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Optic nerve melanocytoma does not usually produce symptoms or grow. If they slowly grow, optic nerve melanocytoma can produce afferent pupillary defects (30%), subretinal fluid (10%), and an enlarged blind spot (75%). On fundoscopic exam, the optic disc may be swollen, atrophic, or even normal. [1] Central retinal vein occlusion may occur.
The optic nerve can be damaged when exposed to direct or indirect injury. Direct optic nerve injuries are caused by trauma to the head or orbit that crosses normal tissue planes and disrupts the anatomy and function of the optic nerve; e.g., a bullet or forceps that physically injures the optic nerve.
Optic gliomas are usually pilocytic tumors, and can involve the optic nerve or optic chiasm. [3] Optic gliomas are usually associated with neurofibromatosis type 1 in 30% of people with the condition. [3] Optic nerve gliomas have low mortality but extremely high prevalence of vision loss and eye-bulging exophthalmos) in children. [4]
Optic nerve sheath meningiomas (ONSM) are rare benign tumors of the optic nerve. 60–70% of cases occur in middle age females, and is more common in older adults (mean age 44.7 years). It is also seen in children, but this is rare. The tumors grow from cells that surround the optic nerve, and as the tumor grows, it compresses the optic nerve.
The anterior optic nerve receives blood primarily from the posterior ciliary arteries. The anterior optic nerve, a.k.a. the optic nerve head, is surrounded by the scleral canal, and is vulnerable to crowding of nerve fibers. The portion of the optic nerve head that is visible by looking into the eye with an ophthalmoscope is called the optic disc.
Photopsia can present as retinal detachment when examined by an optometrist or ophthalmologist. However, it can also be a sign of uveal melanoma. This condition is extremely rare (affecting 5–7 per 1 million people, typically fair-skinned, blue-eyed northern Europeans). Photopsia should be investigated immediately.
The optic tract is a continuation of the optic nerve that relays information from the optic chiasm to the ipsilateral lateral geniculate nucleus (LGN), pretectal nuclei, and superior colliculus. [14] The optic tract represents the first stage in the visual pathway in which visual information is transferred in a homonymous nature. [ 15 ]
The exact mechanism of optic nerve ischemia in these cases remains unclear, but contributing factors may include hypotension, anemia, hypoxia, and changes in the autoregulation of optic nerve arterial blood flow. The incidence of ischemic optic neuropathy leading to vision loss following general surgeries ranges between 0.1% and 0.002%.
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