White Wings of the Optic Disc!

Myelination of the optic nerve fibers normally begins at the lateral geniculate body and ceases at the lamina cribrosa


An abnormal intraocular myelination of the peripapillary nerve fibre layer anterior to the lamina cribrosa is called myelinated nerve fibre layer (MNFL)


Usually unilateral - can be sporadic/ familial/ acquired






Cause:

Oligodendrocytes are involved- a structural or biochemical defect allows oligodendrocytes to migrate intraocularly and continue myelination past the lamina cribrosa


Appearance:

  • White, well-demarcated, feathery edges

  • Run in arcuate bundles

  • Continuous with the optic disc

  • Obscures the underlying retinal vessels

  • Visually insignificant, usually

  • Visual field defects : enlargement of blind spot, mild arcuate scotomas

Associations - myopia, amblyopia, ansiometropia, strabismus, drusen of optic nerve etc.

Syndromes: Down’s, Gorlin- Gortz, NF Type 1 etc


In optic neuritis caused by multiple sclerosis, a demyelinating condition, MNFL can disappear. They can also disappear in neurological conditions such as pituitary adenoma, inflammatory conditions such as Behcet’s after recurrent papillitis and vitritis, and retinal diseases such as arterial occlusions, diabetic retinopathy, vitrectomy etc.


Image from Rajan Eye Care Hospital #ophthalmology #ophthal #opticdisc #myel

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