Looping Nerves!
๐๐น๐ฆ๐ฏ๐ง๐ฆ๐ญ๐ฅ ๐๐ฆ๐ณ๐ท๐ฆ ๐๐ฐ๐ฐ๐ฑ๐ดโฃโฃ
โ They are โintrascleral nerve loops of the long posterior ciliary nerves which are โnormal anatomic landmarksโฃ
๐๐ช๐ด๐ค๐ฐ๐ท๐ฆ๐ณ๐บโฃ
โ First described in Axenfeld in 1902 as a nerve โwhich came from behind, bent at an acute angle inโto the sclera through which it passed for varying distances, even to its outer surface, and then turned on itself and passed inward to the perichoroidal space and thence to its termination in the ciliary body.โฃ
โฃ
๐๐ฏ๐ข๐ต๐ฐ๐ฎ๐บโฃ
โ The ciliary nerve pierces the sclera near the optic nerve and travels within the sclera and suprachoroidal space until it branches at the level of the ciliary body.โฃ
โ The nerve loop is an anastomosis of the long ciliary nerve that turns to enter the sclera before turning back again to continue to the ciliary body.โฃ
โฃ
๐๐บ๐ฎ๐ฑ๐ต๐ฐ๐ฎ๐ด ๐ข๐ฏ๐ฅ ๐๐ช๐จ๐ฏ๐ดโฃ
โ Asymptomatic, Tenderness may be elicited when the overlying conjunctiva is manipulatedโฃ
โฃ
๐๐ญ๐ช๐ต ๐ญ๐ข๐ฎ๐ฑ ๐ฆ๐น๐ข๐ฎ๐ช๐ฏ๐ข๐ต๐ช๐ฐ๐ฏ:โฃ
โ Grey/white nodules under the bulbar conjunctivaโฃ
โ Marked by focal pigmented areasโฃ
โ Found at a constant distance from the corneoscleral junction, usually within 3-4 mm of the limbus.โฃ
โ A relatively large artery was almost alโways present in the emissarium with the nerveโฃ
loop. This is due to the fact that the emissarium utilized by the intrascleral nerve loop is usually that of the perโforating branch of an anterior ciliary artery.โฃ
โฃ
๐๐๐: Consistent with findings of peripheral nerve โฃ
โฃ
๐๐:โฃ
โ Neviโฃ
โ Malignant Melanomaโฃ
โ Cystsโฃ
โ Scleral Foreign Bodiesโฃ
โฃ
๐๐ณ๐ฆ๐ข๐ต๐ฎ๐ฆ๐ฏ๐ต:โฃ
โ No treatment requiredโฃ
โ It is important not to confuse these axenfeld nerve loops with serious conditions such asโฃ
a neoplasm. โฃ
โฃ
www.ophthalmobytes.comโฃ
Image from Rajan Eye Care Hospital
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