulbar
105
Most frequent complication from eye block?
retrobulbar hemorrhage (and maybe superficial hemorrhage too-it's not clear)
106
Which anesthetic should you avoid if a patient is allergic to esther anesthetics?
tetracaine
107
3 symptoms of retrobulbar hemorrhage?
subconjunctival hemorrhage, proptosis (bulging of eye), increased IOP
108
What does occlusion of retinal artery do to loss of vision? And when can this occur?
partial to complete loss of vision; with increased IOP
109
2 types of treatment for retrobulbar hemorrhage?
digital pressure and lateral canthotomy
110
2 ways in which a lateral canthotomy works?
increases the orbital space; reduces the orbital pressure that results from hemorrhage
111
The contralateral pupil should be constricted/dilated prior to the ocular block and if it constricts/dilates after the block that means it's a subarachnoid or subdural injection?
constricted; dilated
112
How soon after injection does it occur that it was injected in to the subarachnoid/subdural space?
15 seconds
113
S/s of intravascular injection and optic nerve sheath penetration?
painless vision loss, disorientation, vomiting, aphasia, hemiplegia, unconsciousness, convulsions, respiratory or cardiac arrest a few minutes after!
114
This type of complication from a block is not always noticeable and may be delayed for days?
globe puncture
115
Globe puncture is easy to do in patients with ?
long eye/severely mioptic
116
Most devastating injury d/t anesthetic injection?
globe injury so if there is resistance stop!
117
Treatment of globe puncture?
it depends but if severe it's a vitreoretinal
118
S/s globe puncture?
increased resistance to injection, immediate dilation and paralysis of pupil, rapid increase in IOP, edematous cornea, subconjunctival hemorrhage, pain and agitation, hypotony of globe (IOP
119
Measures to reduce likelihood of complications from nerve block?
use 1 1/4 in needle, caution in patients with longer axial lengths (miopia/near sighted), avoid supranasal position of gaze, direct needle away from axis of globe, observe globe movement with needle insertion, insert needle slowly, do not force injection, use modified retrobulbar or peribulbar techniques
120
S/s of persistent extraocular muscle paralysis and ptosis?
verticle diplopia (double vision)
121
Treatment of persistent extraocular muscle paralysis and ptosis?
surgical correction of injury to EOM
122
2 causes of facial nerve trauma (Bell's Palsy)?
direct nerve trauma caused by needle or neurotoxicity of LA
123
Normal IOP range?
10-22
124
IOP follows what BP?
arterial
125
Increased IOP means what to the intraocular volume?
decreased intraocular volume
126
Open globe is permanet or reversible eye damage?
permanent
127
2 parts of acid base system that decrease IOP?
hypoxia and hypercarbia
128
Anesthetic drug that decreases IOP and 2 that increase IOP?
volatile gasses; ketamine, anectine
129
Afferent and efferent pathways for oculocardiac reflex involve which cranial nerves?
afferent-trigeminal; efferent-vagal
130
3 causes of oculocardiac reflex?
traction of extraocular muscles, pressure on globe, ocular manipulation
131
4 rhythms that can occur d/t OCR?
bradycardia, junctional rhythm, ventricular ectopy, asystole
132
2 ways to block OCR?
ocular block or deep sedation
133
Treatment for OCR?
atropine
134
Most common pediatric ocular operation?
strabismus
135
Why should you avoid Suxxs for strabismus surgery?
strabismus is more likely to reflect underlying myopathy so MH is more likely to occur
136
A surgery that is high risk for OCR?
strabismus
137
Strabismus surgery has as high as what percentage of N/V?
80%
138
Avoid what gas with SF6 and perfluorocarbons? And why? And how long?
N2O; can tamponade the retina; 10 days after injection N20 should be avoided
139
Difference between closed and open angle glaucoma?
closed angle is acute and where outflow is obstructed; closed is chronic and because of impaired aqueous drainage
140
What is treatment for glaucoma?
miotic drugs
141
Avoid what 2 drugs in glaucoma patients?
scopolamine and atropine drops
142
Main goal in patients with glaucoma?
prevent increases in IOP
143
What is unique about open eye procedures as far as anesthesia is concerned?
treat as full stomach
144
2 contraindications regarding open eye surgeries?
retrobulbar block and awake intubation with suxxs
145
Most common cause of postoperative eye pain after general anesthesia?
corneal abrasion
146
Treatment of corneal abrasion?
antibiotic ointment and patching for about 2 days
147
Treatment for acute glaucoma?
IV Mannitol or Acetazolamide and consult opthmologist
148
2 surgeries that put pt at risk for post op vision loss?
spine surgery in prone position and cardiac surgery
149
4 risk factors for post op vision loss?
hypotension, anemia, increased IOP, prone and head down position
150
Dental specialty that involves treating diseases and supporting and surrounding tissue of the teeth?
Periodonics
151
Dental specialty that encompasses pulp and root of tooth?
endodontics
152
Dental specialty encompassing rehab and maintenance of oral function and appearance of the
prosthodontics/orthodontist
153
Dental specialty for defects and esthetic aspects of maxilofacial region?
oral and maxilofacial surgery
154
What anatomical features place the dental patient at risk for severe pain?
maxillary and mandibular divisions of trigeminal nerve
155
Is it easier to numb the upper or lower teeth and why?
upper because bone is thinner
156
What are the main nerves you're numbing on mandible for dental procedure?
lingual nerve and inferior alveolar nerve
157
Most common cause of postoperative eye pain after general anesthesia?
corneal abrasion
158
Treatment of corneal abrasion?
antibiotic ointment and patching for about 2 days
159
Treatment for acute glaucoma?
IV Mannitol or Acetazolamide and consult opthmologist
160
2 surgeries that put pt at risk for post op vision loss?
spine surgery in prone position and cardiac surgery
161
4 risk factors for post op vision loss?
hypotension, anemia, increased IOP, prone and head down position
162
Why do you not want to get a lot of Afrin spray in the nose?
it can increase the BP
163
What kind of intubation is usually used for dental procedures?
nasal
