Semin Neurol 2009; 29(1): 029-035
DOI: 10.1055/s-0028-1124020
© Thieme Medical Publishers

The Optic Nerve

John B. Selhorst1 , Yanjun Chen1
  • 1Department of Neurology and Psychiatry, Saint Louis University, St. Louis, Missouri
Further Information

Publication History

Publication Date:
12 February 2009 (online)

ABSTRACT

The optic nerve is our most important cranial nerve. As it courses from the eyeball to the brain, it is divided into four segments: intraocular, intraorbital, intracanalicular, and intracranial. Four tests are primarily used to assess its functional integrity and detect optic nerve disorders. These tests are described along with key funduscopic findings. The clinical features of both common as well as notable disorders that occur along the four segments are presented. For example, papilledema and anterior ischemic optic neuropathy involve the intraocular segment, dysthyroid optic neuropathy or optic nerve sheath meningiomas affect the intraorbital segment, traumatic optic neuropathy is mainly within the intracanalicular segment, and pituitary tumors and suprasellar masses compromise the intracranial segment. Ancillary clinical symptoms and signs are highlighted that assist the neurologist in understanding and localizing each disorder along one of these segments. The chief means of confirming the diagnosis, often neuroimaging, are given, and common treatment modalities are provided.

REFERENCES

  • 1 Curcio C A, Allen K A. Topography of ganglion cells in human retina.  J Comp Neurol. 1990;  300 5-23
  • 2 Rizzo J. Embryology, anatomy, and physiology of the afferent visual system. In: Miller NR, Newman NJ Walsh and Hoyt's Clinical Neuro-Ophthalmology. 6th ed. Philadelphia; Lippincott Williams and Wilkins 2005: 25-30
  • 3 Tsu M O, Hayreh S S. Optic disc edema in raised intracranial pressure. IV. Axoplasmic transport in experimental papilledema.  Arch Ophthalmol. 1977;  95 1458-1462
  • 4 Group TIONDTR . Characteristics of patients with nonarteritic anterior ischemic optic neuropathy eligible for the Ischemic Optic Neuropathy Decompression Trial.  Arch Ophthalmol. 1996;  114 1366-1374
  • 5 Beck R W, Servais G E, Hayreh S S. Anterior ischemic optic neuropathy. IX Cup-to-disc ratio and its role in pathogenesis.  Ophthalmology. 1987;  94 1503-1508
  • 6 Hayreh S S, Joos K M, Podhajsky P A, Long C R. Systemic diseases associated with nonarteritic anterior ischemic optic neuropathy.  Am J Ophthalmol. 1994;  118 766-780
  • 7 Repka M X, Savino P J, Schatz N J, Sergott R C. Clinical profile and long-term implications of anterior ischemic optic neuropathy.  Am J Ophthalmol. 1983;  96 478-483
  • 8 Hayreh S S, Podhajsky P A, Raman R, Zimmerman B. Giant cell arteritis: validity and reliability of various diagnostic criteria.  Am J Ophthalmol. 1997;  123 285-296
  • 9 Optic Neuritis Study Group . The clinical profile of optic neuritis: experience of the Optic Neuritis Treatment Trial.  Arch Ophthalmol. 1991;  109 1673-1678
  • 10 Optic Neuritis Study Group . Visual function more than 10 years after optic neuritis: experience with the optic neuritis treatment trial.  Am J Ophthalmol. 2004;  137 77-83
  • 11 Purvin V, Kawasaki A, Jacobson D M. Optic perineuritis. Clinical and radiographic features.  Arch Ophthalmol. 2001;  119 1299-1309
  • 12 Lennon V A, Wingerchuk D M, Kryzer T J et al.. A serum autoantibody marker of neuromyelitis optica: distinction from multiple sclerosis.  Lancet. 2004;  364 2106-2112
  • 13 The Optic Neuritis Study Group . Multiple sclerosis risk after optic neuritis: final optic neuritis treatment trial follow-up.  Arch Neurol. 2008;  65 727-732
  • 14 Frisen L, Hoyt W F, Tengroth B M. Optociliary veins, disc pallor and visual loss. A triad of signs indicating spheno-orbital meningioma.  Acta Ophthalmol (Copenh). 1973;  51 241-249
  • 15 Carrasco J R, Penne R B. Optic nerve sheath meningiomas and advanced treatment options.  Curr Opin Ophthalmol. 2004;  15 406-410
  • 16 Borit A, Richardson E P. The biological and clinical behavior of pilocytic astrocytomas of the optic pathways.  Brain. 1982;  105 161-187
  • 17 Dutton J J. Optic nerve gliomas and meningiomas.  Neurol Clin. 1991;  9 163-177
  • 18 Liu G T, Lessell S. Spontaneous visual improvement in chiasmal gliomas.  Am J Ophthalmol. 1992;  114 193-201
  • 19 Noble M J, McFadzean R. Indirect injury to the optic nerves and optic chiasm.  Neuroophthalmology. 1987;  7 341-348
  • 20 Levin L A, Beck R W, Joseph M P et al.. The treatment of traumatic optic neuropathy: the International Optic Nerve Trauma Study.  Ophthalmology. 1999;  106 1268-1277
  • 21 Cushing H. The chiasmal syndrome of primary optic atrophy and bitemporal visual field defects in adults with a normal sella turcica.  Arch Ophthalmol. 1930;  3 505-555

John B SelhorstM.D. 

Sylvia N. Souers Professor of Neurology, Department of Neurology and Psychiatry, Saint Louis University

1438 S. Grand Blvd., St. Louis, MO 63108

Email: selhorjb@slu.edu