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131 Cards in this Set
- Front
- Back
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What two bones comprise the lateral wall of the orbit?
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Greater Wing of the Sphenoid Bone and Zygomatic Bone
Some remember the two bones that comprise the lateral wall as "Great-Z" |
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Which of the following muscles causes intorsion, abduction, and depression?
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SUPERIOR OBLIQUE
Remember, the primary actions of the superior oblique and inferior oblique are intorsion and extorsion, respectively. The oblique muscles certainly help with elevation and depression but their primary actions deal with torsion! |
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When are the oblique muscles responsible for for elevation and depression?
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When the eye is pointed towards the nose (adducted 51-55 degrees).
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When are the recti muscles isolated for elevaton and depression
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abducting 23 degress
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Which of the following is correct?
Upon adduction 23 degrees the superior rectus is the primary elevator Upon abduction 51 degrees the inferior oblique is the primary elevator Upon abduction 23 degrees the inferior rectus is the primary depressor |
Upon abduction 23 degrees the inferior rectus is the primary depressor
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The optic nerve courses through which portions of the brain (3)
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Superior Colliculus
LGN (and onto the visual cortex) Pretectal nucleus |
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Where do PREGANGLIONIC parasympathetic fibers that course to the pupil originate at in the eye?
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Edinger-Westphal nuclei
Remember, when you are checking pupils in clinic, CN 2 (optic nerve) performs the sensory loop (e.g. takes information back to the pretectal nucleus), while CN 3 (which begins at EW nucleus) performs the motor loop (e.g. takes information from EW nucleus to Ciliary Ganglion and onto ciliary muscle (for accommodation) and sphincter muscle (for miosis) |
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Where do POSTGANGLIONIC parasympathetic fibers that course to the pupil originate at in the eye?
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Ciliary Ganglion
Remember, when you are checking pupils in clinic, CN 2 (optic nerve) performs the sensory loop (e.g. takes information back to the pretectal nucleus), while CN 3 (which begins at EW nucleus) performs the motor loop (e.g. takes information from EW nucleus to Ciliary Ganglion and onto ciliary muscle (for accommodation) and sphincter muscle (for miosis) |
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Which cranial nerve is responsible for shoulder shrugging and head turning?
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Accessory (CN XI)
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What condition results from a lesion at the location of the ciliary ganglion?
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Adie's tonic pupil
Recall that .125% pilocarpine is used for diagnosis. |
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A lesion to the superior division of CN III would result in...
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Ptosis
Remember that the superior division of CN III innervates superior things.... the superior levator muscle (opens the eye) and the superior rectus (elevates the eye). |
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Inability for your patient to look up and out is most likely a result of a:
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lesion of the contralateral SR nucleus
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Cranial Nerve VII innervates...
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Frontalis muscle
Corrugator Platysma NOT MASSETER!! chewing is done with CN V3!!! |
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Which of the following has a different anatomical and physiological origin?
Inferior Oblique Superior Oblique Lateral Rectus |
Superior Oblique
Anatomical Origin = Lesser Wing of the Sphenoid Bone and Common Tendinous Ring (CTR) Physiological Origin = Trochlea Recall that the CTR is also referred to as the Annulus of Zinn. |
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What nerve innervates the lateral conjunctiva and lateral part of the upper eyelid?
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Lacrimal Nerve
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What nerve provides for the lateral part of the lower eyelid?
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Zygomatic Nerve
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Which cranial nerves is most likely to be affected in a patient with papilledema?
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CN VI...
ABDUCENS!!!! |
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What if a patient presents in your office with vertical diplopia (they see two separate objects with one above the other); what is the the most common nerve affected?
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CN IV...
TROCHLEAR |
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A lesion of the Facial Nerve would elicit all of the following symptoms except?
Loss of Reflex tearing Inability to close eyelids tightly Loss of taste from the front of the tongue Decreased hearing |
Decreased hearing / Recall that CN VII dampens sound.
