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Flashcards in Orbit II Deck (40):
1

The only extraocular muscle which originates from the anterior aspect of the orbit is the:

Inferior Oblique

2

A diabetic patient complains of severe photophobia in her right eye. When light is shown directly into her right eye, her pupil does not constrict. Third cranial nerve neuropathy that involves only the periphery of this nerve, if eye movements are all still normal is a clue that which fibers running in the oculomotor nerve have been affected?

Parasympathetic, preganglionic fibers – peripheral portion of oculomotor nerve, one of the first things damaged

3

What are the three layers of the eye?

1. Sclera
2. Choroid
3. Retina

4

What are the major components of the Sclera?Which layer is it?

* it is the Corneo-scleral layer

- dense connective tissue
-posterior 5/6th of eye is opaque
-extraocular muscles attach to sclera ***

5

What are the main components of the Choroid? Which layer is it?

* it is the UVEAL layer

- contain NERVE SUPPLY TO THE EYE (middle vascular layer)
- forms the iris
- heavily pigmented w/ MELANOCYTES (absorb stray photons)

6

What are the 9 components of the Ciliary Body, formed at the Limbus?

1. Ciliary Muscles
2. Ciliary process
3. Canal of Schlemm
4. Iris
5. Sphincter Puppilae
6. Dilator Pupillae
7. Aqueous Humor
8. Lens
9. Postremal chamber

7

Describe the sclera

SCLERA-

- loose system of collagen fibers to a dense layer of connective tissue called Tenon’s capsule,
- The outer sclera consists of dense, fibro-elastic connective tissue,
- the fibers of which are arranged in bundles parallel to the surface.
- is the posterior 5/6ths of the eye, and is OPAQUE
*** provides insertion for the extra-ocular muscles***

The sclera varies in thickness, being thickest posteriorly and thinnest at the coronal equator of the globe

8

Describe the Cornea. What is a main difference from the Sclera?

- transparent
- has a smaller radius of curvature than the sclera.
- principal refracting medium of the eye and roughly focuses an image on to the retina
- avascular structure

* HAS FIVE LAYERS*
Ep: stratified squamous epithelium
BM: Bowman’s (basement) membrane - supports the epithelium
SP: substantia propria - BULK of the cornea
DM: Decemet’s membrane - very thick elastic basement
En: endothelial layer



9

What is the cornea-scleral junction?

LIMBUS


- is marked internally and externally by a shallow depression.




10

What are the three components of the Uveal Layer?

Uveal layer:
The middle layer = the uvea or uveal tract, is a highly vascular layer which is made up of three components:

1. choroid
2. ciliary body
3. iris.

11

How does the lens change from a flattened shape to a thicker shape?

Rest = flat

- PARASYMPATHETICS --> innervated to constrict circumferential (smooth muscle) fibers = lens can THICKEN
- connected to lens capsule by Zonular (suspensory) Fibers

12

What produces the aqueous humor? What important component does the aqueous humor provide the CORNEA and Lens?

1. Ciliary process --> produces aqueous humor

- clear water similar to CSF
- balanced rate of production and reabsorption = pressure of 15 mm Hg

2. METABOLITES for the cornea and lens

13

What component of the ciliary body reabsorbs the aqueous humor? What pumps the aqueous humor into this area?

1. Canal of Schlemm!
- anterior to iris at corneo-screral junction
- continuous with venous system (lined with endothelium)

2. Trabeculae -- pumps aqueous humor from anterior chamber to Schlemm's

BUT --> no direct communication between the trabecular spaces and the canal of Schlemm = reabsorption of aqueous humor involves passage across two layers of endothelium and the intervening connective tissue.

14

What happens if there is a defect in pumping resulting from increased intraocular pressures? How does this defect usually occur

1. GLAUCOMA **

- Glaucoma is the most common cause of blindness
- increased intraocular pressure compresses :
retina, optic nerve & blood vessels.
if severe = blindness
if mild = blurry vision/halos around bright objects

2. production of aqueous humor > the ability of the eye to drain this fluid

OR
decreased outflow through the canal of Schlemm
OR an increase in aqueous humor production.

15

What are the two types of glaucoma? ***

1. Open angle Glaucoma = aqueous cannot drain through meshwork
2. Angle Closure Glaucoma = iris pushed over meshwork

16

What structure of the ciliary body forms an adjustable diaphragm and divides the eye into the anterior and posterior compartment?

IRIS

- pigmented (color) + vascularized + smooth muscle fibers

-**Blue eyes contain little stromal pigment whereas Brown eyes have considerable stromal pigment**

- IRIS = moveable diaphragm, purely reflexive
The brighter the light = the greater parasympathetic stimulation = CONSTRICTION OF THE PUPIL*** (sphincter pupillae)

17

What two muscles control the pupil? What Autonomic system is each muscle controlled by?

1. Sphincter Pupillae = constricts pupil

- circumferentially oriented smooth muscle fibres in the pupillary aspect of the stroma
a. innervated by the PARASYMPATHETIC nervous system

2. Dilator Pupillae = dilation of the pupil

- RADIALLY oriented fibers
- innervated by POST GANGLIONIC SYMPATHETIC FIBERS

18

What path does the aqueous humor follow?

1. ciliary process
2. to posterior chamber
3. around lens
4. through pupil into the anterior chamber
5. reabsorbed in the Canal of Schlemm

19

What is the LENS of the eye? What three clinical considerations should one keep in mind for the lens?

