Trans 001 - Basic Science Of Ophthalmology Flashcards
(117 cards)
1
Q
❛ Most external part of the eye we term this as ❜
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A
Ocular adnexa
2
Q
What comprises the ocular adnexa
A
❛ Eyebrows
• Eyelids
• Lacrimal Apparatus ❜
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3
Q
❛ ▪ A layer of tissue that sits on top of the eye.
▪ It is clear not white.
▪ Protects the eye and creates a surface underneath. ❜
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A
Conjunctiva
4
Q
❛ Loops underneath the inside of the eyelid and forms the back of the eyelid. ❜
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A
Conjunctiva
❛ Explains why if you have a contact lens that slips down it does not go behind your eyeball because it gets trapped by the conjunctiva. ❜
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5
Q
Why does your eyes get pink in conjunctivitis
A
❛ People who get conjunctivitis gets infection on this layer of tissue.
▪ Blood vessels run through the conjunctiva ▪ In conjunctivitis, these BV will get dilated and very red and that’s why your eye’s pink. ❜
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6
Q
❛ Where the conjunctiva inserts ▪ It becomes clear cornea ❜
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A
Limbus
7
Q
What are the two layers of eyelids?
A
❛ 2 layers: Anterior lamella and posterior lamella ❜
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8
Q
Which layer of the eyelid has the muscles?
A
❛ Anterior lamella – has the muscles ❜
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9
Q
❛ layer of tissue that is somewhat tough that gives eyelids its shape. Some of the muscles that open and close the eyes insert here. ❜
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A
Tarsal plate
10
Q
❛ Squirt oil through little pores at the base of the eyelids into the tear film. Oil important to keep tears from evaporating too quickly. ❜
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❛ inside the tarsal plate ❜
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A
Meibomían gland
11
Q
❛ can occur if one of the pores is clogged up. Backflow of lipid into the gland can get a granulomatous reaction. ❜
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A
Chalazion
12
Q
❛ Not an infection but can be seen quite commonly in ophthalmology. Hard lump that is not tender or infected but won’t go away on their own. ❜
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A
Chalazion
13
Q
How to treat chalazion ❛
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A
❛ To treat: flip eyelid, excise, and drain. ❜
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14
Q
❛ more like a pimple. Small localized infection usually self-limited, typically red and very tender ❜
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A
stye
15
Q
2 eyelid muscles?
A
❛ Orbicularis oculi ❜
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❛ Levator Palpebrae ❜
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16
Q
❛ circular pattern around the eyes.
Close the eye. Controlled by CN VII. ❜
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A
❛ Orbicularis oculi ❜
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17
Q
❛ controlled by CN III. Attaches on
top of the tarsal plate. Pulls the eye open. ❜
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A
❛ Levator Palpebra ❜
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18
Q
What is the function of the lacrimal system
A
❛ controls tear and tear drainage. ❜
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19
Q
❛ produces majority of tears ❜
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A
Accessory bland
20
Q
❛ produces reflex tearing in the corner
which squirts tears in the tear film. ❜
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A
❛ Lacrimal gland ❜
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21
Q
❛ drain tears down the canalicular system ❜
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O
A
punctum
22
Q
What comprises the lacrimal system?
A
Accessory gland lacrimal gland punctum lacrimal sac inferior turbinate
23
Q
❛ Tears form the eyes drain down to the nose in the ❜
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A
❛ nasolacrimal duct. ❜
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24
Q
❛ Most worrisome laceration in the lid is ❜
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A
❛ medial laceration ❜
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❛ because it can cut right into the canalicular structures and this needs to be repaired surgically. ❜
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25
Layers of the eyelid from superficial to deep
❛ From superficial to deep, they are the
skin layer
, a layer of striated muscle (orbicularis oculi),
areolar tissue,
fibrous tissue (tarsal plates), and a layer of mucous membrane (palpebral conjunctiva) ❜
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26
What is located in ❛ Anterior part of the eyelid ❜
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❛ orbicularis muscles are located ❜
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❛ If you have a stye (kuliti), it will be located in this anterior part of the eyelid. ❜
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❛ When you have plugging of the duct of the Meibomian gland, you have condition called ❜
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❛ chalazion or chalazia ❜
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❛ the tarsal plates terminate almost at the level of the ❜
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❛ levator palpebral muscle. ❜
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lashes emanates from what segment of the eyelid?
anterior
30
whate sre the anterior margin of the lid?