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What are the THREE MAIN functions of FACIAL NERVE
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1. Sensory: anterior 2/3 taste
2. Voluntary motor: facial expression (but not mastication) 3. Involuntary motor: lacrimation and dampening of sound |
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In terms of laterality, compare STROKES and BELL'S
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Stroke: CONTRALATERAL
Bell's: IPSILATERAL |
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What are symptoms associated with Pancoast Tumor
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D.A.M.P.
Dilatation Lag Anhydrosis Miosis Ptosis (regular and reverse) Pancoast tumor affects the PREGANGLIONIC sympathetic fibers so all of the symptoms will be similar to Horner's Syndrome |
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Sympathetic innervation to the dilator follows the course of which sensory nerve?
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nasociliary nerve
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Which of the following layers of the eyelid contains goblet cells?
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Palpebral Conjunctiva.
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which gland is responsible for lubricating the eyelashes
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ZEIS
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which lymphatic system drains into the following nodes
Submandibular lymph nodes Preauricular lymph nodes Axilla lymph nodes |
Preauricular lymph nodes. Preauricular lymph nodes are also called parotid lymph nodes.
Lateral lymphatics drain into the preauricular (parotid) lymph nodes Medial lymphatics drain into the submandibular lymph nodes |
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Bulbar conjunctival blood supply and the ciliary body both receive part of their blood supply from which artery?
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Anterior Ciliary Artery
Think about a UVEITIS patient, who has inflammation of the ciliary body (because of MACI being inflamed) and what else do uveitis patients typically have?..... Circumlimbal injection - this hyperemia is a result of the anterior ciliary arteries, which course around the limbus, being injected. |
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What is the purpose of the Valve of Hasner?
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Prevents nasal cavity fluid from entering nasolacrimal system. This is its only purpose.
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what is the anterior and posterior radius curvature of the cornea?? which is steeper??
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7.8 mm anteriorly
6.5 mm posteriorly so flatter anteriorly |
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Where are hemidesmosomes located within the cornea?
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Between basal cells and basement membrane
HEMIDESMOSOMES connect CELL to BM!! NOTE: other junctions connect CELL to CELL |
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Which of the following layers does not have capillaries?
A.Iris B.Retina C.Choroid D.Sclera |
Sclera. The sclera is considered avascular.
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Which areas of the eye have non-fenestrated capillaries?
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Iris/Retina
Remember, non-fenestrated means that the endothelial cells are lined with tight junctions, which only allow small ions and water to pass through. It makes sense that in the iris and retina we want tight pores so that leakage is minimized! |
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Which areas of the eye have fenestrated capillaries?
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CB/Choroid
Fenestrated means that there are pores within the endothelial cells that allow passage of some molecules and some proteins. It also makes sense that in the CB (for production of aqueous humor) and choroid (to provide nourishment to retina) we want leakage of fluid. |
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Sclera...where is it...
thickest? thinnest? weakest? |
1. thickest at 1.0mm at the posterior pole
2. thinnest at 0.3mm under rectus tendon 3. weakest at the lamina cribosa |
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Gonioscopy Structure from posterior to anterior
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I Can See The Stupid Line
Iris Ciliary Body Band Scleral Spur Trabecular Meshwork Schwalbe's Line |
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Corneal stem cells originate from... and become...
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Originate from Pallisades of Vogt (limbus), become basal cells
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Which corneal epithelial cells are the only ones that undergo mitosis
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basal cells!!!
stem cells...basal cells...mitosis...wing cells to become surface layer |
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vortex veins drain into...
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the choroid
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what drains into schlemms canal
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A.External collector channels
B.Deep scleral venous plexus C.Intrascleral veins D.Episcleral veins |
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Which layer is the primary contributor to iris color?
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anterior border layer
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The pupillary ruff is formed from which layer?
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posterior pigmented epithelium
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Which region of the ciliary body do the lens zonules begin their course from?
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Pars Plana makes the lens zonules
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Which region of the ciliary body secretes aqueous humor?
