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Flashcards Fundamentals
Flashcards Fundamentals
What are axenfeld loops?;"● Ciliary nerves visible in the sclera near the limbus"
Fast-twitch fibers have what type of neuromuscular junctions and are important in
what type of eye movements?;"● En plaque neuromuscular junctions
● Important saccadic movements"
What are the characteristics of the corneal epithelium and the stroma regarding
lipids and water?;"● Epithelium is lipophilic
● Stroma is hydrophilic"
What are the types of crystallins of the lens?;"● Alpha – largest, 1/3 of lens
protein
● Beta – predominant, 55% of water-soluble lens protein
● Gamma - smallest"
What are the actions of pilocarpine (muscarinic agonist)?;"● Miosis
● Accommodation – the lens becomes more spherical
shaped, adds refractive power to overall refractive
state via circular muscle constriction
● Increased aqueous outflow - contraction of
longitudinal muscle causes tension on scleral spur
which opens trabecular meshwork"
What is the most common site of scleral rupture?;"● Superonasal quadrant near the
limbus
● Circumferential arc parallel to corneal limbus in the
quadrant opposite of side of impact
● Insertion of rectus muscles
● Equator of globe"
What is the number of axons in a normal adult optic nerve?;"● 1.1 million (largest
number at 16 weeks gestation, 3.7 million)"
What are the functions of the Muller cells?;"● Muller cells – their end-footplates
form the internal
limiting membrane and external limiting membrane.
● They provide a buffer to the extracellular space
● They play a role in Vitamin A metabolism of cones"
What are the main neural cells of inner nuclear layer?;"● Bipolar, horizontal, and
amacrine cells"
What are the 3 waves of neural crest cells that are responsible for the development
of the anterior chamber?;"● First wave: corneal endothelium, initially 2-3 cell
layer
● Second wave: iris and pupillary membrane
● Third wave: corneal stroma, sclera"
What structures are derived from the neuroectoderm?;"● Retinal Pigment Epithelium
● Neurosensory Retina
● Optic nerve, axons, glia"
What structures derived from cranial neural crest cells?;"• Corneal stroma
• Corneal endothelium
• Iris pigment epithelium
• Sclera(also mesoderm)
• Trabecular meshwork
• Bones/cartilage
• Ciliary ganglion
• Choroidal stroma
• Extraocular muscle sheaths/tendons
• Fat (also mesoderm)
• Melanocytes (uveal and epithelial)
• Meningeal sheaths of optic nerve
• Vasculature and connective tissue"
What structures are derived from the mesoderm?;"● Extraocular muscle fibers
● Fat (also from neural crest)
● Iris stroma
● Iris sphincter
● Iris dilator
● Sclera (temporal portion)
● Vitreous (also surface ectoderm)
● Vascular endothelium"
What kind of glands are Krause, Wolfring, and Lacrimal glands?;"● Exocrine glands
● Gland secretes products into a duct"
What kind of glands are meibomian glands and goblet cells?;"● Holocrine glands
● Secretion by disruption of plasma membrane and
destruction of cell"
The Tenon capsule fuses anteriorly with what structure and how far from the
limbus?;"● Intermuscular Septum
● 3 mm posterior to corneal limbus"
After how many months of steroid use will steroid-induced IOP be permanent?;"● 18
months or more"
What are the branches of the ophthalmic artery after it has entered the muscle
cone?;"● Central Retinal Artery
● 2 long posterior ciliary arteries"
What muscles are innervated by the superior branch of cranial nerve 3?;"● Superior
rectus and levator"
What structures are innervated by the inferior branch of cranial nerve 3?;"● Medial
rectus
● Inferior rectus
● Inferior oblique
● Pupil"
What are merocrine/eccrine glands and where are they located?;"● Exocrine glands
where cells secrete their substances by
exocytosis (freely released)
● Eyelid (sweat glands)"
What are apocrine glands and what are some ocular examples?;"• Exocrine glands
where cells “bud” or “pinch off” plasma
membrane-bound vesicles
• Examples: glands of Moll"
What are holocrine glands and what are some ocular examples?;"● Entire cell
disintegrates to release its substance
● Examples: meibomian glands, goblets"
Cells of the basal layer of the corneal epithelium are attached to each other by
