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811 Cards in this Set

  • Front
  • Back
EOMs attach to
sclera
Compared to skeletal muscle, EOMS are
better in every way

-denser blood supply
-denser nerve supply
-faster
-fatigue resistant
What makes muscle fast
white fibers
what makes muscle slow but fatigue resistant
red fibers
all recti muscles originate from
CTR
Superior rectus origin
CTR and optic nerve sheath
superior rectus innervation
superior division of CN 3
actions of Superior rectus
elevation
ADDuction
intorsion
inferior rectus origin
CTR
inferior rectus innervation
inferior division of CN 3
actions of IR
depression
ADDuction
extorsion
medial rectus origin
CTR and optic nerve sheath
innervation MR
inferior division of CN 3
MR actions
ADDuction
thinnest and longest EOM
superior oblique
thickest EOM
medial rectus bc of convergence
lateral rectus origin
CTR and greater wing of sphenoid
lateral rectus innervation
CN 6
lateral rectus action
ABDuction
superior oblique origin
lesser wing of sphenoid
superior oblique innervation
CN 4
what does SO use
trochlea
action of SO
intorsion
depression
ABDuction
inferior oblique origin
maxillary bone
what is special about IO
only EOM that originates ANTERIOR to globe
IO innervation
inferior division of CN 3
IO actions
extorsion
elevation
ABDuction
all superiors
INTORT
all obliques
ABDuct
lesser wing of sphenoid projects ___ and connects to ___
anteriorly
frontal b
greater wing projects ____ and connects ___
laterally
zygomatic bone
Foramen Rotundum
V2 (maxillary)
foramen ovale
V3 (mandibular)
inferior petrosal n
foramen spinosum
middle meningeal artery
sella turcia located where; houses what?
located in body of sphenoid
houses pituitary
optic chiasm lies above it
pituitary tumor
compresses nasal fibers OU as cross chiasm
bitemporal hemianopsia
pituitary tumor
CTR
circular band of CT anterior to SOF

origin of recti muscles
SOF
gap btw wings of sphenoid

anterior to cavernous sinus
what passes thru SOF and CTR
NOA fits thru ring and fissure

Nasociliary N
Oculomotor N
Abducens N
What passes thru SOF mneumonic?
I Live Free And True Never Say Otherwise
What passes thru SOF?
Inferior Opt V
Lacrimal N
Frontal N
Abducens N
Trochlear N
Nasociliary N
Superior Opt V
Ocuolomotor
optic canal
optic n
opt artery
carotid canal
ICA
sympathetic plexus
supraorbital foramen
supraorbital n and vessels
infraorbital foramen
infraorbital n and vessel
mandibular foramen
inferior alveolar n and vessel
stylomastoid foramen
facial n
how many bones make up orbit
7
roof
frontal bone
lesser wing of sphenoid
floor
My Zilly Pal

Maxillary
Zygomatic
Palatine
medial
my little eye sits in orbit

maxilla
lacrimal
ethmoid
sphenoid
lateral
zygomatic
greater wing of sphenoid
where are you most likely to get injury/dz?
My pal gets dz on floor

floor of orbit because thats were infraorbital n and maxillary sinus are
which is wall is the thinnest
medial
which wall is the weakest
floor
which wall is the strongest
lateral
external carotid supplies
superficial head/neck and some of the eye
what are the 2 main branches of ECA that supply the eye?
facial a
maxillary a
The terminal branch of the ECA is
superficial temporal a
what does the facial artery supply
supplies medial canthus via the angular artery
what does the maxillary artery supply
supplies orbit as infraorbital a

supplies lower lid and lacrimal sac
superficial temporal artery supplies what
superficial skin/muscle/tissue of face and orbit
what are the 3 branches of the superficial temporal artery
TAZ

transverse facial a
anterior temporal a
zygomatic a
how does the ECA and ICA join together
via transverse facial and anterior temporal arteries which hook up with the supraorbital and supratrochlear a of ICA
the skin of cheek is supplied by
transverse facial a
supplies orbicularis muscle
zygomatic a
supplies skin and muscle of forehead
anterior temporal a
Giant cell arteritis is
inflammation of the superficial temporal a that causes damage to one eye and can move to other eye if not treated

loss of vision

old ppl
how is vision loss in GCA
short posterior ciliary a (zinn) that supplies the optic dix are damage
can GCA be treated
nope, just give strong steroid
ICA supplies
INTERNAL structures of cranium and superficial face and orbit via hooking up with ECA
ICA travels with what nerve through the cavernous sinus
CN 6
ICA exits with what nerves
CN 2 & 3
what is the first branch of ICA near the orbit
ophthalmic artery
how many branches does the opt a have
7
what are the 2 terminal branches of opt a
supratrochlear a
dorsonasal a
skin of forehead, scalp, muscles of forehead are supplied by branch of opt a
supratrochlear a
supplies lacrimal sac
dorsonasal a
medial palpebral arteries
eyelids
the 2 terminal branches of opt a gives off
dorsonasal a
supratrochlear a
medial palpebral a arises from
dorsonasal a
lateral palpebral a arises from
lacrimal a
7 branches of opt a
1 CRA
2 Lacrimal a
3 Short Posterior Ciliary a
4 long posterior ciliary a
5 ethmoid a
6 supraorbital a
7 muscular a
CRA supplies
inner retina
lacrimal a supplies
LR, SR, lacrimal gland