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Pars Plicata secretes aqueous humor
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how does accommodation influence IOP
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Longitudinal muscle contraction pulls on scleral spur which pulls on TM, allowing less outflow resistance and a decrease in IOP.
Exact same mechanism of action as pilocarpine -- KNOW THIS! Remember, when you think about the angle structures, emphasize in your mind that the scleral spur is the ANCHOR. It serves as the central attachment site for the CM (attaches on inferior side) and TM (attaches on superior side). Thus, when the CM contracts, it will naturally pull on the scleral spur. Since the scleral spur is attached to the TM, pulling on the scleral spur will also cause pulling on the TM, thus opening up the TM pores for an increase in outflow, decrease in IOP. |
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Vitreal Attachment from strongest to weakest
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1. Ora Serrata
2. Posterior Lens (at the hyaloideocapsular ligament of Weiger) 3. Optic Nerve 4. Macula 5. Retinal Vessels |
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What condition represents remnants of the hyaloid artery on the LENS?
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Mittendorf's Dot
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What condition represents remnants of the hyaloid artery on the OPTIC DISC?
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Bergmeister's papillae
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What fibers do the fetal nucleus originate from?
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SECONDARY
Secondary does all growth of the lens after the embryonic nucleus |
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Where does the RPE derive from...
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Derived from the outer layer of the optic cup, tight association with the CHOROID.
Tight with choroid b/c shares Bruch`s with choroid - loose with retina). RD`s occur at Retinal/RPE interface. Outer cup gives RPE, inner cup retina. |
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What are the layers of the retina?
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1. RPE
2. Photoreceptor Layer 3. External Limiting Membrane 4. Outer Nuclear Layer 5. Outer Plexiform Layer 6. Inner Nuclear Layer 7. Inner Plexiform Layer 8. Ganglion Cell Layer 9. Nerve Cell Layer 10. Internal Limiting Membrane |
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What are the three nuclear body layers of the retina and what nuclei do they hold?
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ONL (cell body of photoreceptor cells)
INL (cell body of bipolar cells) GCL (cell body of ganglion cells) |
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Where does the first synapse occur in the visual pathway?
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Outer plexiform layer (OPL)
Outer plexiform layer is also the only layer in the retina to receive blood supply from the central retinal artery branches AND the choriocapillaris. |
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Outer Layer of the the retina is supplied by what source? Inner Layer??
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Outer layer supplied by CHOROID
Inner layer supplied by Central Retinal Artery |
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Damage to which of the following regions of the optic nerve would cause a significant decline in vision?
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Papillomacular bundle (MACULAR REGION)
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The central retinal artery forms two capillary networks within the inner retina. Where are these networks located?
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NFL and INL
the network located in the INL is larger (b/c it has to supply more things - cell bodies of horizontal, amacrine and bipolar cells). |
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Which region of the macula has the thickest region of ganglion/bipolar cells?
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Parafovea
this is because the foveala is void of bipolar and ganglion cells. During development, these cells are pushed to the side, contributing to the thickness of the parafovea - this is the thickest area of the entire retina. |
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Where is the thickest region of rods in the retina?
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Just outside the perifovea
(5mm outside the foveala) |
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Vision loss from anterior ischemic optic neuropathy (AION) results from lack of blood flow through which artery?
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SPCA
Recall that the SPCA's (Circle of Zinn) provide the blood supply to the anterior surface of the optic disc. Inflammation of the superficial temporal artery (External carotid artery branch) is not what causes the vision loss. |
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where is the location of the superior and inferior fibers in the optic tract.
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Superior fibers - always go MEDIAL.
Inferior fibers -- always go LATERAL. the superior nasal fibers cross and go medial (into parietal lobe) - while the inferior nasal fibers cross and go lateral (into temporal lobe). The temporal fibers never cross. The superior temporal fibers stay ipsilateral, but course medial (into parietal lobe). The inferior temporal fibers stay ipsilateral, but course lateral (into the temporal lobe). |
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A cuneus gyrus lesion would give which defects within the macula?
