Partial form of nerve atrophy in the eyes. A merciless and difficult to treat disease: how does descending optic atrophy manifest? Partial visual atrophy

More recently, optic atrophy was considered an incurable disease and inevitably led to blindness. Now the situation has changed. The process of destruction of nerve cells can be stopped and thereby preserve the perception of the visual image.

Atrophy, which is the death of nerve fibers, leads to loss of vision. This occurs due to the fact that the cells lose the ability to conduct nerve impulses responsible for transmitting images. Timely consultation with a doctor will help stop the development of the disease and avoid blindness.

Classification of optic nerve atrophy

The death of nerve fibers in the visual organs has the following classification::

• Primary atrophy. It occurs due to failures in the nutrition of nerve fibers and circulatory disorders. The disease has an independent nature.
• Secondary atrophy. A mandatory factor for the existence of a disease is the presence of other diseases. In particular, these are deviations associated with the optic nerve head.
• Congenital atrophy. The body's tendency to develop disease is observed from birth.
• Glaucomatous atrophy. Vision remains at a stable level over time. The cause of the disease is vascular insufficiency of the cribriform plate as a result of increased intraocular pressure.
• Partial atrophy. Part of the optic nerve is affected, which is where the spread of the disease ends. Vision deteriorates.
• Complete atrophy. The optic nerve is completely affected. If the progression of the disease is not stopped, blindness may occur.
• Complete atrophy. The deviation has already formed. The spread of the disease stopped at a certain stage.
• Progressive atrophy. The rapid development of the atrophic process, which can lead to complete blindness.
• Descending atrophy. Irreversible changes in the optic nerves develop slowly.

We see an explanation of how partial atrophy differs from complete atrophy here:

It is important to correctly diagnose the disease in time to avoid consequences leading to blindness. In the early stages, atrophy is treated and vision can be stabilized.

Optic nerve atrophy code according to ICD-10

H47.2 Optic atrophy
Pallor of the temporal half of the optic disc

Causes of atrophy

Despite the fact that there are many causes of optic nerve atrophy, in 20% of cases the exact factor as a result of which the disease develops cannot be determined. The most influential causes of atrophy include:

• Dystrophy of the retina pigment type.
• Inflammation of nerve tissue.
• Defects of blood vessels located in the retina.
• Increased intraocular pressure.
• Spasmodic manifestations related to blood vessels.
• Purulent inflammation of brain tissue.
• Inflammation of the spinal cord.
• Multiple sclerosis.
• Infectious diseases (from simple ARVI to more serious diseases).
• Malignant or benign tumors.
• Various injuries.

Primary descending atrophy can be caused by hypertension, atherosclerosis, or abnormalities in the development of the spine. The causes of the secondary type of disease are poisoning, inflammatory processes and injuries.

Why does atrophy occur in children?

Children are not protected from this disease. Optic nerve atrophy occurs in them for the following reasons::

• Genetic deviation.
• Intrauterine and other types of poisoning.
• Incorrect course of pregnancy.
• Hydrocephalus of the brain.
• Deviations in the development of the central nervous system.
• Diseases affecting the apple of the eye.
• A cranium deformed from birth.
• Inflammatory processes in the brain.
• Tumor formation.

As we see, the main causes of damage to the nerve cells of the visual organs in children are genetic abnormalities and the mother’s poor lifestyle during pregnancy.

One case of childhood atrophy is presented in this commentary:

Symptoms of the disease

Let's consider the clinical picture for each type of atrophy. The primary form of this disease is characterized by the separation of the boundaries of the nerves of the eye disc, which have acquired a deepened appearance. The arteries inside the eye narrow. In case of a secondary type of disease, the reverse process is noticeable. Nerve boundaries blur and blood vessels dilate.

Congenital atrophy is accompanied by an inflammatory process behind the eyeball. In this case, it is impossible to focus vision without causing discomfort. The resulting image loses the clarity of its lines and looks blurry.

A partial type of disease reaches a certain stage of its development and stops developing. Its symptoms depend on the stage the disease has reached. This form of atrophy may be indicated by partial loss of vision, light flashes before the eyes, images similar to hallucinations, the spread of blind spots and other deviations from the norm.

The following manifestations are considered common signs for all types of optic nerve atrophy::

• Limitation of eye functionality.
• External changes in the optic disc.
• If the capillaries in the macula are damaged, the disease affects central vision, which is reflected in the appearance of seals.
• The field of view narrows.
• The perception of color spectrums changes. First of all, this problem is associated with green shades, and then with red ones.
• If peripheral nerve tissue is affected, the eyes do not adapt well to changes in distance and lighting.

The main difference between partial and complete atrophy is the degree of reduction in visual acuity. In the first case, vision is preserved, but it is greatly deteriorated. Complete atrophy implies the onset of blindness.

Hereditary atrophy. Types and symptoms

Hereditary optic atrophy has several forms of manifestation:

• Infantile. Full vision loss occurs between 0 and 3 years of age. The disease is recessive in nature.
• Juvenile blindness. The optic disc becomes pale. Vision decreases to 0.1-0.2. The disease develops between 2 and 7 years of age. She is dominant.
• Optical-oto-diabetic syndrome. It is detected in the age range from 2 to 20 years. Concomitant diseases - various types of diabetes, deafness, problems with urination, cataracts, pigmented retinal dystrophy.
• Beer's syndrome. A serious disease, which is characterized by a decrease in vision in the first year of life to 0.1-0.05. Associated abnormalities include strabismus, symptoms of neurological disorders and mental retardation, damage to the pelvic organs.
• Gender-dependent atrophy. In most cases, the disease develops in male children. It begins to manifest itself in early childhood and gradually worsens.
• Lester's disease. The age from 13 to 30 years is the period in which the disease occurs in 90% of cases.

Symptoms

Hereditary atrophy develops in stages, despite its acute onset. Over a period of several hours to days, vision rapidly declines. At first, optic disc defects are not noticeable. Then its boundaries lose clarity, small vessels change in structure. A month later, the disc becomes cloudier on the side closer to the temple. In most cases, reduced vision remains with the patient for life. Only in 16% of patients it is restored. Irritability, nervousness, headaches, increased fatigue are signs that indicate the development of hereditary optic atrophy.

Diagnosis of optic nerve atrophy

Such studies help to identify the presence of atrophy:

• Spheroperimetry – determination of the visual field.
• Determination of the degree of visual acuity.
• Fundus examination using a slit lamp.
• Measuring intraocular pressure.
• Computer perimetry helps determine the damaged area of ​​tissue.
• Dopplerography using laser equipment shows the characteristics of blood vessels.

If a defect in the optic disc is detected, a brain examination is prescribed. The infection is detected after receiving the results of a blood test. Examinations and collection of data on symptomatic manifestations help to make an accurate diagnosis.

Treatment of optic atrophy

The goal of treatment is to maintain the ability to see at the level that was noted at the time the disease was diagnosed. It is impossible to improve vision with atrophy of the optic nerves, since tissues that die as a result of damage are not restored. Most often, ophthalmologists choose this treatment regimen:

1. Stimulant medications.
2. Drugs that dilate blood vessels. Among them are Papaverine and Noshpa.
3. Tissue therapy. For these purposes, the use of vitamin B and intravenous administration of nicotinic acid are prescribed.
4. Medicines against atherosclerosis.
5. Drugs that regulate blood clotting. This may be Heparin or subcutaneous injections of ATP.
6. Ultrasonic exposure.
7. Reflex therapy in the form of acupuncture.
8. Use of trypsin enzymes.
9. Intramuscular administration of Pyrogenal.
10. The procedure for vagosympathetic blockade according to Vishnevsky. It is the introduction of a 0.5% Novocaine solution into the area of ​​the carotid artery in order to dilate blood vessels and block sympathetic innervation.

If we talk about the use of physiotherapeutic techniques, then in addition to acupuncture, the following treatment methods are used::

1. Color and light stimulation.
2. Electrical and magnetic stimulation.
3. Massages to eliminate ischemic manifestations.
4. Meso- and ozone therapy.
5. Treatment with leeches (gerudotherapy).
6. Healing Fitness.
7. In some cases, a blood transfusion is possible.

Here is a possible clinical picture of atrophy and its treatment regimen:

A set of medications and physiotherapeutic measures helps speed up the healing process. Treatment is aimed at improving metabolism and blood circulation. Spasms and blood clots that disrupt these processes are eliminated.

Some cases of the disease require the possibility of surgical intervention. A medical drug, the patient’s own tissue or donor materials are placed in the retrobulbar space, which promotes the restoration of damaged areas and the growth of new blood vessels. Surgical installation of an electrical stimulator is also possible. It remains in the orbit of the eye for several years. In most cases of treatment of a disease detected in time, vision can be preserved.

Disease prevention

Measures that will reduce the risk of atrophy to a minimum are a standard list:

• Treat infectious diseases in a timely manner.
• Eliminate the possibility of injury to the brain and visual organs.
• Visit your oncologist regularly to detect cancer early.
• Avoid excessive consumption of alcoholic beverages.
• Monitor your blood pressure status.

A periodic examination by an ophthalmologist will help to detect the presence of the disease in time and take measures to combat it. Timely treatment is a chance to avoid complete loss of vision.