❛ o Eyelashes
o Glands of Zeis
o Glands of Moll ❜
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these also contibute to the tear film
31
posterior margin of the lid?
❛ Small orifices of modified sebaceous glands (meibomian, or tarsal, glands) ❜
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❛ contributes to the lipid part of the tear film ❜
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❛ Meibomian gland ❜
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❛ The fascia behind that portion of the orbicularis muscle that lies between the orbital rim and the tarsus and serves as a barrier between the lid and the orbit. ❜
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orbital septum
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❛ In the elderly, when the orbital septum weakens, what happens❜
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❛ fat around the orbit protrudes out and this is the cause of your eye bags ❜
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❛ are responsible for opening the eyelids. ❜
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❛ lid retractors ❜
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36
what are the lid retractors in the upper eyelid?
❛ levator palpebrae superioris & Muller's (superior tarsal) muscle ❜
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❛ In the lower lid: the main retractor ❜
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❛ is the inferior rectus ❜
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❛ The smooth muscle components of the lid retractors are innervated by ❜
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❛ sympathetic nerves. ❜
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❛ Ptosis is thus a feature of both ❜
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❛ Horner's syndrome and third nerve palsy ❜
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❛ Horner’s syndrom ❜
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❛ ptosis, miosis, anhidrosis. ❜
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sensory nerve supple of the eyelids
❛ First and second divisions of the trigeminal nerve (V) ❜
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arterial supply of the eyelids or external eye
❛ The lacrimal and ophthalmic arteries by their lateral and medial palpebral branches. ❜
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venous dra8nage of the external eye
❛ Venous drainage from the lids empties into the ophthalmic vein and the veins that drain the forehead and temple ❜
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lymphatics of the external eye
❛ Lymphatics from the lateral segment of the lids run into the preauricular and parotid nodes. Lymphatics draining the medial side of the lids empty into the submandibular lymph nodes ❜
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The lacrimal apparatus consist of
❛ Consists of the lacrimal gland, the accessory lacrimal glands, the canaliculi, the lacrimal sac ❜
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What are the accessory lacrimal glands?
❛ glands of Krause and Wolfring ❜
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Where are the accessory glands located
❛ located in the substantia propria of the palpebral conjunctiva ❜
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48
Where is the lacrimal apparatus located?
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, ❛ it is located in the outer, upper quadrant of the lid and it supplies 2/3 to ¾ of your liquid tears ❜
49
Tor F your tears are watery only
F. ❛ Your tears are not only watery, there is also a lipid and mucin component. ❜
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_ ❛ The blood supply of the lacrimal gland is derived from the ❜
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Lacrimal artery
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❛ The nerve supply to the lacrimal gland is by ❜
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❛
o The lacrimal nerve (sensory), a branch of the trigeminal first division;
o The great superficial petrosal nerve (secretory), which comes from the superior salivary nucleus; and
o Sympathetic nerves accompanying the lacrimal artery and the lacrimal nerve ❜
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❛ Skin incisions made in surgical procedures on the lacrimal sac should always be placed ❜
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❛ 2-3 mm to the nasal side of the inner canthus to avoid these vessels. ❜
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Excessive tearing
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epiphora
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❛ Thin, transparent mucous membrane that covers the posterior surface of the lids ❜
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❛ and the anterior surface of the sclera ❜
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Conjunctiva
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❛ The one that overlies the eyelid is the ❜
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❛ palpebral conjunctiva ❜
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❛ the one that overlies the sclera ❜
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❛ bulbar conjunctiva ❜
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❛ Tenon's capsule and the conjunctiva are fused for about 3 mm)here ❜
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Limbus
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The edge of cornea
Limbus
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❛ the site where we inject subconjunctival medicines like steroids. ❜
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❛ subconjunctival space. ❜
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Blood and nerve supply of conjunctiva
❛ Anterior ciliary and palpebral arteries.
