Partial and complete optic nerve atrophy: what is it, does it happen in both eyes and how to treat it. Partial optic nerve atrophy (chazn) causes, diagnosis and treatment Compression of the optic nerve

Optic nerve atrophy is characterized by the development of the process of complete or partial death of nerve fibers, accompanied by the replacement of healthy connective tissue.

Types of disease

Optic disc atrophy is divided into several types depending on its etiology. These include:

1. Primary form (ascending and descending optic nerve atrophy). This pathological process develops as an independent disease. The descending type is diagnosed much more often than the ascending type. This disease is usually observed in males, since it is linked only to the X chromosome. The first manifestations of the disease occur at approximately 15-25 years of age. In this case, damage directly to the nerve fibers occurs.
2. Secondary atrophy of the optic nerve. In this case, the pathological process develops against the background of other diseases. In addition, the disorder may be caused by a failure in the flow of blood to the nerve. A disease of this nature can occur in any person, regardless of his age and gender.

Based on the nature of the course, the following types of this disease are distinguished:

1. Partial atrophy of the optic nerve (initial). The main difference between this type is the partial preservation of visual ability, which is most important in case of deteriorated vision (due to which wearing glasses or contact lenses cannot improve the quality of vision). Despite the fact that residual visual ability can usually be preserved, disruptions in color perception often occur. Those areas of the field of view that were saved will continue to be accessible.
2. Complete atrophy of the optic nerve. In this case, the symptoms of the disease have some similarities with such eye pathologies as cataracts and amblyopia. In addition, this type of disease can manifest itself in a non-progressive form, which does not have specific symptoms. This fact indicates that the state of the necessary visual functions remains stable. However, most often there is a progressive form of pathology, during which rapid loss of vision occurs, which, as a rule, cannot be restored. This greatly complicates the diagnostic process.

Symptoms

If optic atrophy develops, symptoms manifest themselves mainly in the form of deterioration in the quality of vision in both eyes at the same time or in just one. Restoring visual ability in this case is impossible. Depending on the type of pathology, this symptom may have different manifestations.

As the disease progresses, vision gradually deteriorates. In the most severe cases, complete atrophy of the optic nerve occurs, which provokes a complete loss of the ability to see. This process can last for many weeks, or can develop in a couple of days.

If partial atrophy of the optic nerve is observed, there is a gradual slowdown in progression, after which it completely stops at a certain stage. At the same time, visual activity stops decreasing.

Signs of optic nerve atrophy often appear as: Usually they narrow, which is characterized by loss of lateral vision. This symptom can be almost invisible, but sometimes tunnel vision occurs, that is, when the patient is able to see only those objects that are located directly in the direction of his gaze, as if through a thin tube. Very often, with atrophy, dark, light or colored spots appear before the eyes, and it becomes difficult for a person to distinguish colors.

The appearance of dark or white spots in front of the eyes (both closed and open) indicates that the destruction process is affecting nerve fibers that are located in the central part of the retina or very close to it. Narrowing of the visual fields begins if peripheral nerve tissues have been affected.

With a more extensive spread of the pathological process, a large part of the visual field may disappear. This type of disease can spread to only one eye or affect both.

Causes

The causes of optic nerve atrophy can be different. Both acquired and congenital diseases, which are directly related to the visual organs, act as a provoking factor.

The appearance of atrophy can be triggered by the development of diseases that directly affect the nerve fibers or the retina of the eye. The following pathological processes can be cited as examples:

• mechanical damage (burn or injury) to the retina;
• inflammatory processes;
• congenital optic nerve dystrophy (OND);
• fluid stagnation and swelling;
• toxic effects of certain chemicals;
• impaired access of blood to nerve tissues;
• compression of certain areas of the nerve.

In addition, diseases of the nervous and other body systems play an important role in the development of this pathological process.

Quite often, the onset of this pathological condition is due to the development of diseases that directly affect the human central nervous system. It can be;

• syphilitic brain damage;
• development of abscesses;
• neoplasms of various types in the brain;
• meningitis;
• encephalitis;
• mechanical damage to the skull;
• development of multiple sclerosis.

More rare causes are alcohol poisoning of the body and intoxication with other chemicals.

Sometimes such a pathology develops against the background of hypertension or atherosclerosis, as well as other cardiovascular diseases. In rare cases, the cause may be a lack of vitamins and macronutrients in the human body.

In addition to these reasons, the development of an atrophic disorder can be affected by obstruction of the central or peripheral retinal arteries. This is because these arteries provide nutrients to the organ. As a result of their blockage, metabolism is disturbed, which provokes a deterioration in the general condition. Quite often, obstruction is a consequence of the development of glaucoma.

Diagnostics

During the examination of the patient, the doctor must necessarily identify the presence of concomitant diseases, the fact of the use of certain drugs and contact with caustic substances, the presence of bad habits and symptoms indicating the development of intracranial disorders.

In most cases, the diagnosis of diseases of this nature does not cause great difficulties. In order to determine an accurate diagnosis, it is necessary first of all to check the quality of visual function, namely, to determine the visual acuity and visual fields and to conduct tests for color perception. After this, ophthalmoscopy is performed. This procedure allows you to identify the pallor of the optic disc and the decrease in the lumen of the fundus vessels, which are characteristic of such a disease. Another mandatory procedure is.