Atrophy of the optic nerve - the death of its fibers - unfortunately occurs in young and active people. You can imagine how tragic this turns out for them. Until recently, progressive diseases of the optic nerve resulted in blindness and doctors could not help, believing that the nervous tissue was irreparable and its damaged areas were lost forever. Now ophthalmologists are convinced: if the nerve fibers in the affected segment have not completely atrophied, vision can be restored.

With primary atrophy, a pale optic disc with clear boundaries, the formation of a flat (saucer-shaped) excavation, and narrowing of the retinal arterial vessels are observed ophthalmoscopically. Central vision is reduced. The field of view is concentrically narrowed, there are central and sector-shaped scotomas.

Secondary atrophy is ophthalmoscopically characterized by blanching of the optic nerve head, which, unlike primary atrophy, has unclear boundaries. In the early stage, there is slight prominence of the optic disc and varicose veins; in the late stage, these symptoms are usually absent. Disk aplanation often occurs, its boundaries are smoothed, and the vessels narrow.

When examining the visual field, along with concentric narrowing, hemianopic prolapses are determined, which are observed during volumetric processes in the cranial cavity (tumors, cysts). With atrophy after complicated congestive discs, loss in the field of vision depends on the localization of the process in the cranial cavity.

Atrophy of the optic nerves in tabes and progressive paralysis has the character of simple atrophy. There is a gradual decrease in visual functions, a progressive narrowing of the visual field, especially in colors. Central scotoma occurs rarely. In cases of atherosclerotic atrophy, which appears as a result of ischemia of the optic nerve head tissue, a progressive decrease in visual acuity, concentric narrowing of the visual field, and central and paracentral scotomas are noted. Ophthalmoscopically, primary optic disc atrophy and retinal arteriosclerosis are determined.

For optic nerve atrophy caused by sclerosis of the internal carotid artery, nasal or binasal hemianopia is typical. Hypertension can lead to secondary optic nerve atrophy caused by hypertensive neuroretinopathy. Changes in the visual field are varied, central scotomas are rarely observed.

Atrophy of the optic nerves after profuse bleeding (usually gastrointestinal and uterine) usually develops after some time. After ischemic edema of the optic disc, secondary, pronounced atrophy of the optic nerve occurs with significant narrowing of the retinal arteries. Changes in the visual field are varied; narrowing of the boundaries and loss of the lower halves of the visual field are often observed.

Atrophy of the optic nerve from compression caused by a pathological process (usually a tumor, abscess, granuloma, cyst, chiasmatic arachnoiditis) in the orbit or cranial cavity usually occurs as simple atrophy. Changes in the visual field are different and depend on the location of the lesion. At the beginning of the development of optic nerve atrophy from compression, a significant discrepancy is often observed between the intensity of changes in the fundus and the state of visual functions.

With mildly expressed blanching of the optic nerve head, a significant decrease in visual acuity and sharp changes in the visual field are noted. Compression of the optic nerve leads to the development of unilateral atrophy; compression of the chiasm or optic tracts always causes bilateral damage.

Familial hereditary optic atrophy (Leber's disease) is observed in men aged 16-22 years in several generations; transmitted through the female line. It begins with retrobulbar neuritis and a sharp decrease in visual acuity, which after a few months turns into primary atrophy of the optic nerve head. With partial atrophy, functional and ophthalmoscopic changes are less pronounced than with complete atrophy. The latter is distinguished by a sharp pallor, sometimes a grayish color of the optic disc, amaurosis.

Before moving on to the specifics of the treatment, we note that it in itself is an extremely difficult task, because the restoration of damaged nerve fibers is in itself impossible. A certain effect, of course, can be achieved through treatment, but only under the condition of restoration of those fibers that are in the active phase of destruction, that is, with a certain degree of their vital activity against the background of such exposure. Missing this moment can cause final and irreversible loss of vision.

Among the main areas of treatment for optic nerve atrophy, the following options can be distinguished:

• treatment is conservative;
• therapeutic treatment;
• surgical treatment.

The principles of conservative treatment are reduced to the implementation of the following drugs in it:

• vasodilators;
• anticoagulants (heparin, ticlid);
• drugs whose effect is aimed at improving the general blood supply to the affected optic nerve (papaverine, no-spa, etc.);
• drugs that affect metabolic processes and stimulate them in the area of ​​nerve tissue;
• drugs that stimulate metabolic processes and have a resolving effect on pathological processes; drugs that stop the inflammatory process (hormonal drugs); drugs that help improve the functions of the nervous system (nootropil, Cavinton, etc.).

Physiotherapeutic procedures include magnetic stimulation, electrical stimulation, acupuncture and laser stimulation of the affected nerve.

The repetition of the course of treatment, based on the implementation of measures in the listed areas of influence, occurs after a certain time (usually within several months).

As for surgical treatment, it implies an intervention aimed at eliminating those formations that compress the optic nerve, as well as ligating the area of ​​the temporal artery and implanting biogenic materials that help improve blood circulation in the atrophied nerve and its vascularization.

Cases of significant loss of vision due to the disease in question necessitate assigning the patient the appropriate degree of impairment to a disability group. Visually impaired patients, as well as patients who have completely lost their vision, are sent to a rehabilitation course aimed at eliminating the restrictions that have arisen in life, as well as compensating for them.

Let us repeat that optic nerve atrophy, which is treated using traditional medicine, has one very significant drawback: when using it, time is lost, which is almost precious as part of the progression of the disease.

It is during the period of active independent implementation of such measures by the patient that there is an opportunity to achieve positive and significant results on their own scale due to more adequate treatment measures (and previous diagnostics, by the way, too); it is in this case that the treatment of atrophy is considered as an effective measure in which the return of vision is permissible .

Remember that treatment of optic nerve atrophy with folk remedies determines the minimum effectiveness of the effect thus provided!

The appearance of symptoms that may indicate optic nerve atrophy requires contacting specialists such as an ophthalmologist and a neurologist.

Inflammatory processes, degenerative processes, compression, swelling, trauma, diseases of the central nervous system, traumatic brain injuries, general diseases (hypertension, atherosclerosis), intoxication, diseases of the eyeball, hereditary atrophies and resulting deformations of the skull. In 20% of cases, the etiology remains unknown.

Among diseases of the central nervous system, the causes of optic nerve atrophy can be:

• tumors of the posterior cranial fossa, pituitary gland, leading to increased intracranial pressure, nipple congestion and atrophy;
• direct compression of the chiasm;
• inflammatory diseases of the central nervous system (arachnoiditis, brain abscess, multiple sclerosis, meningitis);
• injuries of the central nervous system, leading to damage to the optic nerve in the orbit, canal, cranial cavity in the long-term period, resulting in basal arachnoiditis, leading to descending atrophy.

Common causes of optic atrophy:

• hypertension, leading to impaired hemodynamics of the vessels of the optic nerve, such as acute and chronic circulatory disorders and to atrophy of the optic nerve;
• intoxication (tobacco and alcohol poisoning with methyl alcohol, chlorophos);
• acute blood loss (bleeding).

Diseases of the eyeball that lead to atrophy: damage to retinal ganglion cells (ascending atrophy), acute obstruction of the central artery, dystrophic diseases of the artery (retinal pigmentary dystrophy), inflammatory diseases of the choroid and retina, glaucoma, uveitis, myopia.

Skull deformations (tower skull, Paget's disease, in which early ossification of the sutures occurs) lead to increased intracranial pressure, congestive optic nerve papilla and atrophy.

With optic nerve atrophy, the disintegration of nerve fibers, membranes, axial cylinders occurs and their replacement with connective tissue, empty capillaries.

When examining patients with optic nerve atrophy, it is necessary to find out the presence of concomitant diseases, the fact of taking medications and contact with chemicals, the presence of bad habits, as well as complaints indicating possible intracranial lesions.

During a physical examination, the ophthalmologist determines the absence or presence of exophthalmos, examines the mobility of the eyeballs, checks the reaction of the pupils to light, and the corneal reflex. Visual acuity testing, perimetry, and color vision testing are required.

Basic information about the presence and degree of optic nerve atrophy is obtained using ophthalmoscopy. Depending on the cause and form of optic neuropathy, the ophthalmoscopic picture will differ, but there are typical characteristics found in various types of optic atrophy. These include: pallor of the optic disc of varying degrees and prevalence, changes in its contours and color (from grayish to waxy), excavation of the disc surface, a decrease in the number of small vessels on the disc (Kestenbaum’s symptom), narrowing of the caliber of the retinal arteries, changes in the veins, etc. Condition The optic disc is clarified using tomography (optical coherence, laser scanning).

An electrophysiological study (EPS) reveals a decrease in lability and an increase in the threshold sensitivity of the optic nerve. In the glaucomatous form of optic nerve atrophy, tonometry is used to determine an increase in intraocular pressure. Pathology of the orbit is detected using plain radiography of the orbit. Examination of retinal vessels is carried out using fluorescein angiography. The study of blood flow in the orbital and supratrochlear arteries, and the intracranial portion of the internal carotid artery is performed using Doppler ultrasound.