what structures?;"● Desmosomes"
The basal layer of corneal epithelium is attached to the basal lamina by what
structures?;"● Hemidesmosomes"
What are the characteristics of photoreceptors?;"● Outer segments of rods and cones
contact apical
processes of RPE, no intercellular connections between
outer segments and RPE
● Rod photoreceptor outer segments have multiple discs
● Microtubules of rod outer segment cilium have “9 plus 0” configuration
● Rod discs are discrete structures
● Cone discs are attached to cell membrane (important difference)"
What structure divides superior orbital fissure into two?;"● Annulus of Zinn"
Where do the lower retinal fibers travel in the optic tract?;"● Laterally (Low =
Lateral)"
Where do macular retinal fibers travel in the optic tract?;"● Dorsolateral position
as they approach the lateral geniculate body"
How thick, what type of collagen, and where does the Descemet membrane come
from?;"● Type 4 collagen
● Thickness 10 microns
● Secreted by endothelium"
Describe the sizes of the perifovea, parafovea, fovea, and foveola.;"● Perifovea =
most peripheral portion of macula, 1.5 mm wide
● Parafovea = directly surrounding fovea, ganglion cell
layer is thickest, 0.5 mm wide
● Foveola = 350 microns, all cones, 4 mm temporal and
0.8 mm inferior
● Fovea 1.5 mm in diameter"
What is the blood supply to different portions of optic nerve?;"● Nerve fiber layer
– CRA
● Prelaminar short posterior ciliary arteries (SPCA),
recurrent choroidal arteries
● Laminar – SPCA, branch of circle of Zinn-Haller
● Retrolaminar – pial vessels and SPCA
● Anterior intraorbital – branches of CRA pial vessels,
branches of ophthalmic artery
● Posterior intraorbital – pial vessels, branches of
ophthalmic artery
● Intracanalicular – Ophthalmic artery
● Intracranial – ophthalmic artery, ICA"
What are the average internal volumes of the adult eye?;"● 6.5 mL to 7 mL total
● Largest compartment = vitreous (5-6 mL)
● Anterior Chamber = 200 microliters
● Posterior Chamber = 60 microliters"
Describe Leber Hereditary Optic Neuropathy.;"● Single nucleotide base change “G” to
“A” nucleotide
position 117788 in ND-4 gene
● Abnormality of NADH dehydrogenase of mitochondria
● Males 10-30 years
● Acute, severe (<20/200) painless, monocular vision
loss, central scotoma
● Elevation of disc, peripapillary telangiectasia, retinal
arteriolar tortuosity
● Fellow eye becomes involved weeks to months later"
What ligament helps turns the course of levator palpebrae superioris from
horizontal to vertical?;"● Whitnall’s ligament (superior transverse ligament)
● Analogous in lower lid = Lockwood’s ligament"
Describe the growth of the anterior and posterior lens capsules.;"● Anterior
capsule thickens with age
● Posterior does not"
What are the flattest 2 quadrants of peripheral cornea?;"● Superior and nasal"
The posterior medial canthal tendon attaches to which bone?;"● Posterior lacrimal
crest of lacrimal bone"
The anterior medial canthal tendon attaches to which bone?;"● Anterior lacrimal
crest of maxillary bone"
Fibers from which cranial nerve III subnuclei cross to innervate contralateral
muscle?;"● Superior rectus"
Fibers from which cranial nerve III subnuclei are fused and supply muscles in both
eyes?;"● Levator subnuclei"
Which cranial nerve has the longest intracranial course?;"● Cranial Nerve 4"
What molecule creates the viscosity of the vitreous?;"● Hyaluronic acid (also
manufactured to maintain the
anterior chamber as a viscoelastic device)"
What are two mechanisms of aqueous humor formation?;"● Active secretion: pressure
independent, Na-K-ATPase,
carbonic anhydrase II
● Passive secretion: diffuse ands ultrafiltration
● Diffusion – related to concentration and charge
● Ultrafiltration – pressure dependent, depends on IOP,
BP, blood osmotic pressure"
What is the inheritance pattern, gene, and key testing characteristics of Best
disease?;"● Autosomal dominant
● Mutation in VMD2 gene/ BEST1 gene, codes
bestrophin, a transmembrane chloride channel on
basolateral membrane of RPE
● Abnormal EOG, normal ERG"
How does epinephrine lower IOP?;"● Improves trabecular outflow and possibly
increasing
uveoscleral outflow.