Very often, diagnostics involves the use of the following instrumental methods:

• X-ray examination;
• magnetic resonance imaging (MRI);
• computed tomography of the brain;
• electrophysiological diagnostics;
• contrast methods (used to determine the patency of retinal vessels).

It is mandatory to carry out laboratory diagnostic methods, in particular, general and biochemical blood tests.

Treatment options

Treatment for optic nerve atrophy should be carried out immediately after diagnosis. It should be remembered that it is impossible to completely get rid of the disease, but it is quite possible to slow down its progression and even stop it.

During therapy, it is necessary to take into account the fact that this pathological process is not an independent disease, but the result of diseases affecting one or another part of the visual organ. Therefore, in order to cure optic nerve atrophy, it is necessary to first eliminate the provoking factor.

In most cases, complex therapy is used, including the use of drugs and optical surgery. Treatment can be carried out with the following medications:

• vasodilators (Papaverine, Dibazol, Sermion);
• anticoagulants (Heparin);
• drugs that improve metabolism (aloe extract);
• vitamin complexes;
• enzyme preparations (Lidase, Fibrinolysin);
• agents that enhance immunity (Eleutherococcus extract);
• hormonal anti-inflammatory drugs (Dexamethasone);
• drugs that improve the functioning of the central nervous system (Nootropil, Emoxipin).

The listed medications can be used in the form of tablets, solutions, eye drops and injections. In the most severe cases, surgery is required. Many people are interested in whether this disease can be cured only by conservative methods. Sometimes this is possible, but only a specialist can answer the question of how to treat atrophy in a particular case.

Any medicine should be taken only after prescription by the attending physician, observing the prescribed dosage. It is strictly prohibited to choose medications on your own.

Quite often, physiotherapeutic procedures are performed during the treatment of optic nerve atrophy. Acupuncture or laser and magnetic stimulation of the optic nerve are especially effective.

In some cases, treatment with folk remedies may be used. To restore the optic nerve, various infusions and decoctions of medicinal plants are used. However, this method can only be used as an additional therapy in combination with traditional medicine and only after consultation with your doctor.

Surgery is usually prescribed in the presence of neoplasms of various types and hereditary atrophy of the optic nerve. Surgery is required if there are congenital abnormalities of the visual organ, such as Leber optic atrophy.

Currently, the following surgical methods are used for Leber optic nerve atrophy and other congenital disorders:

• extrascleral methods (the most common type of surgery for eye pathologies);
• vasoconstructive therapy;
• decompression methods (used very rarely).

With this pathology, symptoms and treatment are interrelated, since the doctor prescribes therapy depending on the symptoms and type of disease.

In order not to risk your vision, self-medication is strictly prohibited. At the first symptoms of a violation, it is recommended to seek help from a doctor. In this case, you should find a suitable clinic where the disease can be treated most effectively.

Prognosis and prevention

Timely detection of complete or partial atrophy of the optic nerve and its treatment make it possible to prevent the development of destructive disorders in the tissues. Correctly prescribed therapy will help maintain the quality of visual function, and sometimes even improve it. However, it is impossible to achieve complete restoration of vision due to severe damage and death of nerve fibers.

Lack of timely treatment can provoke very serious complications that lead not only to decreased vision, but also to its complete loss. In this case, the prognosis is disappointing, since it will no longer be possible to restore visual ability.

In order to prevent the development of this pathological process, the following rules must be observed:

• engage in the prevention and timely treatment of any infectious and inflammatory diseases of the body;
• prevent mechanical damage to the eye tissue and brain injury;
• periodically undergo examination by a doctor and carry out all necessary diagnostic measures for early detection of diseases;
• stop smoking;
• remove alcoholic beverages from life;
• regularly measure blood pressure;
• adhere to proper nutrition;
• to live an active lifestyle;
• take regular walks in the fresh air.

A disease of this nature is very serious, therefore, at the first symptoms, it is imperative to consult a specialist and in no case self-medicate.

Video

The optic nerve (ocular nerve) is a nerve that connects the eye to the gray matter through the nuclei of the diencephalon. This is not a nerve in the usual sense, which is a chain of neurons connected by axons - long processes, but rather a white medulla located outside the skull.

The structure of the optic nerve is a thick bundle of neurons intertwined with the ophthalmic vein and artery, extending directly into the cerebral cortex through the diencephalon. Considering that a person has 2 eyes, then he also has 2 optic nerves - 1 for each eye, respectively.

Like any nerve, it is prone to specific diseases and disorders, collectively called neuralgia and neuritis. Neuralgia is a disease that is a long-term pain reaction of the nerve to any stimuli without changing the internal structure. And neuritis is the destruction or damage of the nerve fiber under various influences.

Visual neuralgia practically does not occur in humans, since its structure transmits visual signals, analyzing them along the way, which explains its similarity with the medulla, and other fibers are responsible for tactile or pain sensations. Even if a person begins neuralgia directly of the main optic trunk, he most likely simply will not notice it, which cannot be said about the neuralgia of the outgoing lateral branches.

Neuritis is a violation of the structure of the nerve fiber or its damage in some area. In half of the cases, neuralgia passes into neuritis, and in the other, the damage is caused by very real physical causes, which will be discussed a little later. Optic neuritis is most often called optic atrophy.