If necessary, the ophthalmological examination is supplemented by a study of the neurological status, including consultation with a neurologist, radiography of the skull and sella, CT or MRI of the brain. If a patient has a brain mass or intracranial hypertension, consultation with a neurosurgeon is necessary. In the case of a pathogenetic connection between optic nerve atrophy and systemic vasculitis, consultation with a rheumatologist is indicated. The presence of orbital tumors dictates the need to examine the patient by an ophthalmic-oncologist. Therapeutic tactics for occlusive lesions of the arteries (orbital, internal carotid) are determined by an ophthalmologist or vascular surgeon.

For optic nerve atrophy caused by infectious pathology, laboratory tests are informative: ELISA and PCR diagnostics.

The differential diagnosis of optic atrophy should be made with peripheral cataracts and amblyopia.

If we consider the optic nerve visually, its structure resembles in its action a telephone wire, where one end is connected to the retina of the eyes, and its second end is connected to the visual analyzer in the brain, which is responsible for decoding all received video information.

In addition, the optic nerve includes a large number of transmitting fibers, and on the outside of the nerve there is a kind of insulation, that is, its sheath. It is worth noting that in 2 mm of this nerve there are more than a million fibers and each of them is responsible for transmitting a certain part of the image. For example, if some fiber dies or stops working, then the fragments of the picture for which this fiber is responsible will simply fall out of the patient’s field of vision.

As a result, blind spots appear, as a result of which it will be very difficult for a person to see something and he will have to constantly shift his gaze and look for the most suitable angle. In addition, optic nerve atrophy leads to consequences and unpleasant symptoms.

For example, many patients with this condition describe pain that occurs when moving their eyes. Their field of vision is significantly narrowed, they have problems with the perception of the color palette and their visual acuity is reduced. And in some cases, these symptoms are also accompanied by headaches.

To prevent optic nerve atrophy you need:

• prevent traumatic brain and eye injuries;
• undergo regular examination by an oncologist for timely diagnosis of brain cancer;
• do not abuse alcohol;
• monitor blood pressure.

Optic nerve atrophy occurs:

• primary,
• secondary,
• glaucomatous.

Primary atrophy occurs in a number of diseases accompanied by deterioration of nerve trophism and impaired microcirculation. There is descending atrophy of the optic nerve - as a result of damage to the fibers of the optic nerve, and ascending atrophy of the optic nerve, which occurs as a result of damage to retinal cells. As a rule, retinal atrophy is a descending process, a manifestation of general degenerative disorders of the visual analyzer and the brain against the background of vascular disorders due to atherosclerosis, hypertension, dorsopathy of the cervicothoracic spine, etc. There is hereditary genetically determined optic nerve atrophy.

Secondary atrophy is the outcome of papilledema (ONH) due to pathological processes in the retina and optic nerve (inflammatory diseases of the nerve itself or the retina, trauma, tumors, poisoning with alcohol substitutes).

Glaucomatous atrophy occurs due to collapse of the lamina cribrosa secondary to increased intraocular pressure (IOP). In this case, increased IOP plays the role of a hydraulic wedge, destroying the cribriform plate through which the optic nerve passes. This damages the nerve fibers. (More details in the Glaucoma section). This form of atrophy is characterized by long-term preservation of high visual acuity until the moment when the process affects the central zone. Often the atrophy process occurs against the background of microcirculation disturbances and has a combined pathogenesis.

The main signs of optic nerve atrophy are concentric narrowing of the peripheral boundaries of the visual field (with primary atrophy), narrowing of the visual field in the inferior nasal quadrant (with glaucomatous atrophy), the appearance of scotomas and a decrease in visual acuity, while subjectively the patient sees better in the twilight, and in bright light - worse. These symptoms may be expressed differently depending on the extent of the damage. Optic nerve atrophy can be partial or complete.

Partial atrophy of the optic nerve is characterized by a disorder of visual function. Visual acuity is reduced and cannot be corrected with glasses and lenses, but residual vision still remains, and color perception may suffer. Preserved areas remain in the field of vision, and a gradual decrease in vision occurs, down to light perception.

Complete atrophy of the optic nerve. With complete atrophy of the optic nerve, its function is completely lost, the patient does not perceive light of any intensity.

It should be noted that these symptoms can also manifest themselves in cases of damage to the occipital parts of the cerebral cortex, which are the final link of the visual analyzer.

With partial atrophy, you may notice various symptoms:

• visual impairment,
• decreased visual acuity,
• the appearance of spots and “islands” in the field of view,
• concentric narrowing of visual fields,
• difficulty distinguishing colors,
• significant deterioration of vision at dusk;

Descending optic atrophy is an irreversible sclerotic and degenerative change in the optic nerve that is characterized by pallor of the optic disc and decreased vision.

Symptoms and signs of descending optic atrophy.
In the presence of this disease, the patient experiences a gradual deterioration in visual function due to decreased visual acuity and concentric narrowing of the fields. There is a violation of color perception and a narrowing of the fields of vision for colors. Partial atrophy is possible with the ability to maintain fairly good visual acuity. With rapid development, vision decline occurs.

To treat this disease, it is desirable to eliminate the cause of atrophy.

Drug treatment of atrophy depends on the nature of the disease. As a rule, B vitamins, tissue, vasodilator, and tonic drugs are prescribed. You may need to resort to blood transfusions or blood replacement fluids.

Physiotherapy is also used for treatment, for example: magnetic therapy, laser and electrical stimulation of the optic nerve.

To improve blood circulation in the optic nerve, they resort to surgery: dissection of the scleral ring around the disc, implantation of a system to the optic nerve, which allows the supply of medicine to its tissue.

Congenital, genetically determined optic nerve atrophy is divided into autosomal dominant, accompanied by an asymmetric decrease in visual acuity from 0.8 to 0.1, and autosomal recessive, characterized by a decrease in visual acuity, often to the point of practical blindness already in early childhood.

If ophthalmoscopic signs of optic nerve atrophy are detected, it is necessary to conduct a thorough clinical examination of the patient, including determination of visual acuity and the boundaries of the visual field for white, red and green colors, and a study of intraocular pressure.

If atrophy develops against the background of papilledema, even after the edema disappears, the boundaries and pattern of the disc remain unclear. This ophthalmoscopic picture is called secondary (post-edema) optic nerve atrophy. The retinal arteries are narrowed in caliber, while the veins are dilated and tortuous.

When clinical signs of optic nerve atrophy are detected, it is necessary first of all to establish the cause of the development of this process and the level of damage to the optic fibers. For this purpose, not only a clinical examination is carried out, but also CT and/or MRI of the brain and orbits.

In addition to etiologically determined treatment, symptomatic complex therapy is used, including vasodilator therapy, vitamins C and B, drugs that improve tissue metabolism, various options for stimulating therapy, including electrical, magnetic and laser stimulation of the optic nerve.

Hereditary atrophies come in six forms:

• with a recessive type of inheritance (infantile) - from birth to three years of age there is a complete decrease in vision;
• with the dominant type (juvenile blindness) - from 2-3 to 6-7 years. The course is more benign. Vision decreases to 0.1-0.2. In the fundus there is segmental blanching of the optic disc; there may be nystagmus and neurological symptoms;
• opto-oto-diabetic syndrome - from 2 to 20 years. Atrophy is combined with retinal pigmentary dystrophy, cataracts, diabetes mellitus and diabetes insipidus, deafness, and urinary tract damage;
• Beer's syndrome is a complicated atrophy. Bilateral simple atrophy already in the first year of life, reggae drops to 0.1-0.05, nystagmus, strabismus, neurological symptoms, damage to the pelvic organs, the pyramidal tract suffers, mental retardation is added;
• gender-related (more often observed in boys, develops in early childhood and grows slowly);
• Leicester's disease (Lester's hereditary atrophy) - in 90% of cases occurs between the ages of 13 and 30 years.

Symptoms Acute onset, a sharp drop in vision over several hours, less often - several days. The lesion is a type of retrobulbar neuritis. The optic disc is initially unchanged, then blurring of the boundaries and changes in small vessels appear - microangiopathy. After 3-4 weeks, the optic disc becomes paler on the temporal side. In 16% of patients, vision improves. Most often, reduced vision remains for life. Patients are always irritable, nervous, they are bothered by headaches and fatigue. The cause is optochiasmatic arachnoiditis.

How does the disease manifest in children?
A characteristic feature of this disease is visual impairment. Initial symptoms can be noticed already in the first days of the baby’s life during a medical examination. The child’s pupils are examined, the reaction to light is determined, and how the child follows the movement of bright objects in the hand of a doctor or mother is studied.

Indirect signs of optic nerve atrophy are considered to be the lack of pupil response to light, dilation of the pupil, and the child’s lack of tracking of an object. This disease, if not given enough attention, can lead to decreased visual acuity and even blindness. The disease can appear not only at birth, but also when the child gets older. The main symptoms will be:

• Decreased visual acuity, which is not corrected with glasses or lenses;
• Loss of certain areas of vision;
• Changes in color perception – the perception of color vision suffers;
• Changes in peripheral vision - the child sees only those objects that are directly in front of him and does not see those that are slightly to the side. The so-called tunnel syndrome develops.

With complete atrophy of the optic nerve, blindness occurs, with partial damage to the nerve, vision only decreases.