• The first (ophthalmic) division of the fifth nerve. ❜
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❛ Fibrous membrane that envelops the globe from the limbus to the optic nerve. ❜
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❛ Adjacent to the limbus, the conjunctiva, Tenon's capsule, and episclera are fused together. ❜
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Tenon 'S capsule
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❛ They regulate the direction of action of the extraocular muscles and act as their functional mechanical origins. ❜
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Check ligaments
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❛ The lower segment of Tenon's capsule is thick and fuses with the fascia of the inferior rectus and the inferior oblique muscles to form the ❜
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suspensory ligament
64
Suspensors ligament ATA?
Lockwood ligament
65
❛ A pyramid of four walls that converge posteriorly
• The medial walls of the right and left orbit parallel and are separated by the nose.
• In each orbit, the lateral and medial walls form an angle of 45 degrees, which results in a right angle between the two lateral walls. ❜
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Orbit
66
Volume of the ad or both
30 ml
❛ 5 mL – volume of the globe itself 25 mL – orbital fat, extraocular muscles, other structures inside the orbit ❜
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❛ Eyeball occupies only about———- of the space ❜
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1/5 ❛ Fat and muscle account for the bulk of the remainder ❜
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❛ The anterior limit of the orbital cavity is th ❜
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❛ orbital septum ❜
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❛ which acts as a barrier between the eyelids and orbit ❜
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❛ The thinnest portion of the orbit is the ❜
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Floor
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❛ the strongest part of the orbit is the ❜
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❛ temporal side ❜
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❛ which is composed by your zygomatic bone. ❜
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Fracture of the orbital floor?
❛ blowout" fracture ❜
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Paper thin medial wall
lamina papyracea
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Roof of the orbital wall
Frontal bone
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Where is the lacrimal gland located?
❛ located in the lacrimal fossa in the anterior lateral aspect of the roof ❜
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What completes the roof of the orbit posteriorly
❛ lesser wing of the sphenoid bone ❜
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❛ The lateral wall is separated from the roof by the ❜
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❛ superior orbital fissure ❜
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❛ which divides the lesser from the greater wing of the sphenoid bone. ❜
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❛ The anterior portion of the lateral wall is formed by the ❜
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❛ orbital surface of the zygomatic (malar) bone ❜
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Strongest part of the bony orbit
❛ orbital surface of the zygomatic (malar) bone ❜
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❛ The orbital floor is separated from the lateral wall by the ❜
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❛ e inferior orbital fissure. ❜
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❛ forms the large central area of the floor and is the region where blowout fractures most frequently occur. ❜
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❛ Orbital plate of the maxilla ❜
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What completes the inferior orbital rim laterally?
❛ The frontal process of the maxilla medially and the zygomatic bone ❜
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❛ most posterior aspect of the medial wall ❜
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Body of sphenoid
83
❛ forms the upper part of the posterior lacrimal crest. ❜
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❛ The angular process of the frontal bone ❜
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84
❛ The lower portion of the posterior lacrimal crest is made up of ❜
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Lacrimal bone
85
What comprises the medial wall of the orbit?
Ethmoid, lacrimal bone, body of the sphenoid
86
Superior orbital fissure and interior orbital fissure is found medically or laterally?
Lateral
87
❛ Entry portal for all nerves and vessels to the eye and the site of origin of all extraocular muscles except the inferior oblique. ❜
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Orbital apex
88
We inject anesthesia at what part of the orbit?