The classification of optic nerve atrophy includes: primary, secondary, complete, progressive, partial, complete, bilateral and unilateral, subatrophy, ascending and descending, and others.

• Initial, when only a couple of fibers are damaged.
• Progressive atrophy - atrophy that continues to progress despite attempts to stop the disease.
• Completed - a disease that has stopped at some stage.
• Partial atrophy of the optic nerve - partial destruction of the nerve tissue, while maintaining one or another lobe of vision, sometimes referred to as POA.
• Complete – the nerve is completely atrophied and restoration of vision is impossible.
• Unilateral – damage to one eye, and bilateral, respectively – damage to the nerves of both eyes.
• Primary – not associated with other diseases, for example, toxic damage from burnt alcohol.
• Secondary - atrophy, manifested as a complication after an illness, for example, inflammation of the eyeball, membranes of the brain and other tissues.
• Subatrophy of the optic nerve is an uneven damage to neurons, as a result of which the perceived information is distorted.
• Ascending atrophy is a neuronal disorder that begins in the retina and gradually moves upward.
• Descending optic atrophy is a disease that begins in the brain and gradually spreads to the eyes.
• Neuropathy is a dysfunction of the nerve fiber without signs of inflammation.
• Neuritis is inflammation of the optic nerve with pain caused by smaller adnexal optic nerve endings, or the area around the main optic nerve.

In the medical literature there is some confusion in the concepts of neuritis, neuropathy and atrophy of the optic nerves: somewhere it is said that these are one and the same thing, and somewhere that these are three completely different diseases. However, they certainly have a common essence, symptoms and treatment.

If the definition of neuritis is very broad - a violation of the structure of the nerve, which includes many disorders and inflammations for completely different reasons, then atrophy and neuropathy are more likely to be subtypes of neuritis, and not vice versa.

In medical terminology in the ICD (medical classification of diseases, the latest of which is ICD 10), there are many different names for essentially the same process, depending on the degree of severity, characteristics of the course, method of acquisition, etc. this allows doctors to convey information to each other more informatively, and it is quite difficult for the patient to understand all the intricacies of terminology.

Optic nerve atrophy code according to ICD 10 is H47.2, as indicated in the sick leave certificate, medical reference books or in the patient’s card. The international code is used to maintain medical confidentiality from ignorant strangers. The tenth version of the ICD is the most recent.

Optic nerve atrophy symptoms

Symptoms of optic nerve atrophy look like a rapid decline in vision that cannot be corrected or corrected. The process that has begun can very quickly lead to absolute, incorrigible blindness in just a few days to several months, depending on the cause and severity of the disease.

Signs of optic atrophy may appear as changes in vision without loss of visual acuity. That is:

• Vision becomes tunnel-like.
• Changes in visual fields, most often towards their uniform narrowing.
• The presence of permanent, unchanging dark spots before the eyes.
• Asymmetric change in visual fields. For example: the side one remains, but the central one disappears.
• Distortion of color perception or sensitivity to light.

The type of vision change depends on which area is affected, so the appearance of so-called scotomas (dark spots) indicates damage in the central part of the retina, and narrowing of the fields - in the peripheral fibers.

Diagnostics

If a diagnosis of optic nerve atrophy is suspected, diagnosis is carried out primarily by an ophthalmologist, to whom patients come with the first vision problems. The ophthalmologist first conducts a study to separate this disease from peripheral cataracts, as well as amblyopia, which have similar manifestations.

The initial examination carried out to establish a diagnosis is quite simple: examination for acuity with a wide field of vision and ophthalmoscopy.

During ophthalmoscopy (a painless examination of the eye itself through a special apparatus directly in the office at the reception), the optic disc is visible; if it turns pale, it means it is atrophied or damaged. With smooth, normal boundaries of the disc, the disease is primary, and if the boundaries are violated, it is a secondary consequence of another disease.

Checking the reaction of the pupils: with impaired sensitivity, the pupils contract much more slowly when exposed to light.

After confirming the diagnosis, a neurologist joins the treatment and begins to determine the causes of the degenerative process:

• General tests for inflammatory processes, as well as viral infections.
• Tomography.
• Radiography.
• electrophysiological study (EPS) – study of the functioning of all eye systems by recording reactions to special impulses.
• fluorescein angiographic method is a study by introducing a special marker substance into the blood and using it to check the vascular conductivity of the eye.

Causes of the disease

For this diagnosis of optic nerve atrophy, the causes can be so diverse that it is possible to compose an entire scientific treatise on medicine, however, a small circle of the main, most common ones is highlighted.

• Toxic blindness:

Toxic atrophy of the optic nerve, the causes of which lie in the death of neurons under the influence of poisons. In the nineties in Russia, the first place was toxic damage to visual neurons under the influence of burnt alcohol or even liquids not intended for internal use containing methyl alcohol. It is almost impossible for a non-specialist to distinguish methyl alcohol from ethyl alcohol, however, unlike its cheerful brother, this substance is extremely dangerous to life.