Congenital visual atrophy
Optic nerve atrophy is hereditary and is often accompanied by a decrease in visual acuity almost to the point of blindness from a very early age. When examined by an ophthalmologist, a thorough examination of the baby is carried out, which includes examination of the fundus, visual acuity, and measurement of intraocular pressure. If signs of atrophy are detected, the cause of the disease is determined and the level of damage to the nerve fiber is determined.
Diagnosis of congenital optic atrophy

Diagnosis of the disease in children is not always easy. They cannot always complain to everyone that they have poor eyesight. This shows how important it is for children to undergo preventive examinations. Pediatricians, and ophthalmologists when indicated, constantly examine children, but the mother always remains an important observer of the child. She should be the first to notice that something is wrong with the baby and contact a specialist. And the doctor will prescribe an examination and then treatment.

Research is being carried out:

• Fundus examination;
• Visual acuity testing, visual fields are determined;
• Intraocular pressure is measured;
• According to indications - radiography.

Treatment of the disease
The basic principle of therapy is that the earlier treatment is started, the better the prognosis. If left untreated, there is only one prognosis – blindness. Depending on the identified causes, the underlying disease is treated. If necessary, surgical intervention is prescribed.

Medicines include:

• Drugs to improve blood supply to the optic nerve;
• Vasodilators;
• Vitamins;
• Biostimulating drugs;
• Enzymes.

Physiotherapy procedures include: ultrasound, acupuncture, laser stimulation, electrical stimulation, oxygen therapy, electrophoresis. However, given the congenital nature of the disease, it is not always possible to correct the situation, especially if you do not seek medical help in a timely manner. All medications are prescribed only by the attending physician; you should not turn to your neighbors for treatment. The doctor prescribed treatment for them, so let them have only your medications.

Prognosis for optic nerve atrophy in children
If treatment is started in a timely manner, the prognosis will be favorable, given that damaged tissue in children is more amenable to restoration than in adults. If you have the slightest problems with vision in children, you should contact a specialist. Let this be a false alarm, because it is better to once again consult and ask the doctor what is unclear about the baby, than to undergo treatment for a long time and to no avail. The health of children is in the hands of their parents

Optic nerve atrophy and its variety, partial atrophy, is the process of gradual death of the nerve and its replacement with connective tissue. The cause of this disease can be a variety of pathological processes occurring in the body.

Partial atrophy differs from the other form - complete, by the degree of damage, as well as the degree of vision loss. In the first case, residual vision remains, but color perception suffers significantly. In addition, the field of vision narrows, and it is impossible to correct the situation with glasses or contact lenses.

The optic nerve is a channel through which the image that enters the retina of the eye is transmitted to the brain in the form of electronic impulses. In the brain, transmitted signals are transformed into a picture.

The optic nerve is supplied by numerous vessels. If any disease disrupts this process, the fibers are slowly but inexorably destroyed. In this case, the nervous tissue is replaced by connective or auxiliary tissue cells that normally protect neurons.

When the nerve dies, it is no longer able to fully perform its normal functions, that is, transmit signals from the retina to the brain.

In addition to the above-described classification of atrophy into partial and complete, the disease can also be primary or secondary. In the first case, it is an independent disease that can be inherited. Since atrophy is attached to the X chromosome, men are at risk. The age at which the disease is most often diagnosed is fifteen to twenty years.

Secondary optic nerve atrophy, or descending, is a disease formed as a result of some pathology that caused the development of stagnation or impaired blood supply. All people without exception are at risk, and gender and age do not play a role. Even children can get sick.

Symptoms that are characteristic of partial optic atrophy are expressed in different patients to varying degrees.

As a rule, the possibility of developing the disease can be determined by the following symptoms:

• A noticeable decrease in the quality of vision;
• Pain when moving the eyeballs;
• Significant narrowing or loss of the field of vision up to the manifestation of tunnel syndrome, when the patient is able to see only those objects and objects that are in front of the eyes, but not from all sides;
• Formation of blind spots, or scotomas;

Above, we have already outlined the general causes of the development of partial atrophy of the optic nerve.

Let us describe in more detail what pathologies can lead to this problem:

• Various eye diseases, such as: damage to the retina or optic nerve fibers, myopia, glaucoma, inflammatory diseases, tumors leading to compression of the optic nerve;
• Syphilis, which causes brain damage without treatment;
• Infectious diseases such as encephalitis, brain abscess, meningitis, arachnoiditis;
• Pathologies in the central nervous or cardiovascular system, in particular cerebral atherosclerosis, hypertension, multiple sclerosis and cysts;
• Heredity;
• Intoxication of varying severity, poisoning with alcohol surrogates;
• Consequences of severe injury.

Diagnosing partial descending optic atrophy does not seem difficult. As a rule, having noticed decreased vision, a person turns to an ophthalmologist, who, in turn, conducts the necessary studies, makes a diagnosis and prescribes a treatment regimen.

If atrophy occurs, the doctor will notice that the disc is changed and pale. After this, more detailed studies of vision functions are prescribed.

Such procedures include: studying visual fields, measuring pressure inside the eye, fluorescein angiography, electrophysiological, and x-ray studies.

It is important at this stage to determine the cause of the development of atrophy, since in some situations it is impossible to treat the problem without the intervention of microsurgery.

As a rule, therapy for partial optic nerve atrophy has a favorable prognosis. The goal of treatment is to stop irreversible changes in tissues, as well as preserve as much as possible what is still normal. With atrophy, complete restoration of vision is impossible, but lack of treatment is a direct path to blindness and disability.

Review of several pharmaceutical drugs with brief instructions

The medications that the doctor will prescribe as part of the treatment regimen for both adults and children are aimed at improving blood supply and metabolism, and constricting blood vessels. In addition, it is advisable to take multivitamins and biostimulants, which relieve swelling and inflammation, improve nutrition and blood supply to the optic nerve disc.

Drugs can be divided into several groups depending on the purpose:

1. Vasoconstrictor drugs, such as: nicotinic acid, “No-spa”, “Dibazol”, “Complamin”, “Eufillin”, “Trental” and the like, as well as anticoagulants - “Tiklid” or “Sermion”. They improve blood circulation in the vessels that provide nutrition;
2. Biogenic stimulants, in particular aloe extract, “Peat”, vitreous body and the like; vitamins of the same effect - “Ascorutin”, B vitamins; enzymes – lylase and fibrinolysin; glutamic acid, immunostimulants. All of them are needed to improve tissue metabolism processes;
3. Hormonal - "Prednisolone" or "Dexamethasone" - to relieve inflammatory processes;
4. Medicines to improve the functioning of the central nervous system - “Cavinton”, “Emoxipin”, “Cerebrolysin” and so on.

Both adults and children should take the above medications only after a doctor's prescription. He will be the one who will be able to set the dosage specifically for your case and control the treatment process.

If surgery is required to treat the problem, this becomes the primary treatment option. The emphasis in this case is on treating the disease that provoked the atrophy, that is, eliminating the cause.

The following options are assigned as procedures for this:

• magnetic stimulation, electrical stimulation, laser stimulation;
• ultrasound intervention;
• electrophoresis;
• oxygen therapy.

Prevention/prevention of further development of the disease

To save yourself from the possibility of developing partial atrophy of the optic nerve, it is important to follow some simple recommendations:

• Quickly take treatment measures when symptoms of an infectious disease are detected;
• Try to avoid injury to the cranial and eye areas;
• Visit an oncologist with due frequency to prevent possible problems in the brain area;
• Try not to abuse alcoholic beverages;
• Monitor blood pressure status.

It is much easier to cure any disease if you notice it at a very early stage. Therefore, if you notice decreased vision and similar symptoms, you should visit a specialist’s office as soon as possible, who will help take measures to restore it and treat problems, if any.

Optic nerve atrophy is a condition in which partial or complete destruction of nerve fibers occurs and their replacement with dense connective tissue elements.

The following factors can lead to optic nerve atrophy:

• Hypertension, especially in the absence of regular treatment;
• Diabetes;
• Sclerotic lesion of the internal carotid artery;
• Atherosclerotic lesion of retinal vessels;
• Massive blood loss;
• Injuries to the central nervous system and eyes;
• Inflammatory and autoimmune lesions of the central nervous system: multiple sclerosis, brain abscesses, meningitis, arachnoiditis, encephalitis;
• Malignant and benign neoplasms of the pituitary gland, posterior cranial fossa, orbit and the eyeball itself;
• Severe general intoxication of the body;
• Retinal pigmentary dystrophy;
• Glaucoma;
• Uveitis;
• Severe myopia, astigmatism or hypermetropia;
• Acute obstruction of the central retinal artery;
• Congenital malformations of the visual analyzer.

It should be noted that in more than 20% of cases, it is not possible to determine the cause of optic nerve atrophy.

Depending on the time of appearance Optic nerve atrophy occurs:

• Acquired;
• Congenital or hereditary.

According to the mechanism of occurrence Optic atrophy is divided into two types:

• Primary. It occurs in a healthy eye and is usually caused by a violation of microcirculation and nerve nutrition. It is divided into ascending (retinal cells are affected) and descending (the fibers of the optic nerve are directly damaged);
• Secondary. Occurs against the background of eye diseases.

