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94 Cards in this Set

  • Front
  • Back
Epibulbar (mucosal) epithelium
+goblet cells, NO rete ridges, keratin nor granular layer
epidermis
+rete ridges, keratin, granular layer, NO goblet cells
conjunctival epithelium
mucin secreting goblet cells
corneal epithelium
NO mucin secretors
Skin layers:
Basal cell
cuboid or columnar w/ large nuclei aligned in single row above BM
skin layers:
Prickle cell
polygonal w/ numerous hairlike filamentous connections btwn cells
skin layers:
Granular
flat, long squamous cells w/ multiple keratohyaline granules
skin layers:
Keratin
multiple eosinophilic layers of protein w/ no cellular details visible
Tears
Mucus
innermost layer; secreted by conj; permits smooth/even distribution over corneal epi
Tears
Aqeous
middle layer; secreted by glands or Crause & Wolfring; permits diffusion of O2 & metabolites to the cornea; >90% of tear volume
tears
lipid
outermost layer; secreted by meibomian glands; retards tear evaporation
corneal thickness
superior>nasal>inferior>temporal
Schwalbes line
junction between K endo & nonpigmented TM endo
Muller cells
nuclei in INL; modified glial cells; basal process extend to form ILM; outer cell processes extend beyond ONL & are connected to photoreceptors by terminal bars (AKA ELM)
NFL
clinical significance=JXR, reticular retinoschisis
inner plexiform layer
axons of bipolar & amacrine cells & synapses of ganglion cells
inner nuclear layer
retinal BVs supply inner 1/3 (& all layers superficial to this)
outer plexiform layer
connections btwn photoreceptors, horizontal cells, bipolar cells
In macula=Henle’s layer; Clinical significance=CME; senile retinoschisis
outer nuclear layer
Photoreceptors nuclei
ILM
footplates of muller cells; discontinuous over lattice degen
RPE
interdigitates w/ apical processes or rod & cone segments; densely adherent to Bruchs; taller w/ more pigment in macula; comprise outer blood-retinal barrier
bruch's membrane
5 layers: RPE basement membrane (BM), Inner collagenous zone (ICZ), elastic layer, OCZ, choriocapillaris BM
choriocapillaris
circulation from posterior ciliary arteries (i.e. no communication w/ ophthalmic artery)
macula
rods: cones=12:1 (up to 20:1); rod density is greatest 20-40 deg eccentric to fovea; cone density is greatest at fovea; at fovea, rods=cones; cones=40-50% are outside of macula
blood retinal barrier
inner=BV endothelium; outer=RPE
aqueous
more acidic & hypertonic than plasma; 15 x more ascorbate, sig less protein (0.2% vs 7%)
Conventional aqueous outflow
TM, Schlemm’s, episcleral/conj veins (85-90%), IOP dependent
Non-Conventional aqueous outflow
uveoscleral (10-15%), independent of IOP
Optic canal
in lesser wing of sphenoid, 8-10mm long & 6.5mm wide @ optic foramen; sympathetics, ON, ophthalmic art, nasociliary n, CN3, CN6
Ethmoidal foramina
at jxn of ethmoid & frontal bones
Sup orb fissure
separated from optic canal by bony optic strut; CN4, lacrimal & fronal N, sup orbital vein
Inf orb fissure
CN V2 (maxillary N), sphenopalatine ganglion branches, zygomatic N, Inf orb V;
walls: medially=maxilla; anteriorly=zygomatic; laterally=Gr wing of sphenoid & palatine bone
Orbit Floor
MaPZ (maxilla, palatine, zygomatic)
Orbit Medial wall
maxilla, lacrimal, ethmoid, medial part of frontal
Whitnall’s Lat orbital tubercle
entirely on zygomatic bone (2mm inf to frontozygomatic suture)
Lockwoods ligament
Lateral rectus check ligament
Lateral canthal tendon
Lateral horn of levator aponeurosis
Lockwoods ligament
