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Review
. 2018 Apr 12;18(5):25.
doi: 10.1007/s11910-018-0831-9.

Intracranial and Intraocular Pressure at the Lamina Cribrosa: Gradient Effects

Gauti Jóhannesson  1   2 , Anders Eklund  3 , Christina Lindén  4
Affiliations
Review

Intracranial and Intraocular Pressure at the Lamina Cribrosa: Gradient Effects

Gauti Jóhannesson et al. Curr Neurol Neurosci Rep. .

Abstract

Purpose of review: A pressure difference between the intraocular and intracranial compartments at the site of the lamina cribrosa has been hypothesized to have a pathophysiological role in several optic nerve head diseases. This paper reviews the current literature on the translamina cribrosa pressure difference (TLCPD), the associated pressure gradient, and its potential pathophysiological role, as well as the methodology to assess TLCPD.

Recent findings: For normal-tension glaucoma (NTG), initial studies indicated low intracranial pressure (ICP) while recent findings indicate that a reduced ICP is not mandatory. Data from studies on the elevated TLCPD as a pathophysiological factor of NTG are equivocal. From the identification of potential postural effects on the cerebrospinal fluid (CSF) communication between the intracranial and retrolaminar space, we hypothesize that the missing link could be a dysfunction of an occlusion mechanism of the optic nerve sheath around the optic nerve. In upright posture, this could cause an elevated TLCPD even with normal ICP and we suggest that this should be investigated as a pathophysiological component in NTG patients.

Keywords: Cerebrospinal fluid; Intracranial pressure; Intraocular pressure; Normal tension; Translamina cribrosa pressure difference; Translaminar pressure difference.

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Conflict of interest statement

Conflict of Interest

Gauti Jóhannesson and Christina Lindén declare no conflict of interest.

Anders Eklund has received grants from the Swedish Research Council and the Swedish National Space Board and has received royalties from Likvor AB.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Figures

Fig. 1
Fig. 1
Translamina cribrosa pressure difference (TLCPD) dependency on possible occlusion of the optic nerve sheath and its potential importance in normal-tension glaucoma (NTG). The illustrations show four compartments with corresponding pressures, i.e., intracranial pressure (ICP) and intraocular pressure (IOP) at the level of the eye [87], pressure in the orbit [89] as well as hypothetical pressure retrolaminarly in the optic nerve subarachnoid space (ONSAS). a In supine position, TLCPD is 12 mmHg. b In upright position and when ICP decreases substantially, an occlusion mechanism of the optic nerve sheath may preserve higher pressure in ONSAS as it becomes equal to the orbital pressure and thus keep TLCPD stabile at 12 mmHg. c If this occlusion mechanism is deficient and an open fluid communication is present, which we hypothesize in NTG, then the retrolaminar pressure would be the same as the ICP, resulting in an elevated and potentially harmful TLCPD in upright position
See this image and copyright information in PMC

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