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Inferior VF defect in macular region
Superior retinal fibers terminate here, expect INFERIOR VF defect |
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Macular Sparing Homonymous Hemianopsia`s are often the result of which of the following?
A.Stroke B.Tumor |
A.
Two arteries supply the macula: Middle Cerebral and Posterior Cerebral. A stroke will affect one, but rarely both. |
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What two arteries supply the macula?
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Middle Cerebral
Posterior Cerebral |
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A 31 yr. old female is deaf in her right ear and is unable to closer her right eye, but corneal sensation is unaffected. The most likely location of a single lesion that would account for her symptoms is:..
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Internal auditory meatus
VII AND VIII run through the inferior auditory meatus -- a lesion affecting those nerves would contribute to difficulty closing the eye (VII) and sound (VIII). |
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45 yr old man has loss of corneal sensation, can not abduct, and tilts his head to his left shoulder as you examine him. No facial asymmetry is found, nor difficulties in hearing. Where is the most likely site of a lesion.
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Cavernous Sinus
His problems come from affects of the lesion on CN`s V1, IV, and VI -- all nerves that run through the cavernous sinus. The hearing and facial symmetry are related to CN VII -- which is unaffected. |
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Where does CSF flow within the optic nerve?
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Between the Pia and Arachnoid mater
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Which of the following is the most common cause of unilateral proptosis?
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Hyperthyroidism
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Which of the following cranial nerves is responsible for swallowing and posterior 1/3 taste?
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Glossopharyngeal
Remember the G for Glossopharyngeal as GAG.... because has several actions that correspond with the back of the throat, including swallowing and posterior 1/3 taste. AND PAROTID!! |
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-Carcinoma is cancer of...1.
-Sarcoma is cancer of...2. |
1. EPITHELIAL TISSUE
2. CONNECTIVE TISSUE |
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Pathophysiology of EMBD
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A basement membrane forms that is thickened and misdirected into the epithelium. Basal cells have difficulty adhering to this faulty basement membrane making hemidesmosome formation difficult - this is why recurrent corneal erosions are often secondary to EBMD.
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Etiologies of Salzmann's Nodular Degeneration?
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(All have to do with chronic keratitis)
-Dry eye -Trachoma -Phlyctenulosis -Interstitial keratitis UNILATERAL!!!! |
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characteristic appearance of Salzmann's Nodular Degeneration?
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BLUE-GRAY stromal opacities
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Retinoschisis is most common in two retinal locations...
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-Inferior/temporal
-Superior/temporal |
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most common, benign orbital tumor in ADULTS?
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Cavernous Sinus Hemangioma
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most common, benign orbital tumor in KIDS?
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Capillary Hemangioma
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Ocular Ischemic Syndrome...two main characteristics...what age group...most common etiology
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UNILATERAL
mid-periphary hemorrhage 50+ years old Atherosclerosis and GCA |
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cavernous sinus thrombosis is mainly caused by...
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facial infection!!!
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the most common cause of retinal vascular occlusive disease?
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Branch Retinal Vein Occlusions
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Which corneal layer has the MOST MITOCHONDRIA?
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Endothelium
the ENDOTHELIUM is the most active corneal layer because of the Na/K ATPase pump. |
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what four bones make up the medial wall
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S.M.E.L.
Sphenoid Body Maxilla Ethmoid Lacrimal |
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Where does the inferior oblique muscle start its course?
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Maxillary Bone
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How many bones make up the orbit?
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SEVEN
Frontal Sphenoid Ethmoid Lacrimal Maxilla Palatine Zygomatic |
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Which orbital wall does NOT utilize the sphenoid bone?
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FLOOR
"2-2-3-4 all have sphenoid except the floor." The order is roof (two bones), lateral (two bones), floor (three bones), medial wall (four bones). |
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What is another name for the ethmoid bone in the medial wall?
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Lamina Papyracea
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Name the four different regions of the optic nerve and approximate the length for each portion
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1) Intraocular portion (1 mm) - portion of nerve that extends to lamina cribosa.