globe hammock; part of lower lid retractor system (w/ intermuscular septae & tenons); posterior—arises from fibrous attachments on inf side of inf rectus; extends anteriorly as capsulopalpebral fascia (lower lid retractor); medial & lateral horns—attach to retinacula (media= posterior lacrimal crest; lateral= Whitnall’s tubercle)
Whitnall’s ligament
superior transverse ligament; sheath of ant levator muscle; 10mm superior to tubercle attaching to frontal bone & lacrimal gland capsule
laterally—arises from compact sheath of ant levator & attaches to capsule of lacrimal gland & lateral orbital wall above lat orb tubercle;
medially—arrises from trochlea; +extensions to retinacula; limits eyelid elevation
orbital septum
fibrous sheet arises from arcus marginalis (jxn of orbital periosteum & pericranium; fuses on ant surface of levator (upper) & retractor (lower) aponeurosis w/ pre-aponeurotic fat separating
Lacrimal Sac fossa
bound by lacrimal (post lacrimal crest) & maxillary bones (ant lacrimal crest); in DCR, ostomy is made in maxillolacrimal suture line; lined by pseudostratified columnar epi; ant to septum (not w/in orbit); orbicularis contracts (CN 7)-->preseptal portion puts traction on lacrimal diaphragm (fascia lateral to sac)-->lacrimal pump process
lacrimal Ducts
3-5mm into inferior meatus before opening at valve of hasner (mucosal fold)
lacrimal gland
in frontal bone in ant lat orbit; orb & palpebral lobes are separated by lateral horn of levator; orbital lobe empties into palpebral lobe which empties into conj fornix; blood supply from lacrimal artery (branch of ophthalmic artery)
Accessory lacrimal Krause & Wolfing (lid)
eccrine
aqueous
Accessory lacrimal glands in plica & caruncle
eccrine
aqueous (Sebaceous)
meibomiam gland
holocrine
oil
glands of zeiss
follicles of cilia & caruncle
holocrine
oil
glands of moll
apocrine
mucus
Goblet cell:
in conj, plica, caruncle
holocrine
mucus
typical sweat gland
eccrine
lacrimal gland
eccrine
aqueous
vascular supply to cardinal muscles
Lacrimal artery—supplies lateral rectus (1 vessel); all others=ophthalmic artery
Annulus of Zinn
origin of all 4 recti; Sup oblique & levator are superior to annulus; inf oblique originates medially on the maxilla
Innervation of muscles
superior (oblique & recus) are innervated by contralateral nuclei
all others have ipsilateral innervation
Smallest muscle belly
Superior oblique
Longest tendon
Superior oblique
shortest tendon
inferior oblique
Superior oblique
Anatomic origin at orbital apeax. Mechanical origin at trochlea. Max effect when adducted 51 deg
Inferior oblique
Anatomic & mechanical origin both from anteromedial orbital floor
Superior rectus
Recession=widening of palpebral fissure; resection=narrowing of fissure as SR is loosely attached to levator complex
Inferior rectus
Recession=widening of palpebral fissure; resection=narrowing of fissure as IR’s sheatrh gives rise to capsulopapebral fascia
Twitch movement
Glycolysis; en plaque innervations
Tonic movement
Aerobic metabolism; en grappe innervation
neuromuscular innervation
Muscle is innervated at posterior 1/3, anterior 2/3 junction
V1 (ophthalmic)
"NFL" (nasociliary, frontal, lacrimal);
Frontal-->supraorbital & supratrochlear N
V2 (maxillary)
goes through foramen rotundum: infraorbital, zygomatic, sup alveolar N, pterygopalatine ganglion
Zygomatic-->zygomaticofacial & zygomaticotemporal
Sup Orb Fissure
CN 3,4,V1 & 6
Inf Orb fissure
CN V2
Optic nerve
intracranial portion has little slack; (“125-1017”=1 intraocular, 25=intraorbital, 10=intracanalicular, 17=intracranial); enters skull inf to frontal lobe & ACA & medial to ICA & is then no longer sheathed
Optic chiasm