Just 40 to 250 ml of methanol can cause death or very severe disability if resuscitation measures are carried out in time. In order for neurons to die, only 5 to 10 milliliters is enough, even in a mixture with other substances. When it is used, not only the optic nerves die, however, this is not as noticeable to the patient as a sudden loss of vision. In addition, toxic blindness often begins after a long period of time - up to six days after consumption, when methanol breaks down in the liver into its components, one of which is formaldehyde - a terrible poison. By the way, smoking products are also toxic to neurons.

• Congenital pathologies.

For congenital or hereditary reasons, optic nerve atrophy in children occurs most often due to neglect of the child’s health during the mother’s pregnancy or a genetic failure.

• Injuries.

Atrophy caused by blows to the head or injuries to the eyeball, as well as brain surgery.

• Inflammation.

The inflammatory process that leads to the death of visual neurons can occur for many reasons, either simply because of a speck that has entered the eye, causing inflammation of the eyeball, or because of previous infectious diseases: meningitis (infectious inflammation of the brain), measles, chickenpox, smallpox, syphilis, encephalitis (viral brain damage), mononucleosis, sinusitis, tonsillitis and even caries.

• General pathologies of the patient’s entire nervous system.
• Damage to the eye that provoked nerve atrophy as unnecessary, for example, retinal dystrophy. These two diseases intensify and accelerate each other.
• Circulatory disorders.

The disease can cause both obstruction of the supply vessels and their atherosclerosis, high blood pressure or damage with hemorrhage

• Oncology.

All kinds of tumors with abscesses in the brain compress the nerve itself, destroy the area to which it sends a signal, provoke malfunctions in the functioning of the entire neural system, causing complications in the eyes or even appearing directly in the eyeball.

• Other diseases: glaucoma, hypertension, atherosclerosis, diabetes, allergic reactions, lack of vitamins or their excess, autoimmune disorders and many others.

Treatment of optic neuritis

Treatment of optic nerve atrophy is carried out by two doctors at once - an ophthalmologist and a neurologist, and in large cities there are neuro-ophthalmological centers specializing in such ailments. Treatment is always carried out inpatiently and urgently already at the stage of a preliminary unconfirmed diagnosis, since the disease is incredibly fleeting and a person can lose his sight in just a few days.

Can optic nerve atrophy be cured? It is impossible to completely cure the disease. Treatment comes down to stopping the spread of damage and trying to normalize the functioning of surviving neurons as much as possible.

This occurs because neurons lack the ability to divide. The vast majority of neurons in the human nervous system are formed in the mother’s tummy, and increase slightly as the child develops. Neurons themselves cannot divide, their number is strictly limited, new neurons are built only from bone marrow stem cells, which represent the stabilization fund of the body, which has a strictly limited number of cells - lifesavers, laid down during the period of embryonic development and slowly consumed in the process of life. An additional complication is that stem cells can only turn into neurons by forming new chaotic connections, and are unable to become patches for a damaged tissue. This principle of operation is good for renewing the brain, but the body will repair a separate nerve by simply replacing the dead nerve cells with connective tissue cells, which perfectly fill any cellular bald spots in the human body, but are not capable of performing any functions.

Currently, experiments are underway with stem cells obtained from embryos killed during abortions or miscarriages, which give excellent results in the rejuvenation and restoration of various tissues, including nerves, however, in reality this method is not used because it is too fraught with cancer, such as which doctors have not yet figured out to treat.

The place where atrophy can be cured is exclusively in a hospital; in this case, even outpatient (home) treatment is not allowed, during which precious seconds may be lost.

Treatment with folk remedies is not only unacceptable, but simply does not exist. In folk medicine there are no such harsh effective means for accurate diagnosis and very quick treatment.

With complete or partial atrophy of the optic nerve, treatment begins with diagnosing the causes of the disease, after which the attending physician selects an appropriate course, including surgical intervention.

In addition to the use of special means, the patient is often prescribed a biogenic stimulant, aloe extract, which prevents the replacement of body tissues with connective cells. This drug is given in injections after any operation or after inflammation of the appendages in women as an anti-adhesion drug.

All kinds of pinching, compression, tumors, vascular aneurysms near the optic nerve and other similar causes of atrophy are removed surgically.

The inflammatory process caused by the consequences of an infectious infection is stopped using antibiotics or antiviral and anti-inflammatory drugs.

Toxic visual atrophy. the nerve is treated by removing toxins or neutralizing them, stopping further destruction of neurons. The antidote to methyl alcohol is food grade ethyl alcohol. So, in case of poisoning, it is necessary to rinse the stomach with a solution of sodium bicarbonate (sold in a pharmacy, not to be confused with sodium bicarbonate - baking soda), drink a 30-40% solution, for example, high-quality vodka, in an amount of 100 milliliters and repeat after 2 hours, halving the volume.

Dystrophy and other retinal disorders are treated with ophthalmological methods: laser surgery, vitamin or drug courses, depending on the cause. If the nerve begins to atrophy due to unnecessary use, then it will soon begin to recover after the retina is restored.

Congenital and genetic optic nerve atrophy in children is corrected based on the type of pathology and often surgically.

In addition to specific treatment based on the cause of the disease, treatment includes immunostimulation, vasodilation, biogenic stimulation, hormonal drugs to prevent even the slightest hint of inflammation (prednisolone, dexamethasone), drugs that accelerate resorption (pyrogenal, preductal), some means of maintaining work of the nervous system (emoxipin, fezam, etc.), physiotherapy, laser, electrical or magnetic stimulation of the optic nerve.