● No longer available in US as adverse effects are common"
What is unique about the ionic (sodium and potassium) compositions of the lens?;"●
Low sodium
● High potassium
● Due to Na+/K+/ATPase pump that pumps sodium out
and potassium into lens"
When would you want to avoid succinylcholine during surgery?;"● During ruptured
globe repairs
● Causes depolarization of the extraocular muscles and
leads to unwanted contraction. This can cause
extrusion of intraocular contents through an ocular laceration.
● Also in a patient with history of malignant
hyperthermia"
What are the differences between Miochol and Miostat?;"● Miochol = acetylcholine,
acts within seconds, short
duration, rapidly broken down by acetylcholinesterase
in the anterior chamber
● Miostat= carbachol, maximal action in 5 minutes, not
easily broken down by Ach-ase, thus lasts much longer
(24h), more effective in lowering IOP
● Both used for miotic effect, to determine if there is
vitreous prolapse into AC, pupil is often peaked against
the taut strand of vitreous"
What are Blessig-Iwanoff cysts?;"● Very thin and cystic appearing lesions in
peripheral
retina near the ora serrata"
Posterior ethmoid air cells drain into what structure?;"● Superior meatus"
Which layer of the ciliary epithelium maintains the blood aqueous barrier?;"●
Nonpigmented epithelium via tight junctions
● In contrast, pigmented ciliary epithelium is “leaky”"
What are three disorders associated with lens ectopia?;"● Marfan’s (superotemporal)
● Homocystinuria (inferonasal)
● Weill-Marchensani syndrome (small lens, anterior
displacement)"
What wavelength does an excimer laser emit and type of laser is it?;"● Emits light
at 193 nm (UV)
● Argon fluoride laser"
What is the shape of the normal cornea?;"● Prolate (flattens from center to
periphery up to 4.00D)
● Refractive surgery – hyperopic ablation makes the
cornea more prolate
● Myopic ablation makes the cornea more oblate
(central cornea flatter"
Which subnuclei of CN3 is fused and supplies axons to muscles in both eyes?;"●
Levator subnuclei"
What CN3 subnuclei supplies fibers that cross to innervate the contralateral
muscle?;"● Superior rectus subnuclei"
What type of collagen makes up the Bowman layer?;"● Type 1 and 5"
Interconnections between what cells make up the inner plexiform layer?;"● Bipolar
● Amacrine
● Ganglion
● IN a BAG (IN for inner plexiform)"
What separates the greater and lesser wings of sphenoid?;"● Superior orbital
fissure"
When does tear production first occur?;"● 20 or more days after birth"
What is the origin of the cilioretinal artery and what percentage of people have
macular-supplying cilioretinal artery?;"● 20-30% of people
● Cilioretinal artery arises from short posterior ciliary artery
rather than central retinal artery (CRA)
● Not everyone who has cilioretinal artery have collateral
circulation to their macular supplied by the cilioretinal
artery
● Below is picture of CRA occlusion with patent cilioretinal
artery. Picture shows retinal retinal ischemic whitening in
the distribution of CRA but preservation of normal retinal
transparency in the zon4 supplied by cilioretinal artery
<img src='https://aao-resources-enformehosting.s3.amazonaws.com/resources/
Residents/Flashcards/images/content/fundamentals_115.png'>"
What is the most common cause of cilioretinal artery occlusion and why?;"● Most
common occurs in the setting of central retinal
vein occlusion
○ Due to associated increased hydrostatic pressure
→ reduce blood flow in the cilioretinal artery to
the point of stagnation"
What is a potentially fatal side effect associated with systemic mannitol and
urea?;"● Subarachnoid hemorrhage"
What is the blood supply to various regions of optic nerve?;"● Nerve fiber layer:
Central retinal artery (CRA)
● Prelaminar nerve: Short posterior ciliary arteries and
recurrent choroidal arteries
● Lamina: Short posterior ciliary arteries or branches of
arterial circle of Haller and Zinn (circle of Zinn-Haller).
