Atlas of Ophthalmology

Suspected Axenfeld Nerve Loops in Inferior and Superior Sclera (Colour Photography Anterior Segment)

Esclera -> Tumores de la Esclera -> Benign
Patient: 10-year-old child, BCVA 1.0 at OD, 1.0 at OS. General Medical History: no events. Ocular Medical History: neither prior eye operations nor traumatic injury occurred in this region. Purpose: to present skleral nodules unknown genesis. Methods: Colour Photography Anterior Segment. Findings: Colour Photography Anterior Segment: mildly tender, brown nodule, adherent to the sclera, measuring 1.5 × 1.5 mm in surface dimension, located approximately 5 mm from the limbus in the superior sclera. Colour Photography Anterior Segment: mildly tender nodule, adherent to the sclera, measuring 2.5 × 2.5 mm in surface dimension, located approximately 4 mm from the limbus in the inferior sclera. Discussion: Axenfeld nerve loop has a topographic distribution similar to anterior episcleral nerve sheath tumors. Chang et al. reported (1), that the nerve loop of Axenfeld is an anastomotic interconnection of the long ciliary nerve that occasionally turns to enter the sclera before turning back again to continue anteriorly to the ciliary body. The loops occur in the area 2 to 4 mm posterior to the limbus. Literature: (1) Chang HS, Glasgow BJ. Evidence that anterior episcleral nerve sheath tumors arise from the Axenfeld nerve loop. Arch Ophthalmol. 2009 Aug;127(8):1060-2.

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