Which congenital ocular anomaly is characterized by a focal, pigmented, elevated area where the LPCN loops are visible in the sclera?

• A. Horner's syndrome
• B. Peters anomaly
• C. Axenfeld's Nerve Loop
• D. Nevus of Ota

Answer: (C)

A focal, pigmented, elevated area on the sclera where the long posterior ciliary nerves loop forward and become visible is Axenfeld's nerve loop. This is a benign congenital scleral variant in which a segment of the LPCN forms a small, raised, pigmented bump near the limbus, often more conspicuous because of scleral pigment. It can occur with anterior segment dysgenesis but is frequently seen in eyes without other problems. This differs from Horner’s syndrome, which presents with ptosis and miosis and is not a scleral lesion; Peters anomaly, which features central corneal opacity with iris–cornea adhesions; and Nevus of Ota, which shows diffuse blue‑gray scleral pigment rather than a discrete pigmented nerve loop.