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The meninges of the optic nerve are supplied by sensory nerve fibers, which account
in part for the pain experienced by patients with retrobulbar neuritis or other inflamma-
tory optic nerve diseases.

Intracanalicular Region
The optic nerve and surrounding arachnoid sheath are tethered to the periosteum of the
bony canal in the intracanalicular region. In blunt trauma, particularly over the eyebrow,
the force of injury can be transmitted to the intracanalicular region, causing shearing and
interruption of the blood supply to the nerve in this area. Such nerve damage is called
indirect traumatic optic neuropathy. In addition, optic nerve edema in this area can lead to
a compartment syndrome, further compromising the function of the optic nerve within
the confined space of the optic canal.

Intracranial Region
After passing through the optic canals, the 2 optic nerves lie superior to the ophthalmic
arteries and superior and medial to the internal carotid arteries (ICAs; see Fig 3-3). The
anterior cerebral arteries cross over the optic nerves and are connected by the anterior
communicating artery, which completes the anterior portion of the circle of Willis. The
optic nerves then pass posteriorly over the cavernous sinus to join in the optic chiasm.

Visual Pathway
The visual pathway begins in the retina; impulses from the photoreceptors are transmitted
to the optic chiasm via the optic nerve of each eye. Within the chiasm, the retinal fibers
segregate into the right and left optic tracts. Each optic tract carries information for its
respective field of vision. For example, the right optic tract consists of fibers from the
ipsilateral temporal retina and the contralateral nasal retina. The corresponding hemifields
represent the left half of the visual field for each eye. The optic tracts, whose cell bodies lie
in the ganglion cell layer of the retina, go on to synapse at the lateral geniculate nucleus.
The subsequent fibers further divide as they travel to the primary visual cortex (known
variously as V1, striate cortex, or Brodmann area 17), where they terminate; the most infe-
rior of the fibers (subserving the superior visual field) take one path and the more superior
fibers (subserving the inferior visual field) follow a different one (Fig 3-8). Lesions at dif-
ferent locations along the visual pathway produce characteristic visual field defects that
help localize the site of damage. Structures of the visual pathway are described further in
the following sections and in BCSC Section 5, Neuro-Ophthalmology.

Optic chiasm
The optic chiasm makes up part of the anterior inferior floor of the third ventricle. It is
surrounded by pia and arachnoid mater and is richly vascularized. The chiasm is approxi-
mately 12 mm wide, 8 mm long in the anteroposterior direction, and 4 mm thick.
The extramacular fibers from the inferonasal retina cross anteriorly in the chiasm at the
“Wilbrand knee” before passing into the optic tract. Extramacular superonasal fibers cross
directly to the opposite tract. Extramacular temporal fibers pursue a direct course through
116 ● Fundamentals and Principles of Ophthalmology

Frontal lobe Nasal retina

Temporal retina
Optic nerve
Temporal lobe Optic chiasm
Optic tract
Lateral
geniculate Meyer loop
nucleus
Thalamus
Pineal gland
Parietal lobe
Geniculo-
calcarine
radiation
Occipital lobe
Striate cortex

Figure 3-8 The visual pathways. (Illustration by Dave Peace.)

the chiasm to the optic tract as a bundle of uncrossed fibers. The macular projections are
located centrally in the optic nerve and constitute 80%–90% of the total volume of the optic
nerve and the chiasmal fibers. Nasal macular fibers cross in the posterior part of the chiasm.
Approximately 53% of the optic nerve fibers are crossed, and 47% are uncrossed.

Optic tract
Each optic tract is made up of fibers from the ipsilateral temporal retina and the contralat-
eral nasal retina. Fibers (both crossed and uncrossed) from the upper retinal projections
travel medially in the optic tract; lower projections move laterally. The macular fibers are
dorsolateral within the optic tracts.

Lateral geniculate nucleus

The lateral geniculate nucleus (LGN) is the synaptic zone for the higher visual projections.
It is a mushroom-shaped structure in the posterior thalamus that receives approximately
70% of the optic tract fibers within its 6 alternating layers of gray and white matter (the
other 30% of the fibers go to the pupillary nucleus). Layers 1, 4, and 6 of the LGN contain
axons from the contralateral optic nerve. Layers 2, 3, and 5 arise from the ipsilateral optic
nerve. The 6 layers, numbered consecutively from inferior to superior, give rise to the
optic radiations (Fig 3-9).

