Anatomy of the Eye- A study guide for residents.

Basic Science Study List for first year ophthalmology residents.

This list serves to guide you in the reading of ocular anatomy. This is a work in progress. The format is designed to take advantage of the proven study technique known as SQ5R. You can attempt to recite the answers and then click on the link to read to find the right answer. Use it as a self test and for board preparation. Some answers are linked to information that has been published. This list is under continuous revision and should improve in time.

Resources to Consider:
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Ophthalmology Question Database for Board Review

Table of Contents- ANATOMY OF THE EYE, ORBIT AND ADNEXAE

ORBIT

1. Name the precise dimensions and volume of the orbit.
2. Name the bones that form the orbit and their relations.
3. Which are the thinnest 2 bones of the orbit (the most susceptible to blow out fracture)
4. Describe relationships of paranasal sinuses to each other, and the orbital bones and eyes.
5. Name the foramina, ducts, fissures, canals and their contents in all orbital bones
6. The microanatomy of the optic canal. The position of the optic nerve relative to other important structures after passing through the optic canal.
7. Identify the structures on a CT scan, e.g. zygoma, frontal bone, superior ophthalmic vein, superior and inferior orbital fissures, optic canal, lacrimal gland, extraocular muscles, maxillary, ethmoid, sphenoid sinuses, optic nerve, and lens.
8. CT scan: identify maxillary sinus, zygoma bone, temporalis fossa, ethmoid sinus, superior and inferior orbital fissues, optic canal, superior ophthalmic vein, superior oblique muscle, lacrimal gland, frontal sinus, anterior and posterior clinoids, cavernous sinus, sella turcica.
9. What is the ciliary ganglion and what is its precise location? What are the 3 major neural inputs to the ciliary ganglion? What is the relationship of the superior and inferior division of the 3rd nerve to the ciliary ganglion and what is the course of the nerves to the muscles they supply?

CRANIAL NERVE PATHWAYS

1. The complete pathway of cranial nerves II,III,IV,V,VI,VII from its nucleus to final distribution.
2. Anatomic relationships and accompanying important structures at each point along the pathway for cranial nerves. Cranial Nerve #: III, IV, V, VI
3. Organization of fibers at the optic chiasm. What is Wilbrant's knee?
4. Representation of the visual field on the visual cortex and eye sensation on the sensory cortex.
5. The subnuclei of CN III.
6. Know the divisions of the oculomotor nerve and the location of parasympathetic fibers around the nerve.
7. Describe in detail the relationship between CN III and the Circle of Willis
8. Be able to diagram the pathways for pupillary reflexes, both input and output in detail and the adjacent structures, which may be affected by pathology .
9. Detailed anatomic pathway for the IV nerve.
10. Be able to trace the sensory pathway from the iris/cornea back to the brainstem.
11. What is the anatomic basis of Hutchinson sign?
12. Location and contents of the Cavernous Sinus and the relationship to the ophthalmic veins.

EXTRAOCULAR MUSCLES

1. Extraocular muscles and tendons, origin, insertion, blood supply and size, length and width for each.
2. Spiral of Tillaux precise distances.
3. Pulleys composition and relationship to extraocular movement.

EYELIDS

1. Eyelid anatomy, layers in various areas, microscopic anatomy.
2. Details of levator aponeurosis, origin insertion and path, position location and particularly insertion of canthal tendons, composition types and histology of the various glands, attachments and location of the orbital septum, orbicularis, levator, Mueller’s muscle, and tarsus, vascular supply and drainage, lymphatic drainage.
3. Which of the muscles of the eyelid are composed of smooth muscle and which striated muscle?
4. What are the origins and insertions of the eyelid muscles?

LACRIMAL GLANDS AND TEARS

1. Lacrimal gland: Describe the relationships to the orbital bones, levator, etc., and
2. Lacrimal gland histology
3. Lacrimal excretory system, anatomy, histology, important surgical landmarks.
4. The dimensions of the human eye, average, AP, at birth, 3 years, and adulthood.
5. Layers of tear film, source and function
6. What are the major proteins in the tear film?

THE EYE

1. Describe the conjunctival anatomy, histology at different sites, e.g. bulbar, marginal fornices, caruncle, and plica semilunaris.
2. Landmarks of the limbus
3. What are Tenons capsule, sclera, and episclera?
4. Scleral thickness at equator, macula, etc. where is it the thinnest and thickest
5. Dimensions of the cornea horizontal and vertical.
6. Which layers of the cornea are not restored after injury?
7. Determinants of corneal transparency.
8. Describe the anatomy as related to the gonioscopic appearance of the anterior chamber angle.
9. The attachment sites of the uveal tract.
10. Histology of the eye in an overall way. Identification from a glass slide.
11. Layers of the iris, be complete.
12. Innervation of the iris dilator and sphincter muscles, know their pathways
13. Parts of the ciliary body and location
14. Ciliary muscle: innervation, function
15. Dimensions of the lens and how these change throughout life
16. Regional differences in the lens epithelium
17. Regional differences in the RPE and retina
18. Neuronal elements and their connections in the retina
19. Characteristics of retinal blood vessels
20. Differences between the central retinal artery and retinal arterioles.

    Know the location and dimensions of the macula, fovea, foveola, and FAZ
21. Differences between the nasal and temporal ora serrata and relationship to vitreous base and distances from the limbus.
22. What is the blood supply and drainage for the choroid?
23. Attachments of the vitreous.
24. Regional differences dimensions and blood supply of the optic nerve
25. Blood supply to the optic nerve.
26. What are the precise horizontal and vertical dimensions of the optic nerve head?