Fluids in the anterior part of the optic nerve in health and disease

New techniques have recently made it possible to study the flow of fluids (blood, axoplasm, and interstitial fluid) in the anterior part of the optic nerve. Blood flow has been reviewed previously; axoplasm and interstitial fluid are considered in this review. General concepts of axoplasmic transport (anterograde and retrograde) are outlined, and the role of axoplasmic transport in the pathogeneses of optic disc edema of various types, in glaucoma, and in ischemic and toxic optic neuropathies is discussed. The probable sources of interstitial fluid in the anterior part of the optic nerve are capillaries in the nerve itself, peripapillary choroid, vitreous, cerebrospinal fluid and possibly axoplasm in the local axons; the flow is defined by various barrier systems. The role of the interstitial fluid in the pathogeneses of optic disc edema (and associated phenomena) and in serous retinal detachment in the macular region associated with optic disc pit is discussed. Its involvement in the process of diffusion of retrobulbar medication into the optic nerve and vitreous is also considered.