Partial form of nerve atrophy in the eyes. Partial optic nerve atrophy Secondary optic nerve atrophy

The optic nerve (optic nerve) is the 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, which goes directly to the cerebral cortex through the diencephalon. Given 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 commonly referred to as 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.
• Finished - a disease that has stopped at some stage.
• Partial atrophy of the optic nerve - partial destruction of the nerve fabric, 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 burned alcohol.
• Secondary - atrophy, manifested as a complication after an illness, for example, inflammation of the eyeball, meninges of the brain and other tissues.
• Subatrophy of the optic nerve - 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 the smaller optic accessory 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, 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, under which many disorders and inflammations fall for completely different reasons, then rather atrophy and neuropathy are subspecies 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 a lot of different names for, in fact, the same process, depending on the severity, course, method of acquisition, etc. this allows doctors to communicate information to each other more informatively, and it is rather difficult for the patient to understand all the intricacies of terminology.

Optic nerve atrophy code for ICD 10 - H47.2, as indicated in the sick leave, medical reference books or in the patient's card. The international code is used to keep medical secrets from outsiders ignorant people. The tenth version of the ICD is the latest.

Optic nerve atrophy symptoms

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

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

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

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

Diagnostics

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

Conducted to establish the diagnosis of primary examination is quite simple: examination for acuity with the width of the field of view and ophthalmoscopy.

With 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 that it is atrophied or damaged. With even 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 from light.

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

• General tests for inflammatory processes, as well as viral infections.
• Tomography.
• Radiography.
• electrophysiological study (EPS) - a study of the functioning of all systems of the eye by registering reactions to special impulses.
• fluorescein-angiographic method - a study by introducing a special marker substance into the blood and checking with its help the vascular conductivity of the eye.

Causes of the disease

This diagnosis of optic nerve atrophy can have such a variety of causes that it is possible to compile a whole scientific treatise on medicine, however, a small circle of the main, most common ones is distinguished.

• 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, in the first place was the toxic damage to visual neurons under the influence of burned alcohol or even liquids that were 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 amusing counterpart, this substance is extremely life-threatening.

In total, from 40 to 250 ml of methanol can cause death or very severe disability if resuscitation was carried out on time. In order for neurons to die, only 5 to 10 milliliters is enough, even when mixed with other substances. When it is used, not only the optic nerves die, however, this is not as noticeable to the patient as a sharp loss of vision. In addition, often toxic blindness very often begins after a long time - up to six days after consumption, when methanol breaks down in the liver into 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 health of the child during the mother's pregnancy or genetic failure.

• Injuries.

Atrophy caused by blows to the head or trauma to the eyeball, as well as operations on the brain.

• Inflammation.

The inflammatory process, which led to the death of visual neurons, can occur for many reasons, both simply because of a mote that got into the eye, which caused inflammation of the eyeball, and because of past 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 entire nervous system of the patient.
• Damage to the eye that provoked nerve atrophy as unnecessary, for example, retinal dystrophy. These two diseases reinforce 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 site to which it sends a signal, provoke malfunctions in the entire neural system, giving complications to the eyes or even arising directly in the eyeball.

• Other diseases: glaucoma, hypertension, atherosclerosis, diabetes, allergic reactions, vitamin deficiency or 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 in a hospital and urgently already at the stage of a preliminary unconfirmed diagnosis, since the disease is incredibly transient and a person can lose sight in just a few days.

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

This is due to the inability of neurons to divide. The vast majority of neurons of the human nervous system are laid down in the mother's tummy, and slightly increase in the process of child development. Neurons themselves cannot divide, their number is strictly limited, new neurons are built only from bone marrow stem cells, which are the body's stabilization fund, which has a strictly limited number of cells - lifesaver, laid down during 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 canvas. This principle of action is good for updating the brain, but the body will repair a separate nerve by simply replacing the dead nerve cells with connective tissue cells that perfectly fill any cellular bald spots in the human body, but are not able to perform any functions.