later becomes lateral palpebral a --> lids
short posterior ciliary a
posterior choroid
macula
superficial optic nerve via circle of zinn
circle of zinn supplies
optic disc
circle zinn made up of
short posterior ciliary a
long posterior ciliary arteries
anterior choroid
iris
CB
MAC when hooks up with anterior ciliary a to supply iris/CB
how many SPCA are there
20
how many LPCA are there
2
MAC is located where
cb
MAC supplies
iris
CB
MAC made from
LPCA and ACA
MAC vessels are fenestrated or tight
fenestrated and bc of this helps make AH
ethmoid a supplies
sphenoid, frontal, ethmoid sinuses
supraorbital artery supplies
structures within orbit and superficial scalp and forehead
supraorbital artery
SR
SO
LPS
supply skin and muscles of forehead and scalp
muscular artery
supplies EOMS
2 branches
superior: LR, SR, SO, LPS
inferior: MR, IR, IO
anterior ciliary a
7 in total - 2 from each recti except LR which has 1

supply conj and combine with LPCA to form MAC
MAC is combo of what 2 vessels
ACA and LPCA
all veins of the eye drain into what
either the superior opt vein and/or inferior opt vein
CRV
drains CRA
drains into SOV
Anterior ciliary veins
drains all anterior structure including canal of schlemn

drains int SOV and IOV
vortex veins
4 total
drains choroid

drains into SOV and IOV
SOV and IOV drain into
cavernous sinus
cavernous sinus drains into
IJV --> heart
what is the cavernous sinus
large venous channel bordered by sphenoid and temporal bones

posterior to SOF
contents of cavernous sinus
OTOMCAS

oculomotor n
trochlear n
opthalmic division of V1
maxillary division V2
ICA
abducens n
sympathetic plexus
which is the only CN that runs free with the cavernous sinus
CN 6
CN 6 runs with what in the cavernous sinus
ICA
which nerve is most affected by ICA aneurysm in the cavernous sinus
CN 6
cranial nerve saying
O, O, O, to touch and feel very good velvet ah heaven
fxn saying for CN
some say marry money but my brother says big boobs matter most
CN 1
olfactory n

sensory

smell
CN 2
optic n

sensory

vision
CN 3
OCULOMOTOR N

MOTOR

EYE MOVEMENT, ACCOMMODATION, CONSTRICTION OF PUPIL
CN 4
TROCHLEAR N

MOTOR

SO
CN 5
TRIGEMINAL

BOTH

FACIAL SENSATION AND MASTICATION
CN 6
ABDUCENS

MOTOR

LR
CN 7
FACIAL

BOTH

FACIAL EXPRESSION, 2/3 TASTE, LACRIMATION, SALIVATION
CN 8
VESTIBULOCOCHLEAR

SENSORY

HEARING AND BALANCE
CN 9
GLOSSOPHARYNGEAL

BOTH

SWALLOWING, SALIVATION, PAROTID GLAND, POST 1/3 TASTE, CAROTID SINUS
CN 10
VAGUS

BOTH

TASTE, SWALLOWING, PALATE ELEVATION, TALKING, VISCERA
CN 11
ACCESSORY

MOTOR

HEAD TURNING, SHOULDER SHRUG
CN 12
HYPOGLOSSAL

MOTOR

TONGUE MOVEMENT
which cranial n begin at midbrain
3 & 4
which cranial nerves start at pons
5, 6, 7
which cranial nerves start at medulla
8, 9, 10, 11, 12
optic n fibers desucate at
optic chiasm
optic n fibers reach
LGN to go to V1

pretectal nucleus

superior colliculus
oculomotor n (3) is unique bc
it carries parasympathetic fibers in the EW nucleus for sphincter and CM
LPS are controlled
by the same nucleus therefore it is the reason for a BILATERAL PTOSIS
superior division of CN 3 innervates
SR, LPS
inferior division of CN 3 innervates
MR, IR, IO, short ciliary n
the only fibers of CN 3 that descuate are
SR fibers

causes contralateral problems
what is speacial about CN 4
only nerve to leave CNS and travel dorsally and then DESUCATE

innervates contralateral SO muscle
what else is special about CN 4 size wise and fxn
thinnest and uses trochlea
CN 5 is mostly what
sensory for eye with small motor component for muscle of mastication via V3
divisions of V1
NFL

nasociliary n
frontal n
lacrimal n
nasociliary n supplies
sensory innervation to cornea, iris, and side of nose
what are the most important branches of the nasociliary n
long ciliary n

short ciliary n
long ciliary n supplies
sensory innfervation to cornea, iris, CM, sympathetic fibers to dilator
frontal nerve has what 2 branches
supratrochlear
supraorbital
supratrochlear n supplies
skin and muscle of forehead
upper lid
conjunctiva
supraorbital n supplies
scalp
forehead
upper lid
conjunctiva
lacrimal n communicates with what n
zygomatic n
lacrimal n supplies
lateral conj
later upper lid
V1 is called the
opthalmic division
V2 is the
maxillary division
V3 is the
mandibular division
2 branches of V2
infraorbital n
zygomatic n
infraorbital n supplies
lower lids, cheeks, upper lip
zygomaticalfacial supplies
lateral side of cheek and lateral side of lower lid
which nerve is involved in lacrimation
V2
V2 receives
parasympathetic supply from sphenopaplatanie ganglion
V2 relays info from sphenopalatine ganglion to
lacrimal gland
V3 supplies
lower face sensory

motor of muscles of mastication
name the muscles of mastication
masseter
CN 6 runs through what structure
cavernous sinus
CN6 travels with what
ICA
most common nerve affected in ICA aneurysm
CN 6
CN 6 palsy can be due to
ICA aneurysm and elevated intracranial pressure
CN 7 is mostly
motor with some sensory (taste)
CN 7 provides motor innervation to what
muscle of facial expression
inner ear (decrease sound(
CN 7 provides sensory innervation to what 2 things
tongue
parasympathetic for facial glands (lacrimal gland)
how many roots does CN 7 have
3
voluntary motor root
facial muscles
sensory root
taste for anterior 2/3 tongue
autonomic root
parasympathetic (invol motor) to facial glands
CN 7 located in what part of brain
frontal lobe
what structure does CN 7 use to carry taste fibers from tongue and parasymp supply to submandibular/lingual glands
chorda tympani
stapedium muscle is supplied by what and whats its fxn
dampen sound