At the same time, the body is urgently saturated with vitamins, minerals and nutrients. At this stage, lovers of traditional medicine can choose a remedy to their liking from strengthening, immunostimulating and anti-inflammatory drugs. It is only important not to act in secret from the doctor, because everything used by the patient must be correctly combined with a huge number of prescribed drugs, otherwise you may risk losing not only your eyesight, but also your life.

Such a huge complex of procedures, sometimes taking more than a year, is necessary not to restore vision, but simply to stop its loss.

Optic nerve atrophy in a child

Atrophy of the optic nerve in a child is a rather rare disease, characteristic of older people and practically does not differ from the same disease in an adult. The main difference is that in young children, neurons are still able to partially recover, and in the initial stages it is quite possible not only to stop the disease, but also to reverse it. An exception is hereditary atrophy of the optic nerve in children, the treatment of which has not yet been found - Liberov's atrophy, which is transmitted through the male line.

Possible consequences and forecasts

Should I panic after hearing such a diagnosis? At the initial stages, there is no particular reason for panic, at this time the disease is quite easily stopped. And neurons that are not severely damaged even restore their functions. With improper treatment, self-medication and an irresponsible attitude, there is another possible outcome: in addition to vision, in some cases a person can lose his life, since the optic nerve is very large and is directly connected to the brain. Through it, like a bridge, inflammation from the eye can easily spread to the brain tissue and cause irreversible consequences. It is all the more dangerous when atrophy is caused by inflammation of the brain itself, tumors, or problems with blood vessels. Complete or partial atrophy of the optic nerves can also occur, with atrophy of the optic nerve (main trunk).

When the first symptoms occur, you need to remember that a person builds his own future, and his correct actions will determine whether he will be healthy, whether his vision will be restored, whether the normal functioning of the entire nervous system of the body will be maintained, or whether he will prefer to spend invaluable time on not the most important things. activities, for example, being afraid to leave work, trying to save on treatment by ignoring some prescriptions, or wasting time on long-term rehabilitation.

A severe, often progressive disease in which there is a gradual irreversible deterioration in visual acuity, up to the development of blindness. According to WHO, the frequency of detection of this disease is growing throughout the world, and this trend is especially noticeable among the population of economically developed countries. Despite the advances of modern medicine, the search for more effective treatments for optic atrophy is still ongoing.

The optic nerve is formed by processes of nerve cells in the retina of the eye. Retinal cells have the ability to perceive light and convert it into nerve impulses, which are then transmitted along the optic nerve to certain areas of the cerebral cortex responsible for the formation of visual images.

Due to the influence of many different factors, the optic nerve fibers can gradually collapse and die, while the conduction of nerve impulses from the retina to the brain also gradually deteriorates. For a sufficiently long period of time, the process of destruction of the optic nerve fibers remains invisible to the patient, so he does not go to the doctor. At the same time, the later the treatment of optic nerve atrophy is started, the worse the prognosis of the course of the disease, because it will be impossible to restore lost vision.

Depending on the severity of the pathological process, there are partial optic nerve atrophy (PANA)), when visual functions are preserved and complete atrophy when there is no vision.

Causes of development of optic nerve atrophy

Optic nerve atrophy can be caused by a variety of causes, including neuritis, neoplasms, glaucoma, vascular atherosclerosis, poisoning with certain substances (methanol, nicotine), acute viral infections, hypertension, retinitis pigmentosa, etc.

Based on the reasons, it is customary to distinguish several types of disease:

Primary optic atrophy

The cause of the development of primary optic nerve atrophy is diseases that are accompanied by impaired microcirculation and trophism of the optic nerve. It can be observed in atherosclerosis, degenerative diseases of the cervical spine, and hypertension.

Secondary optic atrophy

The pathology occurs as a consequence of swelling of the optic disc due to diseases of the retina or the nerve itself (inflammation, tumor, poisoning with surrogate alcohol, quinine, trauma, etc.).

Symptoms

Patients with optic nerve atrophy may complain of a decrease in visual acuity and the inability to restore it with glasses or contact lenses, many note pain when moving the eyes, persistent headaches, and deterioration in color perception. Subjectively, patients may note that they see better at night than on a sunny day.

Diagnostics

When examining patients with suspected atrophy of the optic nerve, first of all, an examination of the fundus, perimetry, determination of visual acuity, and measurement of intraocular pressure are used.

The main diagnostic sign of optic nerve atrophy is a violation of the visual fields, which is detected during the corresponding ophthalmological examination.

When examining the fundus, a pronounced pallor of the optic nerve head is diagnosed, a change in its shape or clarity, sometimes a bulging of the central part of the disk.

Treatment of partial optic atrophy

Treatment of optic nerve atrophy of any form must be comprehensive. The goal of treatment is to slow down the process of nerve fiber death as much as possible and maintain residual visual acuity. Apply conservative methods of treatment (including hardware techniques) and surgical treatment.

Drug treatment is aimed at improving microcirculation and trophism in the affected nerve in order to prevent further progression of pathological changes and slow down the process of vision loss.