Separately, glaucomatous optic atrophy is distinguished. As is known, this disease is accompanied by an increase in intraocular pressure. As a result, the cribriform plate, the anatomical structure through which the optic nerve exits into the cranial cavity, is gradually destroyed. A characteristic feature of glaucomatous atrophy is that it preserves vision for a long time.

Depending on the preservation of visual functions atrophy occurs:

• Full when a person does not perceive light stimuli at all;
• Partial, in which certain areas of the visual field are preserved.

The clinical picture of optic nerve atrophy depends on the type and extent of damage to the nerve structures.

Atrophy is accompanied by a gradual narrowing of visual fields and a decrease in visual acuity. As the disease progresses, it becomes difficult for a person to distinguish colors. With partial atrophy of the optic nerve, scotomas appear - loss of parts of the visual field.

Almost all patients note worsening vision at dusk and in poor artificial lighting.

If congenital atrophy occurs, it begins to manifest itself from the first months of the baby’s life. Parents notice that the child does not take care of toys and does not recognize close people. This indicates a pronounced decrease in visual acuity. It happens that the disease is accompanied by total blindness.

Older children may complain of headaches or the appearance of dark or black areas in their field of vision. Almost everyone has difficulty recognizing colors.

Unfortunately, congenital atrophy of the optic nerve in a child is practically impossible to correct. However, the sooner the child is examined by a specialist, the greater the chance of stopping the development of the disease.

Fundus ophthalmoscopy plays a key role in diagnosis. This is a fairly simple and accessible method that allows you to reliably establish a diagnosis.

If a person has primary atrophy, the doctor sees pallor of the optic disc in the fundus, as well as narrowing of blood vessels. Secondary atrophy is also accompanied by disc pallor, but there will be dilation of blood vessels caused by concomitant diseases. The boundaries of the disc are blurry, and there may be pinpoint hemorrhages on the retina.

Compare the fundus of a healthy person and a person with atrophy:

For complex diagnostics, the following methods are also used::

• Measuring intraocular pressure (tonometry);
• Perimetry (assessment of visual fields);
• Survey X-ray of the skull (if injuries or tumor formations are suspected);
• Fluorescein angiography (allows you to evaluate the patency of blood vessels);
• Doppler ultrasound (used if blockage of the internal carotid artery is suspected);
• Computer or magnetic resonance imaging.

Often, to clarify the diagnosis, a consultation with a neurologist, rheumatologist, traumatologist or neurosurgeon is required.

There is no treatment for optic atrophy

Unfortunately, to date, not a single doctor has been able to cure optic nerve atrophy. It is not for nothing that there is an opinion in the world that nerve cells cannot be restored. Therefore, the main goal of treatment is to preserve the surviving nerve fibers and prevent them from atrophying. It is extremely important not to waste time.

First of all, it is necessary to establish what caused the disease and begin to treat the concomitant pathology. This is especially true for drug correction of diabetes mellitus and hypertension.

In general, provide The functioning of the optic nerve can be done in two ways: using surgical intervention and conservative methods (drug and physiotherapeutic treatment).

In complex treatment, depending on the doctor’s indications, the following groups of drugs are used:

• Anticoagulants or agents that prevent active blood clotting. The best known drug in this group is heparin;
• Drugs with anti-inflammatory activity. Steroidal anti-inflammatory drugs (glucocorticosteroids) are most often used: prednisolone, dexamethasone, betamethasone;
• Vasodilators: papaverine, aminophylline, nicotinic acid, sermion, trental;
• Antioxidant drugs: tocopherol (vitamin E);
• Products that improve nutrition and metabolic processes in nervous tissue: B vitamins (B12 - cyanocobalamin, B1 - thiamine, B6 - pyridoxine), amino acid preparations (glutamine), ascorbic acid. There are also complex vitamin preparations (for example, neurorubin or neurovitan);
• Drugs that have a stimulating effect on the central nervous system: Actovegin, Vinpocetine, Cerebrolysin, Cavinton, Fezam.

Physiotherapeutic treatment methods show good results, such as acupuncture, laser stimulation, electrophoresis, magnetic therapy, electrical stimulation.

Surgical treatment of optic nerve atrophy is indicated mainly in the presence of tumor-like neoplasms that somehow affect the optic nerve. Surgical tactics are also used in the case of anomalies in the development of the eye and some ophthalmological diseases.

Optic nerve atrophy (optic neuropathy) is partial or complete destruction of the nerve fibers that transmit visual stimuli from the retina to the brain. During atrophy, the nervous tissue experiences an acute lack of nutrients, which is why it ceases to perform its functions. If the process continues long enough, the neurons begin to gradually die. Over time, it affects an increasing number of cells, and in severe cases, the entire nerve trunk. It will be almost impossible to restore eye function in such patients.

The optic nerve belongs to the cranial peripheral nerves, but essentially it is not a peripheral nerve either in origin, or in structure, or in function. This is the white matter of the cerebrum, the pathways that connect and transmit visual sensations from the retina to the cerebral cortex.

The optic nerve delivers nerve messages to the area of ​​the brain responsible for processing and perceiving light information. It is the most important part of the entire process of converting light information. Its first and most significant function is the delivery of visual messages from the retina to the areas of the brain responsible for vision. Even the smallest injuries to this area can have serious complications and consequences.

Optic atrophy according to the ICD has ICD code 10

The development of optic nerve atrophy is caused by various pathological processes in the optic nerve and retina (inflammation, dystrophy, edema, circulatory disorders, toxins, compression and damage to the optic nerve), diseases of the central nervous system, general diseases of the body, hereditary causes.

The following types of disease are distinguished:

• Congenital atrophy - manifests itself at birth or a short period of time after the birth of the child.
• Acquired atrophy is a consequence of adult diseases.

Factors leading to optic nerve atrophy may include eye diseases, central nervous system lesions, mechanical damage, intoxication, general, infectious, autoimmune diseases, etc. Optic nerve atrophy appears as a result of obstruction of the central and peripheral retinal arteries that supply the optic nerve, as well as is the main symptom of glaucoma.

The main causes of atrophy are:

• Heredity
• Congenital pathology
• Eye diseases (vascular diseases of the retina, as well as the optic nerve, various neuritis, glaucoma, pigmentary degeneration of the retina)
• Intoxication (quinine, nicotine and other drugs)
• Alcohol poisoning (more precisely, alcohol surrogates)
• Viral infections (acute respiratory infections, influenza)
• Pathology of the central nervous system (brain abscess, syphilitic lesion, meningitis, skull trauma, multiple sclerosis, tumor, syphilitic lesion, skull trauma, encephalitis)
• Atherosclerosis
• Hypertonic disease
• Intraocular pressure
• Profuse bleeding

The cause of primary descending atrophy is vascular disorders with:

• hypertension;
• atherosclerosis;
• spinal pathologies.

Secondary atrophy is caused by:

• acute poisoning (including alcohol substitutes, nicotine and quinine);
• inflammation of the retina;
• malignant neoplasms;
• traumatic injury.

Optic nerve atrophy can be caused by inflammation or dystrophy of the optic nerve, its compression or trauma, leading to damage to the nerve tissue.

Atrophy of the optic nerve of the eye occurs:

• Primary atrophy (ascending and descending), as a rule, develops as an independent disease. Descending optic atrophy is most often diagnosed. This type of atrophy is a consequence of the fact that the nerve fibers themselves are affected. It is transmitted in a recessive manner by inheritance. This disease is linked exclusively to the X chromosome, which is why only men suffer from this pathology. It manifests itself at 15-25 years of age.
• Secondary atrophy usually develops after the course of any disease, with the development of stagnation of the optic nerve or a violation of its blood supply. This disease develops in any person and at absolutely any age.

In addition, the classification of forms of optic nerve atrophy also includes the following variants of this pathology:

A characteristic feature of the partial form of optic nerve atrophy (or initial atrophy, as it is also defined) is the incomplete preservation of visual function (vision itself), which is important when visual acuity is reduced (due to which the use of lenses or glasses does not improve the quality of vision). Although residual vision can be preserved in this case, there are disturbances in color perception. Preserved areas within sight remain accessible.

Any self-diagnosis is excluded - only specialists with the proper equipment can make an accurate diagnosis. This is also due to the fact that the symptoms of atrophy have much in common with amblyopia and cataracts.

In addition, optic nerve atrophy can manifest itself in a stationary form (that is, in a complete form or a non-progressive form), which indicates a stable state of actual visual functions, as well as in the opposite, progressive form, in which a decrease in the quality of visual acuity inevitably occurs.

The main sign of optic nerve atrophy is a decrease in visual acuity that cannot be corrected with glasses and lenses.

• With progressive atrophy, a decrease in visual function develops over a period of several days to several months and can result in complete blindness.
• In the case of partial atrophy of the optic nerve, pathological changes reach a certain point and do not develop further, and therefore vision is partially lost.

With partial atrophy, the process of vision deterioration stops at some stage, and vision stabilizes. Thus, it is possible to distinguish between progressive and complete atrophy.

Alarming symptoms that may indicate that optic nerve atrophy is developing are:

• narrowing and disappearance of visual fields (lateral vision);
• the appearance of “tunnel” vision associated with color sensitivity disorder;
• the occurrence of scotomas;
• manifestation of the afferent pupillary effect.