Lower why? ❛ Because it is the shortest distance between the outside and the orbital apex. We don’t inject superiorly because that’s a long route into the orbital apex. ❜
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89
❛ When you do retrobulbar anesthesia, what effect would you expect or not expect? ❜
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Paralyzed eye
But the inferior oblique is spared so there is intorsion
90
❛ The superior and inferior divisions of the oculomotor nerve and the abducens and nasociliary nerves pass through the ❜
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❛ medial portion of the fissure within the annulus of Zinn ❜
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91
Along lumalabas sa superior orbital fissure laterally
trochlear nerve
frontal nerve
lacrimal nn
sup opthalmic vein
92
Along lumalabas sa medial part superior orbital fissure
nasociliary nerve
inf division of cranial nerve 3
cranial nerve 6
superior division of cranial nerve 3
93
❛ Principal arterial supply of the orbit ❜
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❛ Ophthalmic artery ❜
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❛ First major branch of the intracranial portion of the internal carotid artery o Passes beneath the optic nerve and accompanies it through the optic canal into the orbit ❜
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❛ Ophthalmic artery ❜
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❛ First intraorbital branch of the ophthalmic artery which enters the optic nerve ❜
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❛ This supplies the anterior 2/3 of the retina, because the posterior 1/3 of the retina is supplied by vessels from the choriocapillaries. ❜
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❛ Central retinal artery ❜
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❛ supplies the lacrimal gland and upper eyelid ❜
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❛ Lacrimal artery ❜
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❛ Supply the choroid and parts of the optic nerve ❜
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❛ Short posterior ciliary arteries ❜
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❛ Supply the ciliary body o Anastomose with each other and with the anterior ciliary arteries to form the major arterial circle of the iris ❜
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❛ Two long posterior ciliary arteries ❜
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❛ Derived from the muscular branches to the rectus muscles o Supply the anterior sclera, episclera, limbus, and conjunctiva and contribute to the major arterial circle of the iris ❜
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❛ Anterior ciliary arteries ❜
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❛ Contribute to the formation of the arterial arcades of the eyelids, which make an anastomosis with the external carotid circulation via the facial artery ❜
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❛ Most anterior branches of the ophthalmic artery ❜
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❛ Primary venous drainage of the orbit into which drain the vortex veins, the anterior ciliary veins, and the central retinal vein ❜
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❛ Drains into the cavernous sinus ❜
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❛ Superior and inferior ophthalmic veins ❜
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❛ Ophthalmic veins communicate with the cavernous sinus via the ❜
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❛ superior orbital fissure ❜
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❛ the pterygoid venous plexus communicates with the cavernous sinus via the
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❛ inferior orbital fissure. ❜
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❛ Initially formed from the supraorbital and supratrochlear veins and from a branch of the angular vein, all of which drain the skin of the periorbital region ❜
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❛ Provides a direct communication between the skin of the face and the cavernous sinus, thus forming the basis of the potentially lethal cavernous sinus thrombosis secondary to superficial infection of the periorbital skin ❜
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❛ Superior ophthalmic vein ❜
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❛ penetrates the optic nerve and divides to form the vasculature of the anterior or inner 2/3 of the retina. ❜
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❛ central retinal artery ❜
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❛ The outer 1/3 of the retina is supplied by the ❜
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CHOROID?
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❛ which emanates from the posterior ciliary arteries outside the eyeball. ❜
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107
❛ EXTRAOCULAR MUSCLES ❜
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- originates from?
❛ common ring tendon ❜
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Except inferior oblique muscle
108
❛ control primarily torsional movement and, to a lesser extent, upward and downward movement of the globe ❜
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❛ Oblique Muscles ❜
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❛ longest and thinnest of the ocular muscles ❜
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❛ Superior Oblique Muscle ❜
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❛ thickest ocular muscle ❜
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❛ Lateral Rectus Muscle ❜
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❛ originates from the nasal side of the orbital wall just behind the inferior orbital rim and lateral to the nasolacrimal duct ❜
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❛ Inferior Oblique Muscle ❜
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❛ Insertion is into the posterotemporal segment of the globe and just over the macular area ❜
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❛ Innervates the medial, inferior, and muscles and the inferior oblique muscle
superior rectus ❜
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❛ Oculomotor nerve (III) ❜
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❛ Innervates the lateral rectus muscle ❜
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❛ Innervates the superior oblique muscle ❜
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❛ Abducens nerve (VI) – LR6 ❜
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❛ Trochlear nerve (IV) – SO4 ❜
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Esotrópia is exotropia
esotropia is duling
| Exotropia is banlag
115
❛ the edge of your cornea and the anterior termination of your conjunctiva. ❜
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❛ limbus ❜
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116
❛ weakens function by altering the attachment site of the muscle on the eyeball. Once the muscle has been identified, a suture is placed through the muscle at the attachment site to the eye. The muscle is detached from the surface of the eye and reattached further back from the front of the eye, loosening the resting tension of the muscle. ❜
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❛ recession ❜
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❛ strengthens muscle function by reattaching a muscle to the eyeball at the original insertion site after a portion is removed. A suture is placed through the muscle at the intended new attachment site. The segment of muscle between the suture and the eyeball is removed and the shortened muscle is reattached to the eye. ❜
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❛ resection ❜
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