Local therapy includes the use of injections of drugs to improve microcirculation, B vitamins, etc. (in the form of subconjunctival, parabulbar, retrobulbar, intravenous and intramuscular injections). Hardware and physiotherapy techniques (magnetotherapy, electrical stimulation, etc.), laser therapy, hirudotherapy are also used.

Since in many cases optic nerve atrophy is the outcome of common diseases (atherosclerosis, hypertension), treatment of the underlying disease is mandatory. Patients with degenerative changes in the cervical spine are prescribed various techniques to improve blood circulation in the collar area and relieve muscle-tonic syndrome (massage, mesotherapy, exercise therapy).

Partial optic atrophy (PANA) is one of the most common ophthalmological diseases. This disease poses a serious danger, since from partial, in the case of improper treatment or lack thereof, it can turn into complete - when a person becomes completely blind.

Description of partial optic nerve atrophy (PANA) and ICD-10 code

Atrophy in ophthalmology is the death of tissues and fibers of the optic nerve. Atrophied tissue is replaced by simple connective tissue, which is unable to transmit signals from nerve cells to the organs of vision. As a result of the disease, the ability to see is sharply reduced, and if treatment is not started in time, partial atrophy can give way to complete atrophy, which will lead to complete loss of vision. The disease code according to ICD is H47.2.

In the case of partial atrophy of the optic nerve head (OND), a person can see, however, colors are not transmitted correctly, the contours of objects are distorted, cloudiness appears before the eyes, blurriness, and other vision defects occur.

diagram of the structure of the eyeball

In this case, vision can decrease either extremely sharply (over several days) or quite gradually (over several months). Usually, having decreased, vision in this case stabilizes - it is this fact that gives grounds to talk about partial atrophy. If vision, having decreased, does not fall any further, complete partial atrophy of the optic nerve is diagnosed. However, the disease can also be progressive - in this case it leads to complete blindness (if left untreated).

Previously, partial atrophy of the optic nerve, not to mention complete, was the basis for the assignment of disability. Modern medicine, fortunately, makes it possible to cure pathology, especially if it is detected in the earliest stages.

Reasons for the death of the optic disc

The main causes of partial atrophy of the optic nerve are the most common eye pathologies:

• myopia (including age-related);
• glaucoma;
• retinal lesions;
• visual fiber defects;
• tumor-like formations of any etiology in the organs of vision;
• inflammatory processes.

stages of optic nerve atrophy

In addition to the above, sometimes (less often) the following pathologies become causes of the disease:

• syphilis;
• encephalitis;
• meningitis;
• purulent brain abscess.

diagram of the location of the optic nerve

The appearance of scotomas (blind spots) is also a common symptom of this disease. In this case, a person sees the picture partially, some areas fall out of the general view, and in their place are whitish, cloudy spots.

Why bestoxol drops are prescribed can be read.

Diagnostics

As a rule, this disease is diagnosed without any difficulties. It is impossible not to notice a sharp decrease in vision, so the vast majority of patients themselves turn to an ophthalmologist, who then makes a diagnosis. An examination of the visual organs of a sick person will certainly in this case show a deformation of the optic nerve, its color paler than necessary.

In children

Partial optic atrophy is a disease typical of adults; it is rare in children. However, in recent years, ophthalmologists have noticed a rejuvenation of the disease, so cases of pathology in adolescents and children are no longer surprising. Sometimes the disease occurs even in newborns.

The causes of illness in children are as follows:

• severe heredity (leads to congenital CHAZN);
• pathology of the retina, nerve - dystrophy, trauma, swelling, congestion, inflammation;
• pathologies of a neurological nature - meningitis, encephalitis, head trauma, purulent abscesses of the meninges, tumor-like formations;

Fundus image with partial atrophy

In addition to the above, this disease in children can develop as a result of prolonged beriberi, high blood pressure, excessive mental and physical stress with malnutrition.

You can familiarize yourself with the causes of optic neuritis.

Treatment and prognosis

Usually, with timely access to a doctor, the prognosis for this disease is favorable. The goal of therapy is to stop the deformation of the tissues of the optic nerve, maintaining the level of vision that is still available. It is impossible to restore full vision in this case, since already deformed tissues of the optic nerve cannot be restored.

The method of therapy is selected depending on the underlying cause that gave rise to the disease. Usually, the following types of medications are used in the treatment of partial atrophy of the optic nerve:

• improving cerebral blood supply;
• activating metabolic processes, metabolism;
• dilating vessels;
• multivitamins;
• stimulators of biological processes.

Also, during treatment, agents are necessarily used that activate regeneration processes in the tissues of the organs of vision and improve metabolic processes. This:

• stimulants- aloe extracts, peat;
• glutamic acid as an amino acid;
• extracts of ginseng, eleutherococcus as vitamin supplements and immunostimulants.

Drugs are also prescribed that help pathological processes resolve faster and stimulate metabolism:

• Pyrogenal;
• Phosphaden;
• Preducted.

It is unacceptable to use any self-prescribed medications - all medications must be taken strictly according to the medical prescription and the regimen suggested by the specialist.

No folk remedies or alternative medicine can help your health in this case. Therefore, you should not waste precious time, but should immediately consult a doctor for qualified help.