Now there are experiments with stem cells obtained from embryos killed during abortions or miscarriages, which give excellent results in rejuvenation and restoration of various tissues, including nervous ones, however, in reality this method is not used, because it is too fraught with cancer, as for which doctors have not yet come up with a cure.

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

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

With complete or partial atrophy of the optic nerve, treatment begins with the diagnosis of the causes of the disease, after which the attending physician selects the appropriate course, up to surgery.

In addition to the use of special agents, 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, aneurysms of blood vessels near the optic nerve and other similar causes of atrophy are removed surgically.

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

Toxic visual atrophy. nerve to be treated by removing toxins or neutralizing them, stopping further destruction of neurons. The antidote to methyl alcohol is food - ethyl. So, in case of poisoning, it is necessary to wash 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, reducing the volume by half.

Dystrophy and other retinal disorders are treated with ophthalmic methods: laser surgery, vitamin or drug courses, depending on the cause. If the nerve began to atrophy as unnecessary, then it will soon begin to recover after the restoration of the retina.

Congenital and genetic atrophy of the optic nerve 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, the 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 kind of means to maintain work of the nervous system (emoxipin, phezam, 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.

Atrophy of the optic nerve 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

Is it worth it to 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 not severely damaged neurons 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 future himself, and 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 preserved, or whether he will prefer to spend invaluable time on not the most important classes, for example, being afraid to leave work, trying to save on treatment, ignoring some prescriptions, or sparing time for a long rehabilitation.

19-12-2012, 14:49

Description

Etiology

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

lead to optic nerve atrophy common diseases. This happens with poisoning with ethyl and methyl alcohols, tobacco, quinine, chlorophos, sulfonamides, lead, carbon disulfide and other substances, with botulism. Vascular diseases can cause acute or chronic circulatory disorders in the vessels of the optic nerve with the development of ischemic foci and softening foci in it (colliquation necrosis). Essential and symptomatic hypertension, atherosclerosis, diabetes mellitus, internal profuse bleeding, anemia, diseases of the cardiovascular system, starvation, beriberi can lead to atrophy of the optic nerve.

In the etiology of optic nerve atrophy are important and diseases of the eyeball. These are lesions of the retina of vascular origin (with hypertensive angiosclerosis, atherosclerosis, involutional changes), retinal vessels (inflammatory and allergic vasculitis, obstruction of the central artery and central vein of the retina), degenerative diseases of the retina (including retinitis pigmentosa), complications of uveitis (papillitis, chorioretinitis), retinal detachment, primary and secondary glaucoma (inflammatory and post-inflammatory, flicogenic, vascular, dystrophic, traumatic, postoperative, neoplastic). Prolonged hypotension of the eyeball after surgery, inflammatory degenerative diseases of the ciliary body, penetrating wounds of the eyeball with the formation of a fistula lead to edema of the optic nerve head (stagnant nipple), after which atrophy of the optic nerve head develops.

In addition to Leber's hereditary atrophy and hereditary infantile optic atrophy, hereditary causes play a role in the occurrence of atrophy in drusen of the optic nerve head. Diseases and deformities of the bones of the skull (tower-shaped skull, Crouzon's disease) also lead to atrophy of the optic nerves.

It should be noted that in practice the etiology of optic nerve atrophy is not always easy to establish. According to E. Zh. Tron, in 20.4% of patients with atrophy of the optic nerves, its etiology was not established.

Pathogenesis

The nerve fibers of the peripheral neuron of the visual pathway can be exposed to various influences. These are inflammation, non-inflammatory edema, dystrophy, circulatory disorders, the action of toxins, damage, compression (tumor, adhesions, hematomas, cysts, sclerotic vessels, aneurysms), which leads to the destruction of nerve fibers and their replacement with glial and connective tissue, obliteration of the capillaries that feed them .

