Optic Nerve

Presented by Guha & Daksha

Anatomy of the Optic Nerve
● Origin: The optic nerve begins at the optic disc, a structure that is 1.5 mm in diameter where
all retinal layers terminate except nerve fiber.
● Course of Optic Nerve:-

- Emerges from eyeball 3 or 4mm nasal to its posterior pole.

-It run backwards and medially, and passes through the optic canal to enter middle cranial
fossa where it joins the optic chiasma.

● The entire nerve is enclosed in three meningeal layers and the subarachnoid space extends
around the nerve up to the eyeball.
 Anatomy of the Optic Nerve
● Optic nerve (about 4 cm long) divided to portions:
1. Intraocular part (1mm) : It begins in the eyeball (globe) with fibers
from the retina
2. Intraorbital part (25mm): runs from the posterior part of the
eyeball to the optic canal and it is surrounded by all three meningeal
layers
3. Intracanalicular part (5mm): Inside the optic canal of the sphenoid
bone
4. Intracranial part (10mm): Travels superior to the diaphragma sellae
and the cavernous sinus, ultimately forming the optic chiasma
 Blood Supply of Optic Nerve
● The intraocular part of optic nerve is subdivided into
4 portions (from anterior to posterior):
1. SNFL (Superficial Nerve Fiber Layer)
2. Prelaminar region
3. Lamina Cribrosa
4. Retrolaminar region
 Blood Supply of Optic Nerve
● Superficial Nerve Fiber Layer
- Capillaries derived from the retinal arterioles which anastomose with vessels
of prelaminar region.
 Blood Supply of Optic Nerve
● Prelaminar region
- Mainly supplied by centripetal branches of the peripapillary choroid.
- Some contribution from the vessels of lamina cribrosa.
 Blood Supply of Optic Nerve
● Lamina Cribrosa
- Branches from the posterior ciliary arteries and arterial circle of Zinn
 Blood Supply of Optic Nerve
● Retro Laminar Region
- Centrifugal branches from central
retinal artery
- Centripetal branches from pial plexus
formed by branches from the choroidal
arteries, circle of Zinn, central retinal
artery and ophthalmic artery.
 Functions of Optic Nerve
● Transmits all visual information including brightness perception, color perception and

visual acuity.

● Conducts the visual impulses that are responsible for two important neurological

reflexes: the light reflex and the accommodation reflex.

● (A).Lesions of the distal optic nerve
○ Marked loss of vision or complete
blindness on the affected side
○ Abolition of the direct light reflex on
the ipsilateral side and consensual on
the contralateral side
● (B)Anterior chiasmal syndrome
○ Produced by lesions that affect the
ipsilateral optic nerve fibres and the
contralateral inferonasal fibres
○ Producing the so-called junctional
scotoma, i.e., a combination of central
scotoma in one eye and temporal
hemianopia defect in the other eye.
● (C.) Middle chiasmal syndrome
○ Lesions involving the decussating fibres in
the body of chiasma
○ Producing bitemporal hemianopia and
bitemporal hemianopic paralysis of
pupillary reflexes
● (E) Posterior chiasmal syndrome - produced by
lesions affecting the caudal fibres in chiasma
lead to smaller, paracentral bitemporal field
loss. Homonymous hemianopia on the
contralateral side

● (E) Lesions of lateral geniculate nucleus

○Homonymous hemianopia
○Pupillary reflexes are normal
● (G) Lesions of optic radiations
○Visual field defects,contralateral inferior
quadrantic hemianopia
○Pupillary reflexes are spared

● (I) Lesions of visual cortex

○Visual field defects in occipital lobe lesions
○Contralateral homonymus hemianopia w
macular sparing
 Clinical Examination
● Introduction, explanation, consent, privacy,
chaperone, sanitation and position

● Visual acuity using Snellen chart

○ Start at roughly 2 meters
○ Covering one eye
○ Start reading from top to bottom
○ Comment on visual acuity
 Clinical Examination
● Colour vision using Ishihara’s chart
○ To be read at reading distance
○ With both eyes open
● Visual field

○ Sit opposite patient around 1 meter away

○ Ask patient to look directly at you
○ Ask if they have difficulty seeing parts of your face
○ Test each eye separately, ask patient to close one eye and look directly at your
opposite eye
○ Hold out your hands and bring an extended finger from the periphery towards center
of visual field. Wiggle your fingertip/white target and ask patient to point to it/ say
when they first see it(Confrontation visual field testing
● Visual field

○ Test all 4 quadrants separately

○ To assess very early visual field loss, repeat using a ret hatpin/ Neurotip. Ask patient
to comment on the colour that they see
○ To test blind spot, place the red tip target equidistance between patient and yourself
at visual fixation point. Move target temporally until it disappears. Then move target
slowly up and down and side to side until it reappears to compare the patient’s blind
spot with yours
● Light reflex
○ Dim the room and assess pupil size, shape and position
○ Ask the patient to cover one eye and shine light from 45* to the eye
○ Observe for light reflex
○ Repeat on other eye
○ For consensual reflex, assess the pupil response in contralateral
pupil and light is directed at the ipsilateral pupil and repeat
● Swinging Light reflex
○ Use a bright light source
○ Swing the light from one eye to another eye
○ Look for the constriction of both pupils

● Accommodation
○ Ask the patient to look at distant target
○ Observe patient’s pupil
○ Ask patient to focus on closer object
○ Observe for constriction
● Fundoscopy
○ Examine optic disc, macula and retinal vessels