CN 7
where does CN 7 exit thru
stylomastoid foramen
where does CN 7 branch out at
parotid gland BUT doesnt innervate it!!!
what are the 5 branches of CN 7
Two Zebras Bit My Cat

temporal
zygomatic
buccal
mandibular
cervical
what do the 5 branches of CN 7 supply
muscles of facial expression
what branches of CN 7 innervates muscles around the eye
temporal and zygomatic
what are the muscles around the eye innervated by temporal and zygomatic branch
frontalis
procerus
corrugator
orbicularis
List the 4 CN that supply motor innervation to eye
3
4
6
7
strokes are due to leasions where
S for SUPRANUCLEAR
what fibers are damaged in strokes
ipsilateral fibers used for contralateral innervation of lower face
what fibers are spared in strokes
contralateral fibers for lid closure and wrinkling of forehead and eye closure
Strokes patients have
contralateral muscle weakness of lower face presenting as mouth drooping
stroke patients can do what
wrinkle forehead and close eye firmly
bell's palsy is due to a lesion where
LMN
bell's palsy damages what fibers
ipsilateral fibers used for muscles of facial expression
bell's patients look like what
mouth drooping and cant close eye on same side as lesion
name 2 CNs that are parasympatheic innervation
3, 7
CN 3 parasumpathetic fxn
miosis and accommodation
EW nucleus is attached to what nucleus
CN 3
where do preganglionic cell bodies come from
EW nuclei
describe what CN 3 looks like
pupil fibers on outside wrapped around EOM and parasympathetic fibers
which fibers of CN 3 are more likely to be damaged by a tumor or aneurysm
pupillary fibers because located peripheraly
CN 3 palsy
CN 3 innervates SR, IR, IO, MR and parasympathetic fibers for miosis and accommodation therefore if there is a palsy, the eye will be DOWN and OUT and can possibly be DILATED
what must be down if a CN 3 palsy is suspected
check the pupils!!!
why is pupillary involvement in a CN 3 palsy important
becauses it is a EMERGENCY patient may have a posterior communicating artery at the PCA/ICA junction
If pupil is not involved in CN 3 palsy then we are not likely to suspect
PCA aneurysm
____ is highly suspect cause of pupil sparing CN 3 palsy
HTN and DM that affect small bv that supply CN 3
where do CM and sphincter fibers synapse
ciliary ganglion
where is the ciliary ganglion located
btw optic n and LR muscle
postganglionic fibers synapse at
ciliary ganglion
postganglionic fibers leave the ciliary ganglion as
short ciliary n
short ciliary n innervates
CM and sphincter
the parasympathetic fxn of CN 7 is
innervates lacrimal gland, choroid, and inferior muller's muscle
preganglionic parasymp nerves of CN 7 synapse at what ganglion
geniculate ganglion
pregang parasymp nerves exit geniculate ganglion as
greater petrosal n
greater petrosal n combine with what nerve to form what
deep petrosal (symp) n to form carotid plexus
vividian n is a combo of what
greater and deep petrosal n
vividian n carries what type of fibers
parasymp and symp
vidian n synapses where
which type
sphenopalatine(pterygopalatine) ganglion

ONLY PARASYMP FIBERS SYNAPSE HERE
the sympathetic fibers courses thru sphenopalatine ganglion and do what
join zygomatic n of V2 providing communicating branch to lacrimal n for AUTONOMIC lacrimal gland innervation
sympathetic course begins where
begin in HYPOTHALAMUS and go to thorocolumbar region
sympathetic fibers synapse where
superior cervical ganglion
where do sympathetic fibers leave in CCB
ventral root to enter sympathetic chain ganglion
where do sympathetic fibers synapse after they leave the CCB
superior cervical ganglion
which type pre or post symp do they become when enter superior cervical ganglion
postganglionic
postganglionic fibers for a sympathetic plexus around what structure entering where
enter thru carotid canal

wrap around ICA
what are the 3 courses the sympathetic system has within the orbit
1. follow superior division of CN 3 to innervate MULLERS MUSCLE