In addition, with an increase in intraocular pressure, it develops collapse of the glial cribriform membrane of the optic disc, which leads to degeneration of nerve fibers in vulnerable areas of the disc, and then to disc atrophy with excavation resulting from direct compression of the disc and secondary microcirculation disorders.

Classification

On the ophthalmoscopic picture, they distinguish primary (simple) and secondary atrophy of the optic nerve. Primary atrophy occurs on a disc that has not been changed before. With simple atrophy, nerve fibers are promptly replaced by proliferating elements of glia and connective tissue that take their places. The borders of the disk remain distinct. Secondary atrophy of the optic disc occurs on the altered disc due to its edema (congestive nipple, anterior ischemic neuropathy) or inflammation. In place of the dead nerve fibers, as in primary atrophy, glia elements penetrate, but this occurs more rapidly and in large sizes, as a result of which rough scars are formed. The boundaries of the optic nerve head are not distinct, washed away, its diameter can be increased. The division of atrophy into primary and secondary is conditional. With secondary atrophy, the borders of the disk are only fuzzy at the beginning, with time the edema disappears, and the borders of the disk become clear. Such atrophy is no different from simple. Sometimes glaucomatous (marginal, cavernous, cauldron-shaped) atrophy of the optic nerve head is isolated in a separate form. With it, there is practically no proliferation of glia and connective tissue, and as a result of direct mechanical action of increased intraocular pressure, the optic disc is squeezed (excavated) as a result of the collapse of its glial lattice membrane.

Atrophy of the optic disc, depending on the degree of color loss detected during ophthalmoscopy, is divided into initial, partial, incomplete and complete. With initial atrophy, against the background of a pink disc color, a slight blanching appears, which later becomes more intense. With the defeat of not the entire diameter of the optic nerve, but only part of it, partial atrophy of the optic nerve head develops. So, with the defeat of the papillomacular bundle, blanching of the temporal half of the optic disc occurs. With further spread of the process, partial atrophy can spread to the entire nipple. With diffuse spread of the atrophic process, uniform blanching of the entire disc is noted. If at the same time visual functions are still preserved, then they speak of incomplete atrophy. With complete atrophy of the optic nerve, the blanching of the disc is total and the visual functions of the affected eye are completely lost (amaurosis). In the optic nerve, not only visual, but also reflex nerve fibers pass, therefore, with complete atrophy of the optic nerve, the direct pupillary reaction to light is lost on the side of the lesion, and the friendly reaction is lost on the other eye.

Topically allocate ascending and descending optic nerve atrophy. Retinal ascending atrophy (wax, valerian) occurs in inflammatory and degenerative processes in the retina due to the primary lesion of the visual ganglionic neurocytes of the ganglionic layer of the retina. The optic disc becomes grayish-yellow, the vessels of the disc narrow, their number decreases. Ascending atrophy does not develop when only the neuroepithelial layer of the retina (rods and cones) is affected. Descending optic nerve atrophy occurs when a peripheral neuron of the optic pathway is damaged and slowly descends to the optic nerve head. Having reached the optic nerve head, the atrophic process changes it according to the type of primary atrophy. Descending atrophy spreads more slowly than ascending. The closer the process is to the eyeball, the faster the atrophy of the optic disc appears in the fundus. Thus, damage to the optic nerve at the point of entry into it of the central retinal artery (10-12 mm behind the eyeball) causes atrophy of the optic nerve head in 7-10 days. Damage to the intraorbital segment of the optic nerve before the entry of the central retinal artery into it leads to the development of atrophy of the optic nerve head in 2-3 weeks. With retrobulbar neuritis, atrophy descends to the fundus of the eye within 1-2 months. With injuries of the chiasm, descending atrophy descends to the fundus 4-8 weeks after the injury, and with slow compression of the chiasm by pituitary tumors, atrophy of the optic disc develops only after 5-8 months. Thus, the rate of spread of descending atrophy is also related to the type and intensity of the pathological process that affects the peripheral neuron of the visual pathway. They matter and blood supply conditions: the atrophic process develops faster with a deterioration in the blood supply to the nerve fibers. Atrophy of the optic discs in case of damage to the optic tract occurs about a year after the onset of the disease (with injuries of the optic tract, somewhat faster).