inf fibers cross first; post portion=macular fibers; ~1cm above pituitary
Lat geniculate body
ipsilateral=2,3,5; contralateral=1,4,6
Optic radiations
inf radiations pass close to internal capsule—infarct-->sup hemianopic contralateral VF defect & contralat hemiparesis
Fused central nucleus
levator palpebrae
Eyelid functions
closure = CN7; Opening=CN3 (levator) & sympathetics (Muellers)
Pupil constriction
parasymp run w/ CN3-->ciliary ganglion-->short ciliary N
Pupil sympathetic pathway
3 neuron chain:
1)hypothalamus-->along brainstem-->
2) Intermediolateral column of spinal cord (ciliospinal center of budge (C8-T2))-->exits brainstem @ T1 & joins cervical sympathetic chain-->
3)superior cervical ganglion -->travels along carotid plexus -->branches join ophthalmic division of V1-->through ciliary ganglion to nasociliary & short ciliary nerve
Vertical gaze
1) frontal lobe (Frontal eye fields or superior colliculus)-->
2) rostral interstitial nucleus of MLF -->deccusates-->CN III & IV nuclei; pursuit control is aided by interstitial nucleus of Cajal
Horiz. Gaze
PPRF
Lacrimation
parasympathetics (from sup salivatory glands) leave brain w/ nervous intermedius (glossopalatine N) & travel w/ CN7 through Gr petrosal canal & geniculate ganglion (after emerging from canal, now called Gr superficial petrosal N)-->joined by deep petrosal N sympatheticenter pterygoid canal (vidian canal)-->extis canal (now called vidian N) to SYNAPSE in pterygopalatine/sphenopalatine ganglion to join CN V2-->lacrimal gland
eyelid Layers
skin, orbicularis, tarsus, muellers, conj
Gray line
marginal edge of pretarsal orbicularis (muscle of Riolan)
eyelid vascular supply
Internal carotid-->ophthalmic (orbital) artery; External carotid-->facial artery-->transverse facial artery-->angular & malar branches
Medial canthal tendon
anterior—attaches to frontal process of maxilla-->origin of superficial head of pretarsal orbicularis;
posterior—inserts on posterior lacrimal crest & fossa
Orbicularis
fxn=lid closure, brow depression, tear drainage; CN7
orbicularis:
orbital
anterior limb to medial canthal tendon & periosteum== forced lid closure; superiorly-->continuous w/ corrugators
orbicularis
Preseptal
wraps around lacrimal sac & post lacrimal crest; laterally forms lateral palpebral raphe overlying lateral orbital rim
orbicularis
Pretarsal
post lacrimal crest & ant limb of medial & lat canthal; medially heads: 1)superficial --> medial canthal tendon 2)deep --> horners tensor tarsi -->inserts @ post lacrimal crest encircling canaliculi to facilitate tear drainage; laterally: lateral palpebral tendon attaches to lateral retinaculum --> atttaches to lateral orbital tubercle of Whitnall
Corrugators
pulls brow to nose -->glabellar skin creases (thytids); frontal bone periosteum-->sub-Q tissue; inferior-->fibers are continuous w/ orbital orbicularis
Procerus
depresses brow; interdigitates w/ inf frontalis--> horizontal lines at nasion & dorsum of nose
Lymph drainage of eyelids
medial upper lid-->submandibular LN;
lateral upper lid-->preauricular LN;
Venous drainage of eyelids
pretarsal medial upper lid-->angular V; pretarsal lateral upper lid-->superficial temporal V
vascular supply to prelaminar region of ON
Capillaries from Short post ciliary artery
vascular supply to Lamina Cribrosa region of ON
Plexus from Short post ciliary artery
vascular supply to retrolaminar region of ON
Ciliary (recurrant pial vessels) + retinal circulation
Cilioretinal artery
present in 15-25%
Central retinal artery
surface NFL of ON; provides centripetal branches from pial region; supplies NFL, GCL, IPL, inner 1/3 of INL