- elastic, biconvex body of elongated epithelial cells
- few nuclei in MATURE cells
- FROM ECTODERMAL CELLS (embryology)
- crystalline*

1. Presbyopia = loses its elasticity as we get older (can't accommodate lens --> blurry vision)
2. Cataracts = clouding of lens
3. Astigmatism - not symmetric about the optical axis = difficulties in seeing fine detail
- can be often corrected by glasses with a lens that has different radii of curvature ground in different planes (a cylindrical lens), contact lenses, or refractive surgery.

20

What is the space behind the lens called?

Postremal Chamber

- filled with gel like vitreous humor (cushions retina)

21

Which part of the eye transduces the energy of light (photons) into action potentials for the CNS to interpret (vision)?

RETINA

22

What embryologically developed structure disappears as the embryo grows?

HYALOID CANAL

- exit of the optic nerve to the posterior surface of the lens - course of the degenerated HYALOID ARTERY which supplied the vitreous body during embryological development*

23

What are the ten divisions of the Retina?

From Outside to Inside:

1. Inner limiting membrane - forms BLOOD - RETINAL BARRIER
2. Optic Nerve layer
3. Ganglion Cell Layer
4. Inner Plexiform
5. Inner nuclear layer
6. Outer plexiform
7. Outer nuclear layer
8. Outer limiting membrane
9. Rods & Cones
10. Pigmented epithelium

24


What are the 3 functional layers of the inner limiting membrane of the retina?

1. the outer layer (lying adjacent to the pigmented epithelium) = consists of rod and cone receptor cells***
- forms blood retinal barrier

2. the intermediate layer= interneurons and bipolar cells
- integrate sensory inputs from the receptor cells before transmission to the CNS

3. the innermost layer = the ganglion cells
- the cell bodies of afferent axons passing to the CNS in the optic nerve.

25

Why do rods form intramembranous disks?

TO INCREASE SURFACE AREA

26

There are action potentials in rods and cones. True or False?

FALSE
- there are no action potentials here
- action potentials are found in the axon of the GANGLIA CELLS

27

What are some main differences between rods and cones?

RODS:
- high sensitivity = good night vision
- more photopigment (but ACROMATIC = only one type of photopigment)
- high amplification
- absent in fovea

CONES:
- lower sensitivity = daylight vision
- less amplification
-less photopigment
-high acuity + Chromatic (3 types of cones sensitive to different part of visible spectrum)

28

What are interneurons?

Contain the bipolar cells + Amacrimal cell + Horizontal cell

- the relative output of rods and cones (when you walk into dark/light room)
- Usually in the middle so its slightly dark and light

29

What kind of cells extend between the outer and inner limiting membranes and form the blood brain barrier?

Muller cells!

- tight junctions between these cells form the BLOOD BRAIN BARRIER
- provide METABOLIC support
- All of the neurons of the retina
- The nuclei of these cells are also located in the bipolar (internal nuclear) cell layer.

30

What type of photoreceptor cells are found ONLY in the FOVEA ? Are there blood vessels in the fovea?

CONES

FOVEA =
- layers of retina that are displaced laterally
- *NO BLOOD VESSELS --> create the MACULA (fovea occupies center of the macula)

31

Where do the axons of ganglion cells converge to form the optic nerve?

OPTIC DISK

- retinal blood vessels exit/enter through optic disk

32

There are no photoreceptors at the OPTIC DISK. True or False?

TRUE!

- it is the "blind spot"
- CSF flows around the optic nerve (covered by dura)
- can observe changes in CSF pressure in this area!!!

33

Increases in CSF pressure will push on the optic disc and cause it to bulge, this is called:

Papilledemia

- retinal vessels run inside the optic nerve
= veins can be compressed resulting in swelling of retinal arteries

34

Optic nerves leaves the eye via numerous perforations through a part of the sclera known as the:

LAMINA CRIBROSA

35

What runs inside the Optic Nerve?

*central artery and vein run INSIDE the optic nerve

- comes out through the blind spot & doesn’t interfere with anything (through Optic Disk)*

36

The ciliary processes are primarily responsible for which one of the following functions in the eye?
constriction of the pupil.
dilation of the pupil. ( dilator puppiale)
production of aqueous humor.
pigmentation of the iris. (melanin)
accommodation of the lens. (ciliary m.)

Production of Aqeuous humor

37

When LIGHT reaches the peripheral retina (NOT at the fovea), the photons will first encounter which retinal layer?

Pigmented epithelium
Photoreceptors (rods & cones)
Interneurons (bipolar, horizontal and amacrine cells)
Ganglion cell bodies and axons
Inner plexiform layer

Ganglion Cell Bodies and Axons

38

Which one of the following statements concerning the optic nerve is correct?

1. The optic nerve is composed of the axons of the photoreceptors.
2. The axons pierce the sclera at the lamina cribrosa.
3. The optic disc has the richest diversity of photoreceptors.
4. The dura covering the optic nerve is continuous with the uveal layer.
5. Aqueous humor is found surrounding the optic nerve.

The axons pierce the sclera at the lamina cribrosa

39

Which one of the following vessels is responsible for papilledema?

Ophthalmic artery
Central artery of the retina
Vorticose veins
Posterior ciliary artery
Central vein of the retina

Central VEIN of the Retina

PAPPILLEDEMA = elavation of optic disk (TEST)

40

Which part of the cornea is avascular and has a smaller radius of curvature & acts as the primary focuser of light entering the eye?


CORNEA!!!

- anterior 1/6th TRANSPARENT and AVASCULAR
- receives metabolites from aqueous humor and vessels of limbus
- SMALL RADIUS OF CURVATURE

- PRIMARY REFRACTOR/focusing of light entering eye