Optic atrophy may be stationary and progressive, which is evaluated in the process of dynamic examination of the fundus and visual functions.

When one eye is affected, it is said unilateral, with damage to both eyes - o bilateral optic nerve atrophy. Atrophy of the optic nerves in intracranial processes is more often bilateral, but the degree of its severity is different. Occurs with intracranial processes and unilateral atrophy of the optic nerve, which is especially common when the pathological focus is localized in the anterior cranial fossa. Unilateral atrophy in intracranial processes may be the initial stage of bilateral. In violation of blood circulation in the vessels of the optic nerve, intoxication, the process is usually bilateral. Unilateral atrophy occurs with damage to the optic nerve, pathological processes in the orbit, or due to unilateral pathology of the eyeball.

Ophthalmoscopic picture

With optic nerve atrophy, there is always blanching of the optic disc a. Often, but not always, there is vasoconstriction of the optic disc.

With primary (simple) atrophy the borders of the disk are clear, its color is white or grayish-white, bluish or slightly greenish. In redless light, the contours of the disk remain clear or become sharper, while the contours of a normal disk are veiled. In red (purple) light, the atrophic disc becomes blue. The cribriform plate (lamina cribrosa), through which the optic nerve passes when it enters the eyeball, is very little translucent. The translucence of the cribriform plate is due to a decrease in the blood supply to the atrophied disc and less than with secondary atrophy, the growth of glial tissue. Disc blanching can vary in intensity and distribution. With initial atrophy, a slight but distinct blanching appears against the background of the pink color of the disc, then it becomes more intense with a simultaneous weakening of the pink tint, which then completely disappears. With advanced atrophy, the disc is white. At this stage of atrophy, vasoconstriction is almost always noted, and the arteries are narrowed more sharply than the veins. The number of vessels on the disk also decreases. Normally, about 10 small vessels pass through the edge of the disc. With atrophy, their number decreases to 7-6, and sometimes up to three (Kestenbaum's symptom). Sometimes with primary atrophy, a slight excavation of the optic nerve head is possible.

With secondary atrophy disk borders are indistinct, washed away. Its color is gray or dirty gray. The vascular funnel or physiological excavation is filled with connective or glial tissue, the cribriform plate of the sclera is not visible. These changes are usually more pronounced in atrophy after congestive nipple than in atrophy after optic neuritis or anterior ischemic neuropathy.

Retinal wax atrophy of the optic disc distinguished by its yellow wax color.

With glaucoma increased intraocular pressure causes the appearance of glaucomatous excavation of the optic disc. In this case, at first the vascular bundle of the disc is displaced to the nasal side, then excavation of the nipple gradually develops, which gradually increases. The color of the disc becomes whitish and pale. The excavation in the form of a cauldron covers almost the entire disc to its edges (cauldron-shaped, marginal excavation), which distinguishes it from the physiological excavation, which has the shape of a funnel that does not reach the edges of the disc and does not displace the vascular bundle to the nasal side. Vessels at the edge of the disk are bent over the edge of the recess. In advanced stages of glaucoma, the excavation captures the entire disc, which becomes completely white, and the vessels on it are severely constricted.

Cavernous atrophy occurs when the vessels of the optic nerve are damaged. The atrophic optic disc begins to bulge under the influence of normal intraocular pressure with the appearance of excavation, while excavation of a normal disc requires increased intraocular pressure. Excavation of the disc in cavernous atrophy is facilitated by the fact that the growth of glia is small, and therefore no additional resistance is created to prevent excavation.

visual functions

Visual acuity of patients with optic nerve atrophy depends on the location and intensity of the atrophic process. If the papillomacular bundle is affected, then visual acuity is significantly reduced. If the papillomacular bundle is affected slightly, and the peripheral fibers of the optic nerve suffer more, then visual acuity does not decrease much. If there is no damage to the papillomacular bundle, and only the peripheral fibers of the optic nerve are affected, then visual acuity does not change.

