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The optic nerve (CN II) is a purely sensory nerve, which carries visual information from the retina to the visual cortex.

Table: Optic Nerve

Cranial Nerve II: Optic Nerve
Anatomy Cranial Optic Nerve (CN II)
Nerve
FRCEM Success

Key Formed from convergence of axons of neurons in ganglion layer of retina, surrounded by cranial meninges, enters skull
anatomy via optic canal of sphenoid bone, receives blood supply from combination of anterior cerebral, ophthalmic and central
retinal arteries

Function Sensory: vision, a erent pathway of pupillary light re ex

Assessment Visual acuity (Snellen chart), colour vision (Ishihara plates), pupillary light response, optic disc (fundoscopy), visual elds
(tests visual pathway)

Clinical Ipsilateral monocular visual loss, loss of colour vision, abnormal pupillary light re ex, visual eld defects if damage to
e ects of visual pathway
injury
KEYWORDS
Cranial Nerves Optic Nerve
Causes of Optic neuritis in multiple sclerosis, optic nerve compression in orbital cellulitis or glaucoma, optic nerve toxicity, trauma
injury (e.g. orbital fracture, penetrating injury to eye), ischaemia secondary to vascular disease

RELATED TOPICS
Anatomy Head and Neck Anatomical Course
Cranial Nerve Lesions Orbit and Eye
The optic nerve is not a true cranial nerve but rather an extension of the brain carrying a erent bres from the retina of the eyeball to the visual
centres of the brain. It is one of two cranial nerves that do not arise from the brainstem, the other being the olfactory nerve.
Something wrong?
The optic nerve is surrounded by the cranial meninges, including the subarachnoid space, which extend as far forwards as the eyeball. Any
increase in intracranial pressure will therefore result in increased pressure in the subarachnoid space surrounding the optic nerve. This impedes
venous return along the retinal veins, causing oedema of the optic disc (papilloedema).

The optic nerve leaves the orbit through the sphenoidal optic canal.

The optic nerve receives its blood supply from the anterior cerebral, ophthalmic and central retinal arteries.

OPTIC N ERV E. (IMAGE BY OPEN STAX [CC BY 4.0 (HTTP://CREATIVECO MMO NS.O RG/L ICE NSE S/BY/4.0)] , V IA W IKIME DIA C OMMON S)

Assessment

To assess the optic nerve:

The patient should be asked if they have noticed any changes in their vision
Visual acuity should be assessed with a Snellen chart
Visual elds should be assessed, testing each visual quadrant in turn
Colour vision should be assessed with Ishihara plates
Pupillary response should be tested using a swinging light to assess direct and consensual re exes (this tests both the a erent optic
nerve and the e erent oculomotor nerve)
The optic disc should be assessed using fundoscopy

Likely Causes of Disease or Injury

Causes of damage to the optic nerve include:

Optic neuritis in multiple sclerosis or secondary to measles or mumps

Optic nerve compression secondary to orbital cellulitis, glaucoma or ocular tumours
Optic nerve toxicity secondary to ethambutol, methanol and ethylene glycol
Optic nerve trauma secondary to orbital fracture or penetrating injury to the eye
Optic nerve ischaemia secondary to arterial disease

Common Clinical E ects

Lesions of the optic nerve result in:

Visual loss in the ipsilateral eye

Loss of colour vision in the ipsilateral eye
Abnormal pupillary light re ex

Loss of pupillary light re ex seen in complete transection of the optic nerve:

Ipsilateral direct re ex lost
Contralateral consensual re ex lost
Contralateral direct re ex intact
Ipsilateral consensual re ex intact
Relative a erent pupillary defect (RAPD) seen in other optic nerve disease:

Paradoxical direct and consensual dilatation when light is shone in the a ected eye directly after being shone in the
una ected eye (the a ected eye still senses light and constricts, but to a lesser extent than when light is shone in the
una ected eye, therefore the pupils appear to dilate)