How to treat through surgery and physiotherapy

If the disease requires surgical intervention, then surgery will be the main method in this case. And if vision has fallen sufficiently, there are grounds for assigning a disability group.

optic nerve pathways

The emphasis in therapy is on eliminating the underlying disease, which was the direct cause of atrophy. To achieve treatment results faster and more effectively, additional procedures are prescribed:

• ultrasound;
• magnetic resonance procedure;
• electrophoresis;
• laser;
• therapy using oxygen.

In this case, it is important to start treatment as early as possible. The sooner therapy begins, the more of the optic nerve can be saved. In addition, atrophied fibers cannot be restored, so the part of the nerve that is affected will not recover.

You can read how to treat lazy eye in adults.

Prevention

In order to cope with this disease as quickly as possible, it is important to seek medical help in a timely manner. In addition, abstaining from alcohol and drugs will help prevent the occurrence of pathology. The fact is that alcohol and drug intoxication is one of the factors that provokes atrophy.

Video

We will learn what atrophy is and signs of the disease from the video.

Conclusion

Partial atrophy of the optic nerve is a serious pathology, and if you do not pay attention to it in time, it can lead to complete blindness. Therefore, be sure to visit an ophthalmologist if your vision begins to sharply and unreasonably decrease - the sooner you start treatment, the larger part of the optic nerve will be preserved.

This condition is the final stage of damage to the optic nerve. This is not a disease, but rather a sign of a more serious disease. Possible causes include direct trauma, pressure or toxic damage to the optic nerve, and nutritional deficiencies.

Causes of optic nerve atrophy

The optic nerve is made up of nerve fibers that carry impulses from the eye to the brain. It contains approximately 1.2 million axons originating in retinal cells. These axons have a thick myelin sheath and cannot regenerate after injury.

In the case of degeneration of fibers in any of the departments of the optic nerve, its ability to transmit signals to the brain is impaired.

Regarding the causes of AD, scientific studies have established that:

• Approximately 2/3 of the cases were bilateral.
• Intracranial neoplasms are the most common cause of bilateral AD.
• The most common cause of unilateral injury is traumatic brain injury.
• Vascular factors are a common cause of AD in people over 40 years of age.

In children, causes of AUD include congenital, inflammatory, infectious, traumatic and vascular factors, including perinatal strokes, mass lesions and hypoxic encephalopathy.

Consider the most common causes of AD:

1. Primary diseases affecting the optic nerve: chronic glaucoma, retrobulbar neuritis, traumatic optic neuropathy, formations compressing the optic nerve (for example, tumors, aneurysms).
2. Primary retinal diseases, such as occlusion of the central retinal artery or central vein.
3. Secondary diseases of the optic nerve: ischemic optic neuropathy, chronic neuritis or papilledema.

Less common causes of ASD:

1. Hereditary optic neuropathy (eg, Leber optic neuropathy).
2. Toxic neuropathy, which can be caused by exposure to methanol, certain drugs (disulfiram, ethambutol, isoniazid, chloramphenicol, vincristine, cyclosporine and cimetidine), alcohol and tobacco abuse, metabolic disorders (eg, severe renal failure).
3. Retinal degeneration (eg, retinitis pigmentosa).
4. Retinal storage diseases (eg, Tay-Sachs disease)
5. Radiation neuropathy.
6. Syphilis.

Classification of optic nerve atrophy

There are several classifications of ADS.

According to the pathological classification, ascending (anterograde) and descending (retrograde) optic nerve atrophy is distinguished.

The ascending ADS looks like this:

• In diseases with anterograde degeneration (for example, toxic retinopathy, chronic glaucoma), the atrophy process begins in the retina and spreads towards the brain.
• The rate of degeneration is determined by the thickness of the axons. Larger axons decay faster than smaller ones.

Descending optic atrophy is characterized by the fact that the atrophy process begins in the proximal part of the axon and spreads towards the optic nerve head.

According to ophthalmoscopic classification there are:

• Primary ADS. In diseases with primary atrophy (for example, pituitary tumor, optic nerve tumor, traumatic neuropathy, multiple sclerosis), degeneration of optic nerve fibers leads to their replacement by columns of glial cells. On ophthalmoscopy, the optic disc appears white and has clear edges, and the retinal blood vessels are normal.
• Secondary ADS. In diseases with secondary atrophy (eg, papilledema or inflammation of the optic disc), degeneration of nerve fibers is secondary to papilledema. On ophthalmoscopy, the optic disc has a gray or dirty gray color, its edges are unclear; retinal blood vessels may be altered.
• Sequential ADS. With this form of atrophy (for example, with retinitis pigmentosa, myopia, central retinal artery occlusion), the disc has a waxy pale color with clear edges.
• Glaucomatous atrophy is characterized by a cup-shaped optic disc.
• Temporary optic disc pallor can occur with traumatic neuropathy or nutritional deficiencies, and is most common in patients with multiple sclerosis. The disc is pale in color with clear edges and normal vessels.

According to the degree of damage to nerve fibers, they are distinguished:

• Partial atrophy of the optic nerve - the process of degeneration affects not all fibers, but a certain part of them. This form of optic nerve subatrophy is characterized by incomplete loss of vision.
• Complete atrophy of the optic nerve - the degeneration process affects all nerve fibers, leading to blindness.