The manifestation of symptoms can be unilateral (in one eye) or multilateral (in both eyes at the same time).

The diagnosis of optic atrophy is very serious. At the slightest decrease in vision, you should immediately consult a doctor so as not to miss your chance of recovery. Without treatment and as the disease progresses, vision may disappear completely, and it will be impossible to restore it.

In order to prevent the occurrence of pathologies of the optic nerve, it is necessary to carefully monitor your health and undergo regular examinations by specialists (rheumatologist, endocrinologist, neurologist, ophthalmologist). At the first signs of vision deterioration, you should consult an ophthalmologist.

Optic nerve atrophy is a fairly serious disease. In case of even the slightest decrease in vision, it is necessary to visit an ophthalmologist so as not to miss precious time to treat the disease. Any self-diagnosis is excluded - only specialists with the proper equipment can make an accurate diagnosis. This is also due to the fact that the symptoms of atrophy have much in common with amblyopia and cataracts.

An examination by an ophthalmologist should include:

• visual acuity test;
• examination through the pupil (diluted with special drops) of the entire fundus of the eye;
• spheroperimetry (precise determination of the boundaries of the field of view);
• laser dopplerography;
• assessment of color perception;
• craniography with an image of the sella turcica;
• computer perimetry (allows you to identify which part of the nerve is damaged);
• video-ophthalmography (allows us to identify the nature of damage to the optic nerve);
• computed tomography, as well as magnetic nuclear resonance (clarifies the cause of optic nerve disease).

Also, a certain information content is achieved to compile a general picture of the disease through laboratory research methods, such as blood tests (general and biochemical), testing for borreliosis or syphilis.

Treatment of optic atrophy is a very difficult task for doctors. You need to know that destroyed nerve fibers cannot be restored. One can hope for some effect from treatment only by restoring the functioning of nerve fibers that are in the process of destruction, which still retain their vital functions. If this moment is missed, then vision in the affected eye can be lost forever.

When treating optic nerve atrophy, the following actions are performed:

1. Biogenic stimulants (vitreous body, aloe extract, etc.), amino acids (glutamic acid), immunostimulants (Eleutherococcus), vitamins (B1, B2, B6, ascorutin) are prescribed to stimulate the restoration of altered tissue, and are also prescribed to improve metabolic processes
2. Vasodilators are prescribed (no-spa, diabazole, papaverine, sermion, trental, zufillin) to improve blood circulation in the vessels supplying the nerve
3. To maintain the functioning of the central nervous system, Fezam, Emoxipin, Nootropil, Cavinton are prescribed
4. To accelerate the resorption of pathological processes - pyrogenal, preductal
5. Hormonal drugs are prescribed to stop the inflammatory process - dexamethasone, prednisolone.

Medicines are taken only as prescribed by a doctor and after an accurate diagnosis has been established. Only a specialist can choose the optimal treatment, taking into account concomitant diseases.

Patients who have completely lost their vision or have lost it to a significant extent are prescribed an appropriate course of rehabilitation. It is aimed at compensating and, if possible, eliminating all the restrictions that arise in life after suffering optic nerve atrophy.

Basic physiotherapeutic methods of therapy:

• color stimulation;
• light stimulation;
• electrical stimulation;
• magnetic stimulation.

To achieve a better result, magnetic and laser stimulation of the optic nerve, ultrasound, electrophoresis, and oxygen therapy can be prescribed.

The earlier treatment is started, the more favorable the prognosis of the disease. Nervous tissue is practically irreparable, so the disease cannot be neglected; it must be treated in a timely manner.

In some cases, with optic atrophy, surgery and surgical intervention may also be relevant. According to research results, optic fibers are not always dead, some may be in a parabiotic state and can be returned to life with the help of a professional with extensive experience.

The prognosis for optic nerve atrophy is always serious. In some cases, you can expect to preserve your vision. If atrophy develops, the prognosis is unfavorable. Treatment of patients with optic atrophy, whose visual acuity has been less than 0.01 for several years, is ineffective.

Optic atrophy is a serious disease. To prevent it, you need to follow some rules:

• Consultation with a specialist if there is the slightest doubt about the patient’s visual acuity;
• Prevention of various types of intoxication
• promptly treat infectious diseases;
• do not abuse alcohol;
• monitor blood pressure;
• prevent eye and traumatic brain injuries;
• repeated blood transfusion for profuse bleeding.

Timely diagnosis and treatment can restore vision in some cases, and slow or stop the progression of atrophy in others.

Optic nerve atrophy is the complete or partial destruction of its fibers with their replacement by connective tissue.

Causes of optic nerve atrophy

The causes of visual atrophy include heredity and congenital pathology; it can be a consequence of various eye diseases, pathological processes in the retina and optic nerve (inflammation, dystrophy, trauma, toxic damage, swelling, congestion, various circulatory disorders, compression of the optic nerve, etc.), pathology of the nervous system or general diseases.

More often, optic nerve atrophy develops as a result of pathology of the central nervous system (tumors, syphilitic lesions, brain abscesses, encephalitis, meningitis, multiple sclerosis, skull injuries), intoxication, alcohol poisoning with methyl alcohol, etc.

Also, the causes of the development of optic nerve atrophy can be hypertension, atherosclerosis, quinine poisoning, vitamin deficiency, fasting, and profuse bleeding.

Optic nerve atrophy occurs as a result of obstruction of the central and peripheral retinal arteries supplying the optic nerve, and it is also the main symptom of glaucoma.

Symptoms of optic atrophy

There are primary and secondary atrophy of the optic nerves, partial and complete, complete and progressive, unilateral and bilateral.

The main symptom of optic nerve atrophy is a decrease in visual acuity that cannot be corrected. Depending on the type of atrophy, this symptom manifests itself differently. Thus, as atrophy progresses, vision gradually decreases, which can lead to complete atrophy of the optic nerve and, accordingly, to complete loss of vision. This process can take place from several days to several months.

With partial atrophy, the process stops at some stage and vision stops deteriorating. Thus, progressive atrophy of the optic nerves is distinguished and complete.

Visual impairment due to atrophy can be very diverse. This can be a change in visual fields (usually narrowing, when “lateral vision” disappears), up to the development of “tunnel vision”, when a person looks as if through a tube, i.e. sees objects that are only directly in front of him, and scotomas often appear, i.e. dark spots in any part of the visual field; It could also be a color vision disorder.

Changes in visual fields can be not only “tunnel”, it depends on the localization of the pathological process. Thus, the appearance of scotomas (dark spots) right before the eyes indicates damage to nerve fibers closer to the central or directly in the central part of the retina; narrowing of the visual fields occurs due to damage to peripheral nerve fibers; with deeper lesions of the optic nerve, half of the visual field (or temporal , or nasal). These changes can occur in one or both eyes.

Examination for suspected optic nerve atrophy

It is unacceptable to engage in self-diagnosis and self-medication for this pathology, because something similar happens with peripheral cataracts, when lateral vision is first impaired, and then the central parts are involved. Also, optic atrophy can be confused with amblyopia, in which vision can also be significantly reduced and cannot be corrected. It is worth noting that the above pathology is not as dangerous as optic nerve atrophy. Aatrophy can be not only an independent disease or a consequence of some local pathology in the eye, but also a symptom of a serious and sometimes fatal disease of the nervous system, so it is very important to establish the cause of optic nerve atrophy as early as possible.

If similar symptoms occur, you should immediately contact an ophthalmologist and neurologist. These two specialists are primarily involved in the treatment of this disease. There is also a separate branch of medicine - neuro-ophthalmology, doctors - neuro-ophthalmologists, who are engaged in the diagnosis and treatment of such pathologies. If necessary, neurosurgeons, therapists, otorhinolaryngologists, infectious disease specialists, oncologists, toxicologists, etc. can also take part in diagnosis and treatment.

Diagnosis of optic atrophy is usually not difficult. It is based on the determination of visual acuity and fields (perimetry), on the study of color perception. An ophthalmologist must perform an ophthalmoscopy, during which he detects blanching of the optic nerve head, narrowing of the vessels of the fundus and measures intraocular pressure. A change in the contours of the optic nerve head indicates the primary or secondary nature of the disease, i.e. if its contours are clear, then most likely the disease has developed for no apparent reason, but if the contours are blurred, then perhaps it is post-inflammatory or post-stagnant atrophy.

If necessary, an X-ray examination is carried out (craniography with a mandatory image of the sella region), computed tomography or magnetic resonance imaging of the brain, electrophysiological research methods and fluorescein angiographic methods, in which the patency of the retinal vessels is checked using a special substance administered intravenously.

Laboratory research methods can also be informative: a general blood test, a biochemical blood test, a test for syphilis or borelliosis.

Treatment of optic atrophy

Treatment of optic atrophy is a very difficult task for doctors. You need to know that destroyed nerve fibers cannot be restored. One can hope for some effect from treatment only by restoring the functioning of nerve fibers that are in the process of destruction, which still retain their vital functions. If this moment is missed, then vision in the affected eye can be lost forever.