CRA does not supply this region
● Retrolaminar nerve: Mainly by pial vessels and short
posterior ciliary vessels. Some help from CRA and
recurrent choroidal arteries
● Intra-orbital region: Proximally by pial vascular
network and branches of ophthalmic artery. Distally by
branches CRA
● Intracanalicular region: Ophthalmic artery
● Intracranial region: Branches of both internal carotid
artery and ophthalmic artery"
What is the primary route of ATP production in the crystalline lens?;"● Anaerobic
glycolysis in metabolically active cells in
anterior portion. Lens has very low oxygen tension"
What cellular configuration do most cells in crystalline lens have and where do
they attain this shape?;"● Ribbon-like
● Equatorial
● Metabolically active cells of crystalline lens are found
in single layer of cuboidal epithelial cells just posterior
to the anterior lens capsule. Greatest activity of these
epithelial cells occurs in “germinative zone” which is
pre-equatorial zone of lens.
● Newly formed cells migrate from germinative zone to
equator to form ribbon-like configuration"
What are the main components of the vitreous?;"● Vitreous components: 99% water,
type 2 collagen,
hyalocytes, hyaluronic acid.
● Fibrils are continuous with ILM of retina and basal
lamina of nonpigmented epithelium of pars plana"
What contributes to the drastic increase in optic nerve size behind the lamina
cribrosa?;"● Meningeal sheaths, myelination of axons, presence of oligodendroglia
● Optic nerve anterior to lamina cribrosa: 1.5 mm (h) x
1.75 mm (v)
● Optic nerve behind lamina cribrosa: 3mm in diameter"
How many short posterior ciliary arteries enter the globe around the optic
nerve?;"● 20 short posterior ciliary arteries enter the globe in a
ring around the optic nerve
● 10 short posterior ciliary nerves enter the globe in a
similar fashion"
What traits are associated with increased risk of developing primary angle closure
glaucoma?;"● Race: Inuit (highest), African-American (lowest)
● Age: >40 (lens increases in thickness and moves forward)
● Family History: 1st degree relatives
● Refraction: Hyperopia
● Anterior chamber depth: <2.5 mm"
The orbital and palpebral portions of the lacrimal gland are separated by what
structure?;"● Levator aponeurosis"
What is the longest extraocular muscle (muscle and tendon)?;"● Superior Oblique
● Active muscular portion of medial, superior, lateral and
inferior rectus muscles and levator: 40-41 mm
● Active muscular portion:
○ Inferior oblique: 37 mm
○ Superior oblique: 40 mm
● Longest tendon: superior oblique (20mm)
● Shortest tendon length: inferior oblique (no tendon)"
Retrobulbar block provides akinesia by blocking which cranial nerves?;"● CN3 and
CN4, ciliary nerve branches of CNV1
● Does not affect CN 4"
What is the optic vesicle?;"● The space between outer and inner layers of optic cup
● This becomes subretinal space. This potential space is
prone to disease (i.e. serous retinal detachment)"
What disease does NADH dehydrogenase deficiency cause?;"● Leber hereditary optic
neuropathy (nucleotide 11778)"