Symptoms of optic atrophy

The main symptom of optic atrophy is blurred vision. The clinical picture depends on the cause and severity of the pathology. For example, with partial atrophy of the optic nerves of both eyes, bilateral symptoms of vision deterioration are observed without complete loss, manifested first by loss of clarity and impaired color perception. When the optic nerves are compressed by the tumor, the visual field may decrease. If partial optic atrophy is left untreated, visual impairment often progresses to complete loss.

Depending on the etiological factors, patients with AD may also exhibit other symptoms that are not directly related to this pathology. For example, with glaucoma, a person may suffer from eye pain.

Characterizing the clinical picture of ADN is important in determining the cause of neuropathy. Rapid onset is characteristic of neuritis, ischemic, inflammatory and traumatic neuropathy. Gradual progression over several months is characteristic of toxic neuropathy and atrophy due to nutritional deficiencies. The pathological process develops even more slowly (over several years) with compressive and hereditary ADN.

If a young patient complains of eye pain associated with eye movement and the presence of neurological symptoms (eg, paresthesia, ataxia, limb weakness), this may indicate the presence of demyelinating diseases.

In older adults with signs of ADN, the presence of temporary vision loss, double vision (diplopia), fatigue, weight loss, and muscle pain may suggest ischemic neuropathy due to giant cell arteritis.

In children, the presence of flu-like symptoms in the recent past or recent vaccination indicates parainfectious or post-vaccination optic neuritis.

Diplopia and facial pain suggest multiple neuropathy of the cranial nerves, observed with inflammatory or neoplastic lesions of the posterior orbit and the anatomical area around the sella turcica.

Short-term blurred vision, diplopia and headaches indicate the possibility of increased intracranial pressure.

Diagnosis of optic nerve atrophy

The described clinical picture can be observed not only with ADN, but also with other diseases. To establish the correct diagnosis, if vision problems occur, you need to consult an ophthalmologist. He will perform a comprehensive eye examination, including an ophthalmoscopy, which can be used to examine the optic nerve head. With atrophy, this disc has a pale color, which is associated with a change in blood flow in its vessels.

To confirm the diagnosis, you can perform optical coherence tomography, an examination of the eyeball that uses infrared light waves for visualization. The ophthalmologist also evaluates color vision, the reaction of the pupils to light, determines the acuity and impairment of visual fields, and measures intraocular pressure.

It is very important to determine the cause of ADN. For this purpose, the patient may undergo computed or magnetic resonance imaging of the orbits and brain, laboratory testing for the presence of genetic abnormalities, or a diagnosis of toxic neuropathy.

How to treat optic nerve atrophy?

How to treat optic nerve atrophy? The importance of vision for a person cannot be overestimated. Therefore, if you have any symptoms of optic nerve atrophy, you should under no circumstances resort to treatment with folk remedies on your own; you should immediately contact a qualified ophthalmologist.

It is necessary to begin treatment at the stage of partial atrophy of the optic nerve, which allows many patients to retain some vision and reduce the degree of disability. Unfortunately, with complete degeneration of nerve fibers, it is almost impossible to restore vision.

The choice of treatment depends on the cause of the disorder, for example:

• Treatment of descending optic atrophy caused by an intracranial tumor or hydrocephalus is aimed at eliminating compression of the nerve fibers by the tumor.
• In the case of inflammatory diseases of the optic nerve (neuritis) or ischemic neuropathy, intravenous corticosteroids are used.
• For toxic neuropathy, antidotes are prescribed to those substances that caused damage to the optic nerves. If atrophy is caused by drugs, their use is stopped or the dose is adjusted.
• Neuropathy due to nutritional deficiencies is treated by adjusting the diet and prescribing multivitamins that contain the microelements necessary for good vision.
• For glaucoma, conservative treatment aimed at reducing intraocular pressure or surgery is possible.

In addition, there are methods of physiotherapeutic, magnetic, laser and electrical stimulation of the optic nerve, which are aimed at preserving the functions of the nerve fibers as much as possible.

There are also scientific works that have shown the effectiveness of treating ADN using the introduction of stem cells. Using this still experimental technique, it is possible to partially restore vision.

Prognosis for ADN

The optic nerve is part of the central, not the peripheral, nervous system, which makes it impossible to regenerate after damage. Thus, ADN is irreversible. Treatment of this pathology is aimed at slowing down and limiting the progression of the degeneration process. Therefore, every patient with optic nerve atrophy should remember that the only place where this pathology can be cured or its development stopped is the ophthalmology departments in medical institutions.

The prognosis for vision and life with AD depends on the cause of it and the degree of damage to the nerve fibers. For example, with neuritis, after the inflammatory process subsides, vision may improve.

Prevention

In some cases, the development and progression of ADN can be prevented by proper treatment of glaucoma, toxic, alcohol and tobacco neuropathy, and eating a nutritious and nutrient-rich diet.

Optic nerve atrophy is a consequence of degeneration of its fibers. It can be caused by many diseases, from glaucoma and blood supply disorders (ischemic neuropathy) to inflammatory processes (for example, multiple sclerosis) and formations that compress the nerve (for example, intracranial tumors). Effective treatment is possible only at the stage of partial atrophy of the optic nerve. The choice of treatment method depends on etiological factors. In this regard, it is necessary to establish the correct diagnosis in time and direct all efforts to preserve vision.

Useful video about optic atrophy