When treating atrophy, it is necessary to keep in mind that this is often not an independent disease, but a consequence of other pathological processes affecting various parts of the visual pathway. Therefore, treatment of optic nerve atrophy must be combined with elimination of the cause that caused it. If the cause is eliminated in a timely manner and if atrophy has not yet developed, normalization of the fundus picture and restoration of visual functions occurs within 2-3 weeks to 1-2 months.

Treatment is aimed at eliminating edema and inflammation in the optic nerve, improving its blood circulation and trophism (nutrition), restoring the conductivity of not completely destroyed nerve fibers.

But it should be noted that the treatment of optic nerve atrophy is long-term, its effect is weak, and sometimes completely absent, especially in advanced cases. Therefore it should be started as early as possible.

As mentioned above, the main thing is the treatment of the underlying disease, against the background of which complex treatment of optic nerve atrophy is carried out. For this, various forms of drugs are prescribed: eye drops, injections, both general and local; tablets, electrophoresis. Treatment is aimed at

• improvement of blood circulation in the vessels supplying the nerve - vasodilators (complamin, nicotinic acid, no-spa, papaverine, dibazol, aminophylline, trental, halidor, sermion), anticoagulants (heparin, ticlid);
• to improve metabolic processes in nerve tissue and stimulate the restoration of altered tissue - biogenic stimulants (aloe extract, peat, vitreous, etc.), vitamins (ascorutin, B1, B2, B6), enzymes (fibrinolysin, lidase), amino acids (glutamic acid ), immunostimulants (ginseng, eleuthorococcus);
• to resolve pathological processes and stimulate metabolism (phosphaden, preductal, pyrogenal); to relieve the inflammatory process - hormonal drugs (prednisolone, dexamethasone); to improve the functioning of the central nervous system (emoxipin, Cerebrolysin, Fezam, nootropil, Cavinton).

Medicines must be taken as prescribed by a doctor after diagnosis. The doctor will select the optimal treatment, taking into account concomitant diseases. In the absence of concomitant somatic pathology, you can independently take no-shpa, papaverine, vitamin preparations, amino acids, emoxypine, nootropil, fesam.

But you should not self-medicate for this serious pathology. Physiotherapeutic treatment and acupuncture are also used; methods of magnetic, laser and electrical stimulation of the optic nerve have been developed.

The course of treatment is repeated after several months.

Nutrition for optic nerve atrophy should be complete, varied and rich in vitamins. You need to eat as much fresh vegetables and fruits as possible, meat, liver, dairy products, cereals, etc.

If vision is significantly reduced, the issue of assigning a disability group is decided.

The visually impaired and the blind are prescribed a course of rehabilitation aimed at eliminating or compensating for the limitations in life that have arisen as a result of vision loss.

Treatment with folk remedies is dangerous because precious time is lost when it is still possible to cure atrophy and restore vision. It should be noted that for this disease, folk remedies are ineffective.

Complications of optic atrophy

The diagnosis of optic atrophy is very serious. At the slightest decrease in vision, you should immediately consult a doctor so as not to miss your chance of recovery. Without treatment and as the disease progresses, vision may disappear completely, and it will be impossible to restore it. In addition, it is very important to identify the cause of optic nerve atrophy and eliminate it as early as possible, because this can not only lead to loss of vision, but can also be fatal.

Prevention of optic atrophy

In order to reduce the risk of optic nerve atrophy, it is necessary to promptly treat diseases that lead to atrophy, prevent intoxication, conduct blood transfusions in case of profuse bleeding and, of course, promptly consult a doctor at the slightest sign of vision deterioration.

Ophthalmologist E.A. Odnoochko

Optic nerve atrophy is usually called the process of partial (PAN), and in some cases, complete destruction of the fibers included in the optic nerve with their replacement by connective tissue.

Causes

According to experts, partial atrophy of the optic nerve is very often caused by: heredity and congenital pathologies, some diseases of the organ of vision, pathologies in the optic nerve itself or in (including inflammation, trauma, swelling, congestion, toxic damage, dystrophy, circulatory disorders and compression of the optic nerve). nerve), diseases of the nervous system, general diseases.

Lesions of the central nervous system are considered to be the main “culprits” for the development of atrophy, these include: tumors, syphilitic lesions, meningitis, brain abscesses, encephalitis, skull injuries, multiple. In addition, the reasons for the development of such an anomaly can be atherosclerosis, hypertension, quinine poisoning, profuse bleeding, and vitamin deficiencies.

Starvation of the tissues of the internal structures of the eye due to obstruction of the central or peripheral arteries can also cause nerve atrophy. In addition, such atrophy is considered the main symptom.

Manifestations of the disease

In ophthalmology, it is customary to divide optic nerve atrophy into primary and secondary, partial and complete, complete and progressive, as well as unilateral and bilateral.

A characteristic symptom of this pathology is uncorrectable vision loss. This symptom can manifest itself in various ways, depending on the type of atrophy. The progression of the disease leads to a continuous decrease in vision due to the death of the optic nerve, which ultimately leads to complete blindness. This process, as a rule, occurs either rapidly - in a few days, or gradually - over the course of months.

Partial atrophy of the optic nerve in its course always stops the process of vision deterioration at some stage, after which vision stabilizes. This makes it possible to distinguish between progressive and complete atrophy.

Visual impairments during the course of the disease are of a very diverse nature, including changes in visual fields (usually narrowing with loss of “lateral vision”), up to “tunnel vision”, when a person sees as if through a tube, i.e. only those objects that are directly in front of it. This condition is associated with the appearance of dark spots in some areas of the visual field or color vision disorder.

With CHAZN, changes in visual fields are not only “tunnel”, which is due to the localization of the pathological process. Thus, the development of scotomas before the eyes may indicate a change in the nerve fibers of the central part of the retina or the area immediately adjacent to it. When the nerve fibers of the periphery are affected, a narrowing of the visual fields develops, and when the lesions are deep enough, the disappearance of half the visual field is observed. These changes can develop in either one or both eyes.

Diagnosis of CHAZN

It is unacceptable to engage in self-diagnosis, and even more so self-medication, in case of optic nerve atrophy, since similar symptoms are observed in peripheral atrophy, in which lateral vision is initially affected, with the involvement of the central parts in later stages. It must be remembered that optic nerve atrophy is not always an independent disease. Often, this is a manifestation of a serious disease of the nervous system. Therefore, establishing its causes in the early stages seems especially important.

The symptoms described above are a reason for immediate contact with specialists (including an ophthalmologist and a neurologist).

Diagnosis of optic atrophy is usually not difficult. To identify it, an examination is prescribed, including: determination of visual acuity, its fields, as well as tests for color perception. At the same time, it is necessary to carry out a test, which can reveal the characteristic pallor of the optic nerve head and some narrowing of the fundus. Intraocular pressure is measured.

Often, to clarify the diagnosis, an X-ray examination (craniography with an image of the sella turcica), magnetic resonance or computed tomography of the brain, fluorescein angiographic or electrophysiological research methods are prescribed, using contrast, when the patency of the retinal vessels is inspected.

Laboratory tests are also necessary - a general blood test, its biochemistry, a test for borelliosis, as well as syphilis.

Video about the latest developments in the treatment of CHAZN

Optic nerve atrophy, including partial, is almost impossible to cure, because the affected nerve fibers cannot be restored. There is little hope that there will be an effect from therapy for those fibers that are not yet completely destroyed and partially retain their vital functions. True, if this moment has already been missed, vision is lost forever.

It is worth remembering that often partial atrophy of the optic nerve is not a separate disease, but develops due to certain pathological processes developing in parts of the visual pathway. Therefore, its treatment, as a rule, begins with eliminating the causes of the pathology. If by this time the atrophy has not yet developed sufficiently, then within some time (sometimes up to two months) the picture will most likely normalize, with the restoration of visual functions.

Drug treatment for this disease is aimed at the timely elimination of swelling and inflammation, improving the trophism of the optic nerve and its blood circulation, and restoring the conductivity of nerve fibers.

It should be noted that this process is lengthy, with a weakly expressed effect, which is completely absent in advanced cases. Therefore, the success of treatment certainly depends on how quickly atrophy is diagnosed.

1. As noted above, the main thing is the treatment of the disease that caused the atrophy, therefore complex therapy is prescribed with various forms of drugs: eye drops, injections (general and local), tablets, physiotherapy. Such treatment aims to:
2. Improving blood circulation and vessels supplying the nerve. For this purpose, vasodilators are used (complamin, no-shpu, nicotinic acid, papaverine, dibazol, halidor, aminophylline, sermion, trental), as well as anticoagulants (heparin or ticlid);
3. Improving tissue metabolic processes and activating the regeneration of affected tissues. For this, biogenic stimulants (aloe extract, peat, etc.), tamines (B1, B2, B6, ascorutin), enzymatic agents (fibrinolysin, lidase), essential amino acids (glutamic acid), as well as immunostimulants (ginseng, eleuthorococcus);
4. Relief of inflammatory processes through hormonal drugs (dexamethasone,);
5. Improving the functions of the central nervous system (Cerebrolysin, nootropil, Fezam, emoxipin, Cavinton).

Any medications must be taken strictly according to the regimen prescribed by the attending physician after diagnosis. Since only a specialist can choose the optimal treatment, taking into account concomitant diseases.

At the same time, physiotherapeutic procedures and acupuncture may be prescribed; sessions of laser, magnetic, and electrical stimulation of optic nerve tissue.

