Anda di halaman 1dari 2

Optic Nerve

The optic nerve begins anatomically at the optic disc but physiologically
and functionally within the ganglion cell layer that covers the entire retina.
The first portion of the optic nerve, representing the confluence of
approximately 1.0–1.2 million ganglion cell axons, traverses the sclera
through the lamina cribrosa, which contains approximately 200–300
channels. The combination of small channels and a unique blood supply
(largely from branches of the posterior ciliary arteries) probably plays a
role in several optic neuropathies. Axonal transport—both anterograde and
retrograde—of molecules, subcellular organelles, and metabolic products
occurs along the length of the optic nerve and is an energy-dependent system
requiring high concentrations of oxygen. The anterograde axonal transport
system can be subdivided into slow, intermediate, and fast speeds. The
axonal transport system is sensitive to ischemic, inflammatory, metabolic,
toxic, and compressive processes.
Just posterior to the sclera, the optic nerve acquires a dural sheath that
is contiguous with the periorbita of the optic canal and an arachnoid
membrane that supports and protects the axons and is contiguous with the
arachnoid of the subdural intracranial space through the optic canal. This
arrangement permits free circulation of CSF around the optic nerve up to the
optic disc.
Just posterior to the lamina cribrosa, the optic nerve also
acquires a myelin coating, which increases its diameter to approximately 3
mm (6 mm in diameter, including the optic nerve sheath) from the 1.5 mm of
the optic disc. The myelin investment is part of the membrane of
oligodendrocytes that join the nerve posterior to the sclera.
The intraorbital optic nerve extends approximately 30 mm to the optic
canal. The extra length of the intraorbital optic nerve allows unimpeded
globe rotation as well as axial shifts within the orbit. The CRA and CRV
travel within the anterior 10–12 mm of the optic nerve. The CRA supplies
only a minor portion of the optic nerve circulation; most of the blood supply
comes from pial branches of the surrounding meninges, which are in turn
supplied by small branches of the OphA (see ​Fig 1-10​). An approximate
topographic representation is maintained in the optic nerve. Peripheral
retinal receptors are found more peripherally, and the papillomacular
bundle travels temporally and increasingly centrally within the nerve.
As the optic nerve enters the optic canal, the dural sheath fuses with the
periorbita. It is also surrounded by the ​annulus of Zinn, ​which serves as the
origin of the 4 rectus muscles and the superior oblique muscle. Within the
canal, the optic nerve is accompanied by the OphA inferiorly and separated from the superior
orbital fissure by the optic strut (the lateral aspect of the
lesser wing of the sphenoid), which terminates superiorly as the anterior
clinoid. Medially, the optic nerve is separated from the sphenoid sinus by
bone that may be thin or dehiscent. The optic canal normally measures
approximately 8–10 mm long and 5–7 mm wide but may be elongated and
narrowed by processes that cause bone thickening (eg, fibrous dysplasia,
intraosseous meningioma). The canal runs superiorly and medially. Within
the canal, the optic nerve is relatively anchored and can easily be injured by
shearing forces transmitted from blunt facial trauma (see Chapter 4).
At its intracranial passage, the optic nerve passes under a fold of dura
(the falciform ligament) that may impinge on the nerve, especially if it is
elevated by lesions arising from the bone of the sphenoid (tuberculum) or
the sella. Once it becomes intracranial, the optic nerve no longer has a
sheath. The anterior loop of the carotid artery usually lies just below and
temporal to the nerve, and the proximal anterior cerebral artery passes over
the nerve. The gyrus rectus, the most inferior portion of the frontal lobe, lies
above and parallel to the optic nerves. The 8–12 mm intracranial portion of
the optic nerve terminates in the optic chiasm.