Optic radiations
The optic radiations connect the LGN with the visual cortex of the occipital lobe. From
the LGN, inferior fibers (which subserve the superior visual field) travel anteriorly, then
laterally and posteriorly, looping around the temporal horn of the lateral ventricles in
the temporal lobe (Meyer loop). Superior fibers (which subserve the inferior visual field)
travel posteriorly through the parietal lobe (Fig 3-10).
 ChaPter 3: Cranial Nerves: Central and Peripheral Connections ● 117

ar
cul
no
Bi field

field ular
c
Mono Temporal
crescent

Left Right

Optic
nerves

Optic tracts

Optic chiasm Lateral

6 geniculate
5
nucleus
Ventral 4 Dorsal
3
2
1

Optic radiations
Magnocellular Parvocellular
pathway pathway
(M channel) (P channel)
Primary visual cortex
(area 17)
A

Hilum

5
Medial Lateral
horn 4 horn

3
2
1
B
Figure 3-9 Lateral geniculate nucleus (LGN). A, The LGN receives the fibers of the correspond­
ing optic tract. Layers 1, 4, and 6 receive input from the crossed fibers of the optic tract; layers
2, 3, and 5 receive input from the uncrossed fibers. Layers 1 and 2 represent the magnocellular
pathways, which are concerned with detection of movement. The remaining 4 layers represent
the parvocellular pathways, which are responsible for color vision and visual acuity. B, The hilum
represents central (macular) vision and is perfused by the posterior choroidal artery, the medial
horn represents inferior vision, and the lateral horn represents superior vision. These areas are
perfused by the anterior choroidal artery. (Redrawn with permission from Liu GT, Volpe NJ, Galetta SL. Neuro­
Ophthalmology: Diagnosis and Management. 2nd ed. New York: Elsevier; 2010:299–300. Illustration by Mark Miller.)
118 ● Fundamentals and Principles of Ophthalmology

Parietal lobe
Mid-sagittal section

Fibers representing
superior retinal
quadrants
(inferior visual field)

Occipital lobe

Calcarine fissure
Lateral geniculate
nucleus Fibers representing
inferior retinal
quadrants
Temporal lobe (superior visual field)

B Meyer loop

Figure 3-10 Optic radiations. A, Axial view of the brain demonstrating the optic chiasm, optic
tract, and optic radiations, which connect the LGN to the occipital lobe. B, Schematic of the
optic radiations, sagittal view. The lower radiations (subserving the superior visual field) course
anteriorly before looping posteriorly in the temporal lobe. The upper radiations course dorsally
in the parietal lobe to terminate in the occipital lobe above the calcarine fissure. (Part A reproduced
with permission from Sherbondy AJ, Dougherty RF, Napel S, Wandell BA. Identifying the human optic radiation using dif-
fusion imaging and fiber tractography. J Vis. 2008;8(10):12.1–11, Figure 1. Part B redrawn with permission from University
of Texas at Dallas. Illustration by Mark Miller.)
 ChaPter 3: Cranial Nerves: Central and Peripheral Connections ● 119

Superior

Peripheral
Central Temporal
Inferior crescent

Central

Superior
Inferior
A B
Figure 3-11 Primary visual cortex and corresponding visual field representation. A, Left occipital
cortex showing the location of the striate cortex within the calcarine fissure. Blue represents the
macula (central visual field); green represents the inferior visual field; and orange represents the
superior visual field. The most peripheral fibers are represented by the stippled colors. B, Right
visual hemifield, plotted with kinetic perimetry, corresponds to the regions of the striate cortex
in part A. The stippled area corresponds to the monocular temporal crescent, which is mapped in
the most anterior 8%, approximately, of the striate cortex. (Illustrations by Christine Gralapp.)

Primary visual cortex

The primary visual cortex, the thinnest area of the human cerebral cortex, has 6 cellular
layers and occupies the superior and inferior lips of the calcarine fissure (also called calca-
rine sulcus) on the posterior and medial surfaces of the occipital lobes. Macular function is
extremely well represented in the visual cortex and occupies the most posterior position at
the tip of the occipital lobe. The most anterior portion of the calcarine fissure is occupied
by contralateral nasal retinal fibers only (Fig 3-11).
Trobe JD. The Neurology of Vision. New York: Oxford University Press; 2001:1–42.

Blood Supply of the Optic Nerve and Visual Pathway

The blood supply of the optic nerve varies from one segment of the nerve to another. Al-
though the blood supply can vary widely, a multitude of studies have revealed a basic pat-
tern (Fig 3-12). See Table 3-1, which summarizes the blood supply of the optic nerve. The
blood supply of the visual pathway is summarized in Table 3-2 and depicted in Figure 3-13.
The following sections discuss the vascular supply of the intraocular and intraorbital seg-
ments in greater detail.
Intraocular region
The ophthalmic artery lies inferior to the optic nerve. The CRA and, usually, 2 long pos-
terior ciliary arteries branch off from the ophthalmic artery after it enters the muscle cone
at the annulus of Zinn.
The lumen of the CRA is surrounded by nonfenestrated endothelial cells with typical
zonulae occludens that are similar to those in retinal blood vessels. The CRA, however,