Such treatment must be repeated in courses several times a year.

If there is an obvious decrease in vision, a disability group may be assigned.

Those who are blind due to disease and visually impaired are prescribed rehabilitation courses, which are aimed at eliminating or compensating for the limitations in life that have arisen due to loss of vision.

Remember that this disease cannot be treated with folk remedies; do not waste precious time on it when there is still a chance to cure atrophy and preserve vision.

Where to treat?

Choosing a medical institution for the treatment of optic nerve atrophy is a very important issue, since the result of treatment, including the prognosis for recovery, completely depends on the thoroughness of the examination and the professionalism of the doctor. Be sure to pay attention to the level of equipment of the clinic, as well as the qualifications of its specialists, because only the attention and experience of the medical staff can achieve the best effect in the treatment of eye diseases.

Any sensations in the human body, both external and internal, are possible only thanks to the functioning of nervous tissue, the fibers of which are found in almost every organ. The eyes are no exception in this regard, therefore, when destructive processes begin in the optic nerve, a person faces partial or complete loss of vision.

Definition of disease

Optic nerve atrophy (or optic neuropathy) is the process of death of nerve fibers, which occurs gradually and is most often the result of a malnutrition of the nervous tissue due to poor blood supply.

The transmission of images from the retina to the visual analyzer in the brain occurs through a kind of “cable”, consisting of many nerve fibers and packed in “insulation”. The thickness of the optic nerve is no more than 2 mm, but it contains more than a million fibers. Each section of the image corresponds to a certain part of them, and when some of them cease to function, “silent zones” (image disturbance) appear in the image perceived by the eye.

When nerve fiber cells die, they are gradually replaced by connective tissue or nerve auxiliary tissue (glia), which is normally designed to protect neurons.

Kinds

Depending on the causative factors, two types of optic nerve atrophy are distinguished:

• Primary. The disease is caused by an affected X chromosome, so only men aged 15-25 years are affected. The pathology develops in a recessive manner and is inherited;
• Secondary. It occurs as a consequence of an ocular or systemic disease associated with impaired blood supply or congestion of the optic nerve. This pathological condition can appear at any age.

Classification is also carried out according to the location of the lesion:

The following types of atrophy are also distinguished: initial, complete and incomplete; one-sided and two-sided; stationary and progressive; congenital and acquired.

Causes

The frequency of various pathological processes in the optic nerve is only 1-1.5%, and in 19-26% of them the disease ends in complete atrophy and incurable blindness.

The cause of optic nerve atrophy can be any disease that results in swelling, compression, inflammation, damage to nerve fibers or damage to the vascular system of the eyes:

• Eye pathologies: retinal pigmentary dystrophy, etc.;
• Glaucoma and increased IOP;
• Systemic diseases: hypertension, atherosclerosis, vascular spasms;
• Toxic effects: smoking, alcohol, quinine, drugs;
• Brain diseases: abscess, multiple sclerosis, arachnoiditis;
• Traumatic injuries;
• Infectious diseases: meningitis, encephalitis, syphilitic lesions, tuberculosis, influenza, measles, etc.

Is it possible to cure glaucoma?

Whatever the reason for the onset of optic nerve atrophy, the nerve fibers die irrevocably, and the main thing is to quickly diagnose it in order to slow down the process in time.

Symptoms

The main sign of the onset of pathology can be a steadily progressive deterioration of vision in one or both eyes, and it cannot be corrected by conventional methods.

Visual functions are gradually lost:

The onset of symptoms may last several days or months, depending on the severity of the lesions, but without a timely response it invariably leads to complete blindness.

Possible complications

The diagnosis of “optic atrophy” must be made as early as possible, otherwise vision loss (partial or complete) is inevitable. Sometimes the disease affects only one eye - in this case the consequences are not so severe.

Rational and timely treatment of the disease that causes atrophy allows in some cases (not always) to preserve vision. If the diagnosis is made at the stage of an already developed disease, the prognosis is most often unfavorable.

If the disease begins to develop in patients with vision indicators below 0.01, then treatment measures will most likely not give any result.

Diagnostics

A targeted ophthalmological examination is the first mandatory step if a disease is suspected. In addition, consultation with a neurosurgeon or neurologist may be required.

The following types of examinations may be performed to detect optic nerve atrophy:

• Fundus examination (or biomicroscopy);
• – determination of the degree of visual perception impairment (myopia, farsightedness, astigmatism);
• – visual field examination;
• Computer perimetry – allows you to determine the affected area of ​​nervous tissue;
• Assessment of color perception - determination of the localization of nerve fiber lesions;
• Video-ophthalmography – identifying the nature of the damage;
• Craniography (x-ray of the skull) - the main object is the area of ​​the sella turcica.

Read more about How is a fundus examination performed? By .

To clarify the diagnosis and additional data, it is possible to conduct studies: CT, nuclear magnetic resonance, laser Dopplerography.

Treatment

If the nerve fibers are partially damaged, treatment must begin quickly and intensively. First of all, the efforts of doctors are aimed at eliminating the cause of the pathological condition in order to stop the progression of the disease.

Drug therapy

Since restoration of dead nerve fibers is impossible, therapeutic measures are carried out to stop the pathological process by all known means:

• Vasodilators: Nicotinic acid, No-spa, Dibazol, Eufillin, Complamin, Papaverine, etc. The use of these drugs helps stimulate blood circulation;
• Anticoagulants: Heparin, Tiklid. The drugs prevent blood thickening and the formation of blood clots;
• Biogenic stimulants: Vitreous body, Aloe extract, Peat. Increase metabolism in nerve tissues;

Heparin ointment is used in the treatment of optic nerve arthritis

• Vitamins: Ascorutin, B1, B6, B2. They are catalysts for most biochemical reactions occurring in eye tissues, just like amino acids and enzymes;
• Immunostimulants: Ginseng, Eleutherococcus. Necessary for stimulating regeneration processes and suppressing inflammation in infectious lesions;
• Hormonal agents: Dexamethasone, Prednisolone. Used in the absence of contraindications to relieve symptoms of inflammation;
• Improving the functioning of the central nervous system: Nootropil, Cavinton, Cerebrolysin, Phezam.

Instruction D Examethasone for the eyes is located.

Dexamethasone is used in the treatment of optic nerve osteoarthritis.

In each specific case, treatment is prescribed individually under the supervision of the attending physician.

In the absence of contraindications, an additional effect can be achieved using acupuncture, as well as physiotherapeutic treatment methods:

• Ultrasound;
• Electrophoresis;
• Electrical and laser stimulation of the optic nerve;
• Magnetotherapy.

Such procedures can have a positive effect when nerve cells do not completely lose their functionality.

Surgically

Surgical methods are resorted to when there is a threat of complete blindness, as well as in other situations requiring surgical intervention. The following types of operations can be used for this:

Various surgical treatment methods are successfully practiced in clinics in Russia, Israel and Germany.

Folk remedies

Optic atrophy should be treated with medications under the guidance of a qualified physician. However, such therapy often takes a long time, and in this case, folk remedies can provide invaluable help - after all, the effect of most of them is aimed at stimulating metabolism and increasing blood circulation:

• Dissolve 0.2 g of mumiyo in a glass of water, drink before lunch on an empty stomach, and also drink a glass of the product in the evening for 3 weeks (20 days);
• Make an infusion of crushed astragalus herb (2 tablespoons of dried raw material per 300 ml of water), leave for 4 hours. Within 2 months. take 100 ml of infusion 3 times. in a day;
• Peppermint is called an eye herb, it is useful to eat it, and instill the juice mixed with equal amounts of honey and water into the eyes, morning and evening;
• You can eliminate eye fatigue after long-term work on the computer by using lotions from infusions of dill, chamomile, parsley, blue cornflower and regular tea leaves;
• Grind unripe pine cones and cook 1 kg of raw materials for 0.5 hours. After filtering, add 1 tbsp. honey, stir and refrigerate. Use 1 r. per day - in the morning before meals 1 tsp. ;
• Pour 1 tbsp. l. parsley leaves 200 ml of boiling water, let it brew in a dark place for 24 hours, then take 1 tbsp. l. in a day.

Folk remedies should be used in treatment only after consulting an ophthalmologist, since most herbal components have an allergenic effect and can have an unexpected effect in the presence of certain systemic pathologies.

Prevention

In order to avoid optic nerve atrophy, it is worth paying attention to preventive measures not only for eye, but also for systemic diseases:

• Treat ocular and systemic infectious diseases in a timely manner;
• Prevent eye and traumatic brain injuries;
• Carry out preventive examinations in an oncology clinic;
• Limit your consumption or eliminate alcohol from your life;
• Get your blood pressure under control.

You can find a color blindness test online.

Video

conclusions

Optic nerve atrophy is an almost incurable disease in the later stages that threatens the patient with complete blindness. However, partial atrophy can be stopped, and the main direction before developing medical tactics should be extensive diagnostics - after all, it is this that will allow us to establish the cause of the changes and try to stop them.

Therefore, try to pay special attention not only to the health of your eyes, but also to the health of your entire body. After all, everything in it is interconnected, and diseases of blood vessels or nerves can affect the quality of vision.

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