INTO THE DEEP EYE: CLINICORADIOLOGIC CORRELATION OF THE OPTIC NERVE AND ITS MENINGEAL SHEATH IN INFLAMMATORY, DEMYELINATING, AND COMPRESSIVE NEUROPATHIES

Abstract

DOI: https://doi.org/10.46296/gt.v8i16.0315

Abstract

The optic nerve is an extension of the central nervous system and can be affected by various pathologies that compromise vision. In inflammatory, demyelinating, and compressive optic neuropathies, magnetic resonance imaging (MRI) is the imaging modality of choice to evaluate the optic nerve and its meningeal sheath. However, radiological findings are often non-specific and require clinical correlation to establish an accurate differential diagnosis. This critical review article examines the microanatomy of the optic nerve and its relationship with the meninges, describes optimal imaging techniques for its evaluation, and summarizes the main patterns of radiologic involvement according to the underlying etiology: inflammatory (including idiopathic optic neuritis and optic perineuritis), demyelinating (multiple sclerosis, neuromyelitis optica spectrum, and MOG antibody-associated disease), and compressive (optic nerve tumors, orbital lesions, and optic neuropathy due to intracranial hypertension, among others). The strengths and limitations of MRI versus computed tomography (CT) in the assessment of the optic nerve are compared, highlighting the superiority of MRI in detecting intrinsic lesions and the utility of CT in identifying calcifications or bony involvement. Additionally, the image-function correlation is explored through studies linking imaging findings (such as lesion enhancement length or sheath diameter) with clinical parameters like visual acuity and functional recovery. Based on recent literature, a standardized MRI protocol for orbital imaging in optic neuropathy is proposed, emphasizing fat-suppressed sequences and intravenous contrast. Finally, the clinical implications of an integrated radiologic approach are discussed, underscoring the importance of distinguishing between these etiologies given that visual prognosis and management strategies differ significantly.

Keywords: optic nerve; optic neuritis; magnetic resonance imaging; demyelinating optic neuropathy; compressive optic neuropathy; neuroradiology.