2. follow nasociliary nerve and branch with LPCN or SPCN

3. become vividian n to vasoconstrict lacrimal gland
LPCN innervates what 2 muscles
dilator
CM
SPCN innervates
choroidal and conj bv
which symp fibers do not synapse at CG
SPCN
SPCN originate from
ciliary ganglion
SPCN carry what
postgang para and symp supply from CG

take sensory info back to eye via CG thru nasociliary n
LPCN carries
postganglionic symp fibers to eye

take sensory info from eye to trigeminal ganglion
sensory info from SPCN and LPCN is taken where
trigeminal ganglion
palpebral fissure
distance between open eyelids
superior palpebral sulcus
divides lid into tarsal portion and orbital portion
portion of lid that contains fat
orbital
portion of lid that contains lashes but no fat
tarsal
what structure divides the eyelid margin
punctum
what are the 2 divisions of the eyelid margin
lacrimal
ciliary
lacrimal portion of lid margin
medial 1/6 of margin

devoid of lashes or meibomian pores
ciliary portion of lid margin
lateral 5/6 of margin
Name the layers of the eyelid from ant/superficial to post/deep
1. Skin
2. Subcutaneous areolar CT
3. Orbicularis
4. Orbital Septum
5. Muscle
6. Tarsal Plate
7. Palpebral conj
thin layer of skin containing no fat
skin layer
layer containing loose CT btw skin and orbicularis
subcutaneous areolar layer
orbicularis oculi is innervated by what n
zygomatic branch of CN 7 FACIAL N
name the 2 parts of the orbicularis
orbital
palpebral
forced lid closure
orbital portion of OM
spontaneous and reflex blinking
palpebral portion of OM
Ciliary Muscle of Riolan and Horner's Muscle are located where
part of palpebral portion of OM
keeps lid tightly apposed to globe
Riolan
helps drain tears into lacrimal sac
horner's
dense irregular CT layer that serves as a barrier preventing fat from falling and keeps infections localized anteriorly
orbital septum
where is the orbital septum attached to
posterior lacrimal crest medially
what is important about the lacrimal sac
lacrimal sac is not protected by orbital septum bc the sac lies anterior to posterior lacrimal sac
the muscular layer contains what 2 muscles
LPS and Muller's
where does the LPS originate
lesser wing of sphenoid
what innervates LPS
superior division of CN 3
what does the LPS do
main retractor of lid

ELEVATES lid
fan shaped tendon
levator aponeurosis
muller's muscle is what type of muscle
smooth
muller's origin
superior potion - LPS

inferior - IR
muller's fxn
maintains lid opening
muller's innervation
sympathetic
injury to LPS results in
severe ptosis since it is the main retractor
injury to muller's results in
slight ptosis bc it isnt the main retractor
dense irregular CT layer that provides rigidity to lids
tarsal plate
what is located inn the tarsal plate
MG
Lateral and medial palpebral ligaments
MG
sebaceous glands that make lipid layer of tear film
MG located
posterior to cilia
role of lateral and medial palpebral ligaments
keep lid against eye during movements
palpebral conjunctiva
inner lid linning
name the 2 layers of the palpebral conj
stratified epithelial layer
submucosa
layer of palpebral conj that is protective and contains goblet cells
stratified epithelial layer
loose vascularized CT cotaining a lymph and fibrous layer
submucosa of palpebral conj
outer lymphoid layer
IMMUNOLOGICALLY ACTIVE
deep fibrous layer
connects conj to internal structures

contains accessory lacrimal glands, bv, nerves
modified sebaceous glands located in follicles that lubricate lashes
Zeis
modified swear glands
Moll
accessory lacrimal gland located in subconj CT or fornices
Krause
large accessory lacrimal gland that open onto to palpebral conj
Wolfring
localized, painless, sterile inflammation of MG
chalazion
staph infection of Zeis or Moll with inflammation on skin of lid margin
external hordeolum
staph infection of MG with inflammation on conj side of lid margin
internal horedolum
do hordeoulums hurt
yes, H is for hurt
motor innervation of lids
zygomatic branch of CN 7 for orbicularis

sympathetic for Muller's

motor for LPS via CN 3
upper lid nerve supply
V1 - frontal and lacrimal n
lower lid nerve supply
V2 - infraboribtal and zygomaticofacial n
what branch of ICA supplies deep lids
lateral and medial palpebral arteries (opt a branches)
peripheral arcades made up of what
medial and lateral palpebral arcaded
peripheral aracades role
main supply for deep id and palpebral conj
peripheral arcades communicate with which vessels
ACA
superficial lid supplied by
ECA
where does conj lymph drain into
lids
lateral lymphatics drain into
parotid gland
PAN
medial lymphatics drain into
submandibular node
facial muscle that raises eyebrows to look surprised
frontalis
facial muscle that moves brow medially to look like concentrating
corrugator
facial muscle that pulls medial part of brow down to look like menace/aggression
procerus
palpebral conj
inner lining of lids
forniceal conj
lines fornices
bulbar conj
lines eyeball
transuluscent layer above sclera
bulbar
bulbar contains what 2 layers
stratified epi
submucosa
which layer of bulbar has microvilli, melanin, and goblet cells
stratified eu=pi
submucosa is made up of
CT stroma like
conjunctival fold at medial canthus
plica semilunaris

vestigial 3rd lid
purpose of plica semilunaris
provides slack for lateral eye movements
modified mound of tissue containing hair and glands located medial to plica
caruncle
blood supply of palpebral conj
peripheral arcades
blood supply of forniceal conj
peripheral arcades
blood supply of bulbar conj
ACA
palpebral conj innervation
V1
V2
bulbar conj innervation
LPCN
pinguecula
modified sunmucosal tissue that is yellow and elevated due to dust, wind, UV
pterygium
like pinguecula but has own blood supply and grows onto cornea
name the 4 layers of the tear film
Lipid
Aqueous
Mucin
Epithelium conj
lipid layer produced by
MG
small bit from Zeiss
purpose of lipid layer
slow down evaporation of tears
provide smooth surface
aqueous layer produced by
lacrimal gland
accessory lacrimal glands (k & w)
purpose of aqueous layer
contains glucose,protein, enzymes, antibacterials (IgA, IgG)
mucin layer made by
goblet cells
puprose of mucin layer
absorbed by glycoalyx
adhesion of aqueous to cornea
meibomianitis
lipid deficiency
sjorgrens's, systemic meds
aq deficiency
ocular pemphigoid
steven johnson's
mucin deficiency
TBUT determines
lipid problem
shirmer's determines
aq problem
how tears drain
puncta--> canaliculi --> lacrimal sac --> NLD --> Hasner --> IM
puncta drains into
canaliculi
backflow is prevented via what feature of canaliculi
angle it takes when entering sac
where does lacrimal sac reside
fossa btw maxillary and lacrimal bone
NLD terminates where
IM
valve of Hasner is located where
at end of NLD
purpose of Hasner
prevent backflow of nasal fluid into lacrimal system
main function of cornea
refract and transmit light
what is the power of the cornea
about 2/3 (of 60) so 45 D
main refracting property of cornea
air tear film interface big n difference
where is cornea thickest at centrally or peripherally
peripherally
peripheral thickness of cornea
.67 um
center thickness of cornea
.52 um
cornea is atoric or toric
toric
WTR
more steeper/power in vertical
ATR
more steeper/power in horizontal
radius of curvature of central cornea for anterior surface
7.8mm
center of curvature of posterior cornea for poster surface
6.5mm
anterior horizontal diameter
11.7mm
anterior vertical diameter
10.6mm
posterior cornea is
spherical
anterior cornea is
toric
posterior cornea vertical and horizontal diameter
11.7mm
anterior cornea is
flatter
posterior cornea is
steeper
4 properties of cornea
thin
translucent
toric
avascular
name the 5 layers of cornea from anterior to posterior (superficial to deep)
epithelium
bowman's
stroma
descemet's
endothelium
the K epithelium is what type
stratified sqaumous
non keratinized
how many layers does the K epithelium have
4
name the layers of the K epithelium a-p(s-d)
surface
wing
basal
stem
describe the surface layer
2 cells thick
nonkeratinized squamous cels
what does the surface layer secrete and contain
glycocalyx
microvilli
what happens to surface cells with age
sloughed off into tear film
name the 2 types of jxn found in K epithleium
zonular occludens -- tight jxns

desomosomes
wings cells communicate with surface cells and basal cells and to other wing cells via
desomosomes
basal layer is made up of
single layer of columnar cells
what is special about the basal layer
only mitotic layer
what does the basal layer secrete
its own BM
Basal layer connects to Bowman's via
hemidesomosome which attach BM to cell
stem cells are found where
at limbus, same level as basal cell
stem cells start off what cascade
stem - basal - wing - surface
what type of layer is Bowman's membrane
TRANSITIONAL LAYER to the stroma

IT IS NOT A MEMBRANE
when is bowman's made and why is this an important factor
bowman's is made PRENATALY thus it DOESNT regenerate

BOWman's BOWS OUT
stroma makes up what % of cornea
90%
stroma is made up of how much water
75-80%
what 3 things is the stroma made up of
collagen fibrils
fibroblasts
ground substances
what are the fibroblasts of the cornea called
keratocytes
describe keratocytes
flattened cells lying w/in and btw collagen fibrils
lamellae
200-300 parallely layers of collagen fibrls
which area of stroma is where the collagen fibrils are most organized
posterior 2/3
where are the ground substance located
btw fibroblasts and keratocytes
what do the ground substance contain
GAGs
what are GAGs
hydroPHILIC negatively charged carbs that take up water allowing precise spacing btw lamellae
what is the major GAG found in the cornea
keratin sulfate
GAGs
attract water!
role of stroma
uniform spacing and lattice arrangement help the stroma be transparent
Descemet's membrane is what
the BM of the endothelium
Descemet's is made by which structure
endothelium
what 2 structures are resistant to trauma and damage
the MEMBRANES

bowmans's
descemet's
how are bowman's and descemet's membrane different
D3 --> descemet's REGENERATES 3X; true BM

bowman's --> BOWS OUT; DOESNT regenerate; not a true BM, just a TRANSITIONAL layer
K endothelium is a single layer containing what speacial structure
Na/K ATPase pumps
role of Na/K ATPase pump
regulate water and ion flow from aqueous to maintain lamellae spacing and hydration of K
what type of jxn is found in enodthelium
Macular occludens (spot jxn)

thus it is weak barrier allowing nutrients from AH to enter K
do endothelial cells replicate
NOPE
what happens to endothelial cells with age
cells wear out and neighboring cells change shape (pleo) and size (poly)to help out but this makes matters worse by decreasing pump effectivity and thus inducing stromal swelling
damaged endothelial cells produce
clumps of BM that accummulate in Descemet's
clumps of descemet's located centrally are called
Corneal Gutata
clumps of BM located in descemet's are called
Hassal Henle bodies
how long does it take for epithelium to turnover
7 days
which to layers can regenerate in the cornea
epithelium
descemet's
which 2 layers can not regenerate in the cornea
bowman's
endothelium
can K stromal cells be replaced if damaged
yes but will SCAR
neurotrophic keratitis
lack of nerve sensation leading to delayed K regeneration
vascularature supply of cornea
avascular, no bv in cornea
how does cornea get blood supply
diffusion from aqueous
limbal and episcleral bv
what nerves innervate cornea
V1
at which layer does V1 enter cornea
midstroma
when V1 first enters stroma how are the nerves
MYELINATED
inside cornea what happens to V1 nerves
become UNMYELINATED
once V1 enters stroma where does it go from here
the UNMYLEINATED nerves go up into bowman's and epithelium
which layers of the cornea lack n innervation
descemet's
endothelium
why are the 1st 3 layers of the cornea so sensitive
because they are UNMEYLINATED thus naked more exposed thus more sensitive
what is the sclera
outer posterior protective CT layer of eye
name the layers of sclera from outer to inner
episclera
stroma
inner lamina fusca
fxn of sclera
attachment site for EOMS
where is the sclera thinnest and how thin
.3mm