2) Intraorbital portion (30 mm) - extends from lamina cribosa until exits the orbit. S-shaped portion of the nerve that allows for eye movements without stretching the nerve. 3) intracanalicular (6-10 mm) - portion of optic nerve just posterior to the orbit to the optic chiasm. 4) Intracranial (10-16 mm) - portion of optic nerve from optic chiasm and beyond (posterior to chiasm). |
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Which portion of the optic nerve has some attachments with extraocular muscles and is responsible for pain during eye movements in optic neuritis?
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IntraOrbital
Within the orbit, the superior rectus and medial rectus share a common sheath with the optic nerve and are responsible for the pain experienced during eye movement (90% of cases) that occurs with optic neuritis. |
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What two arteries provide blood supply to the optic nerve head?
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Short Posterior Ciliary Arteries (SPCA's)
branches of the Central Retinal Artery (minor contributor) |
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What is the name for the most superficial portion of the orbicularis oculi?
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Muscle of Riolan
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The lacrimal gland is located within a fossa of what bone?
The lacrimal gland is divided into two parts by what structure? |
The lacrimal gland is located in the temporal portion of the FRONTAL BONE.
The tendon of the superior levator palpebrae muscle splits the lacrimal gland into an ORBITAL PORTION and a PALPEBRAL PORTION. |
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What type of muscle is Muller's muscle and how is it innervated?
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Smooth Muscle
Innervated by the Sympathetic Nervous System |
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What is the function of the vortex veins?
How many are there per eye? |
Drains Choroid, Ciliary Body and Iris
4-7 per eye |
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Put these muscles in correct order, from superior to inferior --
superior oblique, superior levator palpebrae, superior rectus |
Superior Levator Palpebrae
Superior Rectus Superior Oblique |
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What vascular system nourishes the lens during fetal development?
Occasionally, remnants of this arterial system are left behind and we can detect them clinically on the back of the lens and on the optic disc. What clinical terms are given to these arterial remnants? What nourishes the lens later in life? |
Correct Answer = Hyaloid vascular system nourishes the lens during development.
Correct Answer = Mittendorf's dot - on back of lens ("dot the lens") and Bergmeister's papillae (on optic disc) Correct Answer = Aqueous and Vitreous nourish the lens after hyaloid vascular system has regressed. |
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What does the Uvea composed of...
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Iris
Choroid Ciliary Bodies |
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What two cranial nerves and utilized to transmit parasympathetic innervation to ocular structures?
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CN3 (EW nucleus in Midbrain)
- innervate sphincter muscle and ciliary body CN7 (Lacrimal nucleus in Pons) - innervate lacrimal glands |
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What are the two major pigments found in the macula lutea?
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Zeaxanthin
Lutein |
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What is the size of the fovea?
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1.5mm = 1,500 um's = 1 disc diameter
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What 3 cell types and found within the foveala?
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3 cell types = photoreceptors, glial cells, Muller cells
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What 5 retinal layers are found within the foveala?
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5 retinal layers = RPE, Photoreceptor layer, ELM, ONL, Henle's Fiber Layer, ILM.
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What does the optic nerve consist of?
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Axons of Ganglion Cells
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What bone does the optic foramen pass through?
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Lesser Wing of the Sphenoid
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Which of the following cranial nerves exit from the Midbrain? Pons? Medulla?
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1) CN'S 3,4 = exit from the MIDBRAIN
2) CN's 5,6,7,8 = exit from the PONS -CN 6 is the only CN to course between the pons and the medulla. 3) CN 9-12 = exit from the MEDULLA |
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what is Uncal Herniation? Ocular Manifestations?
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Uncal herniation results from an increase in intracranial pressure and the brainstem is compressed downward, with major emphasis on the lower brainstem (mainly the MIDBRAIN). The worst case scenario in this condition is the midbrain being squeezed through the foramen magnum, resulting in death.
UNCAL HERNIATION = MIDBRAIN = CN 3 DAMAGE. |
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Which of the following ocular effects is expected FIRST with uncal herniation?