Visual field changes with atrophy of the optic nerve are important in topical diagnosis. They depend to a greater extent on the localization of the pathological process and to a lesser extent on its intensity. If the papillomacular bundle is affected, then a central scotoma occurs. If the peripheral fibers of the optic nerve are affected, then narrowing of the peripheral boundaries of the visual field develops (uniform along all meridians, uneven, sector-shaped). If atrophy of the optic nerve is associated with damage to the chiasm or the optic tract, then hemianopia (homonymous and heteronymous) occur. Hemianopia in one eye occurs when the intracranial part of the optic nerve is affected.

Disorders of color vision more often occur and are clearly expressed with atrophy of the optic nerve head that occurs after neuritis, and rarely with atrophy after edema. First of all, the color perception for green and red suffers.

Often with atrophy of the optic nerves changes in the fundus correspond to changes in visual functions, but this is not always the case. So, with descending atrophy of the optic nerve, visual functions can be greatly changed, and the fundus of the eye remains normal for a long time until the atrophic process descends to the optic nerve head. Perhaps a pronounced blanching of the optic nerve head in combination with a slight change in visual functions. This can be with multiple sclerosis, when the death of myelin sheaths in the plaque area occurs while the axial cylinders of nerve fibers are preserved. Pronounced blanching of the disc with the preservation of visual functions may also be associated with the peculiarity of the blood supply in the region of the cribriform plate of the sclera. This area is supplied with blood from the posterior short ciliary arteries, the deterioration of blood flow through them causes intense blanching of the disc. The rest (orbital) part of the optic nerve is supplied with blood from the anterior and posterior arteries of the optic nerve, that is, from other vessels.

With blanching of the optic nerve head, combined with the normal state of visual functions, it is necessary to study the visual field using campimetry to detect small visual defects. In addition, you need to collect an anamnesis about the initial visual acuity, since sometimes visual acuity can be higher than one, and in these cases, its decrease to one may indicate the influence of an atrophic process.

With unilateral atrophy a thorough study of the functions of the second eye is necessary, since unilateral atrophy can only be the beginning of bilateral, which often happens with intracranial processes. Changes in the visual field of the other eye indicate a bilateral process and acquire important topical diagnostic value.

Diagnostics

In severe cases, diagnosis is not difficult. If the pallor of the optic disc is insignificant (especially temporal, since the temporal half of the disc is normally somewhat paler than the nasal one), then a long-term study of visual functions in dynamics helps to establish the diagnosis. At the same time, it is necessary pay special attention to the study of the field of view for white and colored objects. Facilitate diagnosis Electrophysiological, X-ray and fluorescent angiographic studies. Characteristic changes in the visual field and an increase in the threshold of electrical sensitivity (up to 400 μA at a norm of 40 μA) indicate atrophy of the optic nerve. The presence of marginal excavation of the optic disc and an increase in intraocular pressure indicate glaucomatous atrophy.

Sometimes it is difficult only by the presence of atrophy of the disc in the fundus to establish the type of lesion of the optic nerve or the nature of the underlying disease. Washing out of the borders of the disc during atrophy indicates that it was the result of edema or inflammation of the disc. It is necessary to study the anamnesis in more detail: the presence of symptoms of intracranial hypertension indicates the post-congestive nature of the atrophy. The presence of simple atrophy with clear boundaries does not exclude its inflammatory origin. So, descending atrophy on the basis of retrobulbar neuritis and inflammatory processes of the brain and its membranes causes disc changes in the fundus of the eye according to the type of simple atrophy. The nature of atrophy(simple or secondary) is of great importance in diagnosis, since certain diseases lead to certain, “favorite” types of damage to the optic nerves. For example, compression of the optic nerve or chiasm by a tumor leads to the development of simple atrophy of the optic nerves, tumors of the ventricles of the brain - to the development of congestive nipples and further to secondary atrophy. However, the diagnosis is complicated by the fact that some diseases, such as meningitis, arachnoiditis, neurosyphilis, can be accompanied by both simple and secondary atrophy of the optic discs. In this case, concomitant eye symptoms matter: changes in the vessels of the retina, the retina itself, the choroid, as well as a combination of atrophy of the optic nerves with a disorder of pupillary reactions.