under rectus tendon
where is the sclera weakest
lamina cribosa posteriorly
where is he sclera thickest and how much
1mm

posterior pole
what layer is of sclera is continous with suprachoroidal layer
lamina fusca
blood supply of sclera
AVASCULAR

but some branches of LPCA, episcleral, choroidal vessels
scleral nerve supply
LPCN
SPCN
episclera is what layer and contains what
anterior/outer layer

contains capillaries from ACA that surround cornea
episcleritis
inflammation if CB or iris causes dilation of ACA thereby causing FLUSHING
sclera stroma
thick dense CT continous with K CT
sclera stroma architecture
RANDOM and IRREGULAR collagen bundles provide strength

less GAGS and fibroblasts
compared to the cornea the sclera is
DEHYDRATED bc less GAGs
lamina fusca
thin dark inner layer filled with melanocytes

inside of the choroid
color of sclera
white
osteogenesis imperfecta and Ehlers Danlos - CT disorder that does what to sclera

what does liver problems do to color of sclera
makes it blue

makes it yellow
where does the cornea enter the sclera
anterior scleral foramen
what is tenon's capsule
thin CT sheet that covers globe separating it from retroorbital fat
why is tenon's capsule perforated
to allow optic nerve, ciliary vessels, ciliary n, and CTR thru
lamina cribosa
scleral tissue with hole that optic nerve passes thru

weakest area of sclear
what CT/structure in eye is most likely to be damaged in eye with high IOP
lamina cribosa
limbus located
1-2mm circular band that encircle cornea
limbus is junction btw what structures
cornea & conj AND sclera & cornea
what is the role of the limbus
provides nutrition to other structures

passageway for AH drainage
Pallisades of Vogt
limbal epithelium and limbal stroma that project onto corneal

this is where stem cells originate
what changes occur at limbu
layers of epithelium increase and become but is still SSNKE

collagen arrangement is irregular

bowman's and descemet's terminat

conj stroma, episclera, tenon's begin
lateral end of descemet's
schwalbe's line
average IOP
15.5 mm Hg
AC boundaries
K endothelium, TM, SS, CB
angle structures from posterior to anterior
Iris
CB
SS
TN
SC
SL

I Can See The Stupid Line
scleral spur
circular band of collagen

anchors TM sheets and longitudinal CM
TM
lines circumferance of AC

beginning site of aqueous filtration

looks like triangle, apex at SL and base at SS
2 divisions of TM
corneoscleral meshwork
JXT
corneoscleral meshowrk
lies closer to AC

sheets run from K to SS
JXT
lies closer to SC

most resistance to AH outflow
where is resistance to AH outflow highest
JXT
SC
circular venous channel lined by endothelial cells

inner = against SS and TM
outer = against limbal sclera
IOP must be ___ compared to venous pressure to enetr SC
higher than venous pressure
AH outflow
TM - SC - external collector channels - deep scleral plexus -- intrascleral v -- episcleral v -- ACV -- Muscular v - SOV/IOV -- cavernous sinus - heart
what drains SC
episcleral veins
SL
lateral end of descemet;s membrane

outer limit of cornea at limbus
why is episcleral venous pressure high
so that aqueous can get inside SC
what type of gradient does AH use
high to low
is IOP high or low compared to venous pressure
IOP is high

venous pressure is low
IOP wants to go where
from high to low pressure

IOP --> veins
iris divides the eye into
AC and PC

cornea and iris = AC
iris and lens = PC
what does pupil do
limit light into eye
where is iris thickest
collarette
where is iris thinnest
iris root
what is the collarette
site of attachment for fetal pupil membrane during development

near pupil margin
what does collarette divide iris into
pupil vs ciliary zones
4 layers of iris

ant - post
anterior border layer
stroma
anterior epithelium and dilator
posterior pigmented epithelium
what provides the color of iris
anterior border layer
what determines eye color
number of melanoCYTES in anterior border layer
name 2 cells found in ABL
melanocytes
fibroblasts
collagen columns that serves as passageway for aqueous to enter stromal gives rough appearance to iris
crypts
loose collagen network continous with CB stroma
iris stroma
what 3 important things are found in stroma
nerves and bv
sphincter
pigment cells
what innervates iris
LCN
SCN
iris capillaries are what
non fenestrated
does iris vessels contrivute to blood aqueous barrier
yes because nonfenestrated
blood supply to iris
long anterior ciliary a
ACA
where is MAC located
CB
what does MAC supply
iris and CB
where is minor AC located
iris stroma
in what layer is sphincter located
stroma
what innervates sphincter
SCN of CN 3
what type of muscle is sphincter
circular
what does sphincter do
constrict pupils
where is anterior iris epi located
under stroma
what does the anterior iris epithelium become
dilator m
dilator muscle is
radial

symp innervated
what is the most pigmented part of iris
posterior pigmented epithelium
what does the posterior pigmented epi become
non pigmented epi of CB
pupillary ruff is made from
posterior pigmented epi of iris that curls anteriorly
posterior synchiae
posterior iris stuck to anterior lens causes pupil block
peripheral anterior synchiae
anterior iris to corneal endothelium or TM
pigment from pigment dispersion syndrome comes from what
posterior pigmented epi of iris
what does the CB bound
looks like triangle

touches:
ora
scleral spur
PC
what does the CB do
has the CM for acc

makes AH via NPCE
wide anterior region of CB that has ciliary processes
pars plicata
what makes aqueous
the NPCE of the pars plicata
regions btw ciliary processes
valley of kuhnt
flat posterior portion of CB where lens fibers located
pars plama
where does pars plan extend to
ora to pars plicata
where does CB begin
ora
retinal extensions onto pars plana
dentate processes
areas of pars plana btw dentate processes
oral bays
layers of CB post-ant
supracilliaris
CM
Stroma
epithelium
outermost layer of CB continious with suprachoroid
supracilliaris
supracilliaris contains what
loose CT collagen
smooth muscle of accommodation
CM
what innervates CM
Para and symp
what does the CM use as an anchor
scleral spur
longitudinal fiber of CM
most CM fibers

extends into choroid
radial fiber of CM
ends at ciliary processes
circular fiber of CM
least

aka MULLER"S muscle

lies closest to lens
what happens during accommodation
diameter decreases
radius decreases
increase curvature of lens
lens zonules relax
what happens to IOP during acc
decreased because the CM pulls on scleral spur which pulls on TM and opens up pores
ciliary stroma has 2 regions what are they continous with
anterior = iris stroma

posterior = choroid stroma
is the ciliary stroma vascularized
yes very
is MAC fenestrated
yes this how AH enters blood
how does AH enter blood
MAC
pigmented ciliary epithelium is outer or inner
outer close to stroma
NPCE is inner or outer
inner closer to PC
what makes AH
NPCE
pigmented ciliary epi is cont with what
anterior iris epi
RPE
Bruch's
NPCE is cont with what
posterior iris epi
ora
eventually becomes neural retina
where is choroid located
btw sclera and RPE
where does choroid extend to
ora to ON
where is choroid thickest
posterior pole (.2mm)
where is choroid thinnest
ora (.1mm)
how many layers does choroid have
4
are all the layers of the choroid vascularied
no

2 yes
2 no
layers of choroid post-ant
suprachoroid lamina
stroma
choriocapillaris
bruch's
space btw sclera and bv of choroid
suprachoroid lamina
what enters the suprachoroid lamina
LPCA
LPCN
loose CT with bv, nerves, and melanin
choroid stroma
how many layers does the choroid stroma have
2
what forms the 2 layers of the choroidal stroma
SPCA separates them
2 layers of the choroidal stroma
haller's
sattler's
posterior to anterior stromal layer
H before S
which layer has larger vessels
Hallers - HUGE
haller's form what
sattler's
which layer has small vessels
Satllers- SMALL
vortex veins do what
drain the choroid

come from Satllers
why are vortex veins unique
no valves
what innervates choroid
para and symp
symp innervation does what to choroidal bv
constriction
where is melanin found in choroid
stroma
why do choroidal melanomas form
because choroidal is highly vascular and has a lot of melanin
primary intraocular tumor
choroidal melanoma because it pushes thru vortex vein to come into eye
choriocapillaris
capillary bed with lots of fenestrations highly concentrated around macula
what does choriocapillaris supply
outer retina
Choriocapillaris are damaged by
DM
bruch's
innermost layer of choroid

runs from ON to CB

fusion of choriocapillaris and RPE
why are breaks in bruch's bad
fusion btw choroid and RPE

angiod streak in bruchs can lead to RD

retinal detachments!!!
how many layers does bruchs have
5
layers of bruchs
BM of choriocapillaris
outer collagen
elastic layer
inner collagen
BM of rpe
what makes up the core of bruchs
collagen
pseudoxanthoma elasticu, damages what and causes what
CT
causes angiod streaks in bruch's
what supplies choroid
SPCA for choriocapillaris
LPCA for anterior choroid
what innervates choroid
LCN
SCN
boundary of PC
posterior iris, anterior vitreous, CB
canal of hannover
contain zonules

PC
canal of petit
pc

from vitreous to zonules
P comes before H
Petit, Hannover
vitreous chamber
4ml out of 5ml
large
spherical
bowl like depression of vitreous
patellar fossa
what are the main components of vitreous
collagen
HA
what do collagen and HA do
keeps the vitreous gel like
breakdown of HA
floaters
strongest attachment of vitreous to ora
vitreous base
Weiger's ligament
where vit attaches to lens
are btw weigers and lens
berger's space
weakest attachment of vitreous
retinal vessels

vitreous goes thru ILM to attach to retinal vessels
list vitreal attachments from strong to weak mneumonic
VPOMR
very pearly oyster made round
strong to weak vit attachments
vitreous base
posterior lens
optic disc
macula
retinal vessels
vitreous cortex lies where and contains what
lies next to retina; consists of anterior hyaloid and posterior hyaloid

contains collagen, cells, protein, muco-polysaccharides
where is anterior hyaloid located
located anteriror to vit base
where is posterior hyaloid located
posterior to vit base goes around back of eye
cloquet's canal
where hyaloid artery was located
hyaloid artery
nourished the lens during development
mittendorf's dot
small dot on posterior lens where hyaloid was once attached
bergmiester's papillae
small dot on optic disc where hyaloid artery was once attached
where is lens located
btw iris and vitreous
what does iris divide eye into
AC
VC
what is thickest BM in the body
lens capsule
what are the lens zonules formed from
embryonically from tertiary vitreous
describe lens capsule
acellular
elastic
transparent1
where is lens capsule thickest
anteriorly mid peripheral
where is lens capsule thinnest
posteriorly
describe lens epithelium
single layer cuboidal epi
lots of organelles
gap jxns
what part of lens epithelium is not found in adults
posterior lens epi
what forms the embryonic nucleus
posterior lens epithelium that turn into primary lens fiber and go up thru anterior epi
what fibers form embryonic nucleus
primary
all growth after dev of embryonic nucleus is due to what fibers
secondary
which lens fibers contain nucleus and organelles
the young ones
anterior lens epithelium are what fibers
secondary
anterior lens fibers form what from what
from secondary fibers form:

adult nucleus
fetal nucleus
juvenile nucleus
lens cortex
adult nucleus contains what
secondary (anterior) from after birth to puberty
lens cortex
secondary (anterior) from after puberty on
summary
PLE -- primary lens fibers -- embryonic nucleus

ALE-- secondary lens fibers -- fetal nucleus, adult nucleus, cortex...
erect Y suture and inverted Y suture come from
secondary lens fiber
y sutures denote what
boundaries of fetal nucleus
what nucleus contains no sutures
embryonic
what fibers contribute to no sutures
primary (PLE)
where are the sutures located
fetal nucleus
erect Y sutures are found where
anterior fetal nucleus
inverted Y sutures are found where
posterior fetal nucleus
3 layers of eye
fibrous outer layer - cornea and sclera

vascular inner layer - iris, CB, choroid

inner neural layer - retina, RPE
inner tunic of eye
retina
fxn of retina
transform light into chemical energy
what is retina derived from
neural ectoderm
retina extends from
optic disc to ora
space btw RPE and neural retina
subretinal space
layers of the retina going from deep to superficial
Retinal Layers (deep-superficial)
In New Generation Its Only Optometrist Examines Patients Retina

ILM, NFL, GC, INL, ONL, OPL, ELM, PR, RPE
single layer of pigmented cells derived from outer layer of optic cup
RPE
describe RPE cells
highly active
lots of organelles
melanocyted
lipofuscin for phagocytosis
Basal side of RPE attaches to
bruch's membrane
apical side of RPE attaches to
retina
where are RD likely to occur
btw RPE and retina
which attachment of RPE is strongest
attachment to bruchs
which attachment of RPE is weakest
attachment to retina
what are the 2 types of PR
cones
rods
what do PR do
change light energy into chemical energy
what part of PR absorbs light
photopigment
how many rods are there
120 million
how many cones are there
6-8 million
outer segment of PR does what
makes the discs that hold the photopigment
what is the photopigment of rods called
rhodopsin
what is the photopigment of cones called
iodopsin

3 types all 11-cis = blue, green, red
what does the inner segment do
makes the photopigments
what do the discs made in the outer segment do
house the photopigments
once photopigments are made in ____ they are taken to ___ to be incorporated into ____
inner seg
outer seg
discs
2 regions of inner segment are called
myoid
ellipsoid
where is the myoid located
what does it do
inner layer of inner seg
location of protein synthesis thus has rER and golgi
where is the ellipsoid located
what does it do
outer layer of inner seg
e for energy thus lots of mitochondria
rods are used for
scotopic vision
cones are used for
photopic vision
which PR are used for color vision
cones
max scotopic sensitivity
507nm
max photopic sensitivity
555nm
where is the density of rods greatest
5mm away from fovea
where is the density of cones greatest
at fovea
where are there the fewest cones
in the periphery
within 1 degree of fovea what PR are there
red and green cones only

no rods or blue cones
the fovea is ___ to optic nerve
temporal and inferior
external limiting membrane
not a true membrane

contains no cells
role of ELM
structural

acts as barrier for large metabolites
ONL
contains PR cell bodies
OPL
where rods and cones synapse with horizontal and bipolar cells
where do synapses occur in rods
spherule
where do synapses occur in cones
pedicles
which is larger spherules or pedicles
pedicles
which is the only type of bipolar cells rod synapse with
ROD BIPOLAR CELLS
where does the first synapse in visual pathway occur
OPL
inner nuclear layer
cell bodies of:

horizontal cells
bipolar cells
amacrine cells
muller cells
interplexiform cells
what happens at the INL
horizontal cells go down towards RPE from here

amacrine and IPC go up towards vitreous from here
what do horizontal cells synapse with
PR, Bipolars, Horizontal cells
what do horizontal cells do
lateral inhibition
what is lateral inhibition
modification of info that reaches bipolar cells performed by horizontal cells
IPL
synapse btw 1st and 2nd order neurons in visual pathway
what synapses occur in IPL
ganglion with bipolar

modified by amacrine cells providing temporal input and increased resolution
what can amacrine cells synapse with
bipolars
ganglion cell bodies and dendrites
amacrine
IP cells
rule of thumb for amacrine and bipolar cells effects on ganglion cells
they have the opp effect

bipolar increase stimulation of GC

amacrines decrease stimulation of GC
ganglion cell layer
ganglion cell bodies
how many axons do GC have
1
where can GC axo termintae
LGN or midbrain
most common GC that extends to parvolayer of LGN; has 1 dendrite, common in fovea
Midget P1 GC
ganglion cells with branced dendrites that extends to parvolayer of LGN
midget P2 GC
m type ganglion cell that projects to magnocellular layer of LGN, jas many dendrites, located in perpiphery
diffuse ganglion cells
midget GC synapse with
midget bipolar cell

1:1
NFL
GC axons, form optic nerve
where is the NFL thickest
at ONH
where do GC axons enter optic nerve
ONH
where is NFL thinnest
macula
NFL fibers that extend from macula to disc
papillomacular bundle
ILM
innermost boundary