Dilated pupil "Down and Out" location of the pupil |
DILATED PUPIL
Recall that the pupillary fibers lie on the outside of Cranial Nerve 3. Compression on the midbrain during uncal herniation will initially push on the outside fibers of cranial nerve 3, affecting the pupil (e.g. dilated pupils, lack of pupil response to light) before affecting the EOM's. |
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what are the contents of the cavernous sinus??
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CN III
CN IV CN V1/V2 CN VI Internal Carotid Artery Postganglionic Sympathetic Fibers |
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Central Retinal Vein drains...
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Central Retinal Artery...inner 6 layers of the retina
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Anterior Ciliary Artery drains...
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all anterior structures...iris, ciliary body, conjunctiva, canal of Schlemm
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Vortex Veins drains...
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Choroid
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The superior and inferior ophthalmic veins drains...
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the globe by emptying into the cavernous sinus
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neovascular glaucoma is a major concern in patients with...
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CRVO...90 day glaucoma
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what are the indices of...
1. Tear Layer 2. Cornea |
1. Tear Layer : 1.336
2. Cornea : 1.376 |
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What are the thicknesses of the FIVE LAYERS of the CORNEA
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1. Epithelium (52)
2. Bowman's Layer (8-14): Acellular random Type 1 collagen, not a membrane, just a transition layer into stroma 3. Stroma (450) 4. Descemet's Membrane (5-15) 5. Endothelium (5) |
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angle structures...posteror to anterior
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I Can See The Stupid Line
1. Iris 2. CBB 3. Scleral Spur 4. Trabecular Meshwork 5. Schlemm's Canal 6. Schwalbe's Line |
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Iris color is dependent on...
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amount of melanin within melanocytes in the anterior border layer and stroma (minor)
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drusen are located...
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between the inner collagenous layer of Bruch's Membrane and the BM of the RPE
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Vitreal Attachment from strongest to weakest
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1. Vitreous Base
2. Posterior Lens 3. Optic Disc 4. Macula 5. Retinal Vessels |
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Mittendorf dot
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Embryological remnant of hyaloid artery on the POSTERIOR LENS CAPSULE
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Bergmeister's papillae
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Embryological remnant of hyaloid artery on the OPTIC DISC
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pathophysiology of retinal detachments in respect to subretinal space
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RPE has NO intercellular junctions to the rod and cones.
This creates a subretinal space that can lead to RD. |
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where is the greatest density of RODS
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ROD RING:
5mm (20 deg) concentrically from the fovea |
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structurally...
rods terminate in... cones terminate in... |
1. rods terminate in spherules
3. cones terminate in pedicles |
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rhodopsin absorbs photons maximally at...
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507nm
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hard exudates are located...
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in the OPL
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retinoschisis occurs from...
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from splitting of the OPL
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central retinal artery provides blood to...
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NFL
GCL IPL INL portions of OPL |
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Bipolar cells and Amacrine cells in respect to Ganglion Cells
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1. Bipolar Cells INCREASE stimulation to GC
2. Amacrine Cells DECREASE stimulation to GC |
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Describe Parvocellular cells
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have small diameter axons and are sensitive to color and fine details.
more common than M-cells. project to parvocellular layer of the LGN |
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Describe Magnocellular cells
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large diameter axons and are sensitive to dim changes in illumination
project to magnocellular layer of the LGN |
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epiretinal membrane occurs...
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on the INTERNAL LIMITING MEMBRANE
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clinical difference between CN X and CN XII palsy
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CNX: UVULA deviates AWAY from the side of lesion and there is failure of palate elevation (hoarse voice)
CNXII: TONGUE deviates TOWARDS the side of the lesion. |
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three destinations of optic nerve course
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LGN: relaying onto the primary visual cortex
Pretectal nucleus: pupil innervation Superior colliculus: for saccades |
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a lesion of the levator palpebrae subnucleus will result in...
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sudden onset bilateral ptosis because the levator palpebrae muscle for each eye is controlled by only ONE CENTRAL SUBNUCLEUS
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