When assessing the degree of color loss and blanching of the optic disc it is necessary to take into account the general background of the fundus. Against the parquet background of the fundus in brunettes, even a normal or slightly atrophied disc appears paler and whiter. Against a light background of the fundus, the atrophic nipple may not look so pale and white. In severe anemia, the optic discs are completely white, but more often a faint pink tint is retained. In hypermetropes, the optic discs in the normal state are more hyperemic, and with a high degree of hypermetropia, there may be a picture of false neuritis (severe hyperemia of the nipples). In myopia, the optic discs are paler than in emmetropes. The temporal half of the optic disc is normally slightly paler than the nasal one.

Optic nerve atrophy in some diseases

brain tumors . Secondary atrophy of the optic nerve in brain tumors is a consequence of congestive nipples. More often it happens with tumors of the cerebellopontine angle, hemispheres and ventricles of the brain. With subtentorial tumors, secondary atrophy is less common than with supratentorial ones. The incidence of secondary atrophy is affected not only by the location, but also by the nature of the tumor. It is more common in benign tumors. Especially rarely, it develops with metastases of malignant tumors in the brain, since death occurs earlier than congestive nipples turn into secondary atrophy.

Primary (simple) atrophy of the optic nerve occurs when compression of a peripheral neuron of the optic pathway. Most often, the chiasm is affected, less often the intracranial part of the optic nerve, and even more rarely the optic tract. Simple atrophy of the optic nerve is characteristic of supratentorial brain tumors, especially often it is caused by tumors of the chiasmal-sellar region. Rarely, primary atrophy of the optic nerves occurs with subtentorial tumors as a symptom at a distance: compression of the peripheral neuron of the optic pathway is carried out through an expanded ventricular system or by dislocation of the brain. Primary optic nerve atrophy rarely occurs with tumors of the ventricles of the cerebral hemispheres, cerebellum and cerebellopontine angle, and secondary atrophy in tumors of this localization is common. Rarely, simple atrophy of the optic nerves develops in malignant tumors and often in benign ones. Primary atrophy of the optic nerves is usually caused by benign tumors of the sella turcica (pituitary adenomas, craniopharyngiomas) and meningiomas of the lesser wing of the sphenoid bone and olfactory fossa. Optic nerve atrophy develops in Foster Kennedy syndrome: simple atrophy in one eye and congestive nipple with a possible transition to secondary atrophy in the other eye.

brain abscesses . Congestive discs often develop, but they rarely progress to secondary optic atrophy, since the increase in intracranial pressure is not so long-lasting, because intracranial hypertension either decreases after surgery, or patients do not live to see congestive nipples turn into secondary atrophy. Rarely, Foster Kennedy syndrome occurs.

Optochiasmatic arachnoiditis . More often, primary atrophy of the optic discs occurs in the form of blanching of the entire nipple or its temporal half (partial atrophy). In isolated cases, blanching of the upper or lower half of the disc is possible.

Secondary atrophy of the optic discs in optochiasmal arachnoiditis can be postneuritic (transition of inflammation from the meninges to the optic nerve) or postcongestive (occurs after congestive nipples).

Arachnoiditis of the posterior cranial fossa . Often lead to the development of pronounced congestive nipples, which then turn into secondary atrophy of the optic discs.

Aneurysms of the vessels of the base of the brain . Anterior circle of Willis aneurysms often press on the intracranial optic nerve and chiasm, resulting in simple optic atrophy. Simple atrophy due to compression of the optic nerve is unilateral, always located on the side of the aneurysm. With pressure on the chiasm, bilateral simple atrophy occurs, which may first occur in one eye and then appear in the other. Unilateral simple atrophy of the optic nerve most often occurs with aneurysms of the internal carotid artery, less often with aneurysms of the anterior cerebral artery. Aneurysms of the vessels of the base of the brain are most often manifested by unilateral paralysis and paresis of the nerves of the oculomotor apparatus.

Thrombosis of the internal carotid artery . The presence of an alternating optic-pyramidal syndrome is characteristic: blindness of the eye with simple atrophy of the optic disc on the side of thrombosis, combined with hemiplegia on the other side.

Tabes dorsalis and progressive paralysis . In tabes and progressive paralysis, atrophy of the optic nerves is usually bilateral and has the character of simple atrophy. Atrophy of the optic nerves in tabes is more common than in progressive paralysis. The atrophic process begins with peripheral fibers and then slowly goes deep into the optic nerve, so there is a gradual decrease in visual functions. Visual acuity gradually decreases with varying degrees of severity in both eyes up to bilateral blindness. Fields of vision gradually narrow, especially on colors, in the absence of cattle. Atrophy of the optic nerve with tabes usually develops in the early period of the disease, when other neurological symptoms (ataxia, paralysis) are not expressed or absent. Tabes is characterized by a combination of simple optic nerve atrophy with Argil Robertson's symptom. Reflex immobility of the pupils in tabes is often combined with miosis, anisocoria, and pupillary deformity. Argil Robertson's symptom also occurs with syphilis of the brain, but much less frequently. Secondary atrophy of the optic discs (postcongestive and postneuritic) speaks against tabes and often occurs with cerebral syphilis.

Atherosclerosis . Atrophy of the optic nerve in atherosclerosis occurs as a result of direct compression of the optic nerve by a sclerotic carotid artery or as a result of damage to the vessels supplying the optic nerve. Primary atrophy of the optic nerve develops more often, secondary atrophy is much less common (after disc edema due to anterior ischemic neuropathy). Often there are sclerotic changes in the vessels of the retina, but these changes are also characteristic of syphilis, hypertension and kidney disease.

Hypertonic disease . Optic nerve atrophy may be due to neuroretinopathy. This is secondary disc atrophy with accompanying symptoms characteristic of hypertensive angioretinopathy.

With hypertension, optic nerve atrophy may occur as an independent process, not associated with changes in the retina and retinal vessels. In this case, atrophy develops due to damage to the peripheral neuron of the visual pathway (nerve, chiasm, tract) and is in the nature of primary atrophy.

Profuse bleeding . After profuse bleeding (gastrointestinal, uterine) after a more or less long time, from several hours to 3-10 days, anterior ischemic neuropathy may develop, after which secondary atrophy of the optic discs develops. The lesion is usually bilateral.

Leber's optic nerve atrophy . Family hereditary atrophy of the optic nerves (Leber's disease) is observed in men aged 16-22 years in several generations and is transmitted through the female line. The disease proceeds as a bilateral retrobulbar neuritis, starting with a sharp drop in vision. A few months later, simple atrophy of the optic discs develops. Sometimes the entire nipple turns pale, sometimes only the temporal halves. Complete blindness usually does not occur. Some authors believe that Leber's atrophy is a consequence of optochiasmal arachnoiditis. The type of inheritance is recessive, linked to the X chromosome.

Hereditary infantile optic nerve atrophy . Children 2-14 years old are ill. Gradually, simple atrophy of the optic nerves develops with temporal blanching of the disc, less often the nipple. Often, high visual acuity is preserved, there is never blindness in both eyes. Often there are central scotomas in the field of view of both eyes. Color perception is usually impaired, and more blue than red and green. The type of inheritance is dominant, that is, the disease is transmitted from sick fathers and sick mothers to both sons and daughters.

Diseases and deformities of the bones of the skull . In early childhood, with a tower-shaped skull and Crouzon's disease (craniofacial dysostosis), congestive nipples may develop, after which secondary atrophy of the optic discs of both eyes develops.

Principles of treatment

Treatment of patients with atrophy of the optic nerves is carried out taking into account its etiology. Patients with optic nerve atrophy, which has developed due to compression of the peripheral neuron of the optic pathway by the intracranial process, require neurosurgical treatment.

To improve the blood supply to the optic nerve use vasodilators, vitamin preparations, biogenic stimulants, neuroprotectors, infusion of hypertonic solutions. Perhaps the use of oxygen therapy, blood transfusions, the use of heparin. In the absence of contraindications, physiotherapy is used: ultrasound on the open eye and endonasal drug electrophoresis of vasodilators, vitamin preparations, lecozyme (papain), lidase; apply electrical and magnetic stimulation of the optic nerves.

Forecast

Prognosis of optic nerve atrophy always serious. In some cases, you can count on the preservation of vision. With developed atrophy, the prognosis is unfavorable. Treatment of patients with atrophy of the optic nerves, whose visual acuity was less than 0.01 for several years, is ineffective.

Article from the book: .

Atrophy of the optic nerve develops due to the complete or partial death of the fibers of this nerve. Necrotic processes in the tissues occur as a result of the transferred pathologies of an infectious and non-infectious nature.

Optic nerve atrophy: causes

This pathology is rarely recorded in ophthalmic practice. The main causes of optic nerve atrophy include the following factors:

Atrophy of the optic nerve is accompanied by inflammatory reactions, circulatory dysfunction, which ultimately leads to the destruction of neurocytes, replacing them with glial tissue. In addition, with increased intraocular pressure, the collapse of the optic disc membrane develops.

Optic nerve atrophy: symptoms

Clinical signs of pathology depend on the form of atrophy. Without appropriate and timely therapy, optic nerve atrophy progresses and can provoke the development of complete blindness. The main clinical sign of the presented pathology is a sharp decrease in visual acuity, which is not amenable to any correction.

Partial atrophy of the optic nerve is accompanied by partial preservation of vision. Visual acuity is reduced and cannot be restored with lenses or glasses. The clinic of the disease can manifest itself with varying degrees of severity. Partial atrophy of the optic nerve is manifested by the following symptoms:

• color perception changes;
• decreased visual acuity;
• the emergence of "tunnel vision";
• disorientation in space;
• decreased peripheral and central vision;
• the appearance of cattle (blind spots);
• problems in the process of reading or other visual work.

Objective symptoms of the above pathology are determined only in the process of ophthalmological examination.

Features of the development of the disease in childhood

Optic nerve atrophy in children can be congenital or acquired. In the first case, children are already born with impaired vision. According to the condition of the pupils and their reaction to light, this pathology can be diagnosed at the early stages of its development. Dilated pupils, as well as their lack of reaction to bright light, are key indirect symptoms of unilateral or bilateral optic nerve atrophy. During the wakefulness of the child, chaotic floating eye movements are observed. As a rule, congenital diseases in children are detected during routine examinations at the age of up to a year. It should be noted that atrophy of the optic nerve in children under 2 years of age quite often goes unnoticed.

Diagnosis of the disease

If you have any vision problems, you should contact an ophthalmologist. It is important to find out what exactly caused the development of the disease. In order to establish the diagnosis of "atrophy of the optic nerve of the eye", you need to do the following:

• ophthalmological examination (visual acuity testing, computer perimetry, fundus examination, video ophthalmography, spheroperimetry, dopplerography, color perception test);
• x-ray of the skull;
• tonometry;
• fluorescein angiography;
• magnetic resonance and computed tomography;
• laboratory blood test.

Conservative treatment

Once the diagnosis of optic nerve atrophy is made, treatment should be immediate. Unfortunately, it is impossible to completely cure this disease, but in some it is possible to slow down and