Looping Nerves!


⁣𝘈𝘹𝘦𝘯𝘧𝘦𝘭𝘥 𝘕𝘦𝘳𝘷𝘦 𝘓𝘰𝘰𝘱𝘴⁣

● They are ​intrascleral nerve loops of the long posterior ciliary nerves which are ​normal anatomic landmarks⁣




𝘋𝘪𝘴𝘤𝘰𝘷𝘦𝘳𝘺⁣

● First described in Axenfeld in 1902 as a nerve ​which came from behind, bent at an acute angle in​to 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.⁣

𝘈𝘯𝘢𝘵𝘰𝘮𝘺⁣

● 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.⁣

● 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.⁣

𝘚𝘺𝘮𝘱𝘵𝘰𝘮𝘴 𝘢𝘯𝘥 𝘚𝘪𝘨𝘯𝘴⁣

● Asymptomatic, Tenderness may be elicited when the overlying conjunctiva is manipulated⁣

𝘚𝘭𝘪𝘵 𝘭𝘢𝘮𝘱 𝘦𝘹𝘢𝘮𝘪𝘯𝘢𝘵𝘪𝘰𝘯:⁣

● Grey/white nodules under the bulbar conjunctiva⁣

● Marked by focal pigmented areas⁣

● Found at a constant distance from the corneoscleral junction, usually within 3-4 mm of the limbus.⁣

● A relatively large artery was almost al​ways present in the emissarium with the nerve⁣

loop. This is due to the fact that the emissarium utilized by the intrascleral nerve loop is usually that of the per​forating branch of an anterior ciliary artery.⁣

𝘏𝘗𝘌: Consistent with findings of peripheral nerve ⁣

𝘋𝘋:⁣

● Nevi⁣

● Malignant Melanoma⁣

● Cysts⁣

● Scleral Foreign Bodies⁣

𝘛𝘳𝘦𝘢𝘵𝘮𝘦𝘯𝘵:⁣

● No treatment required⁣

● It is important not to confuse these axenfeld nerve loops with serious conditions such as⁣

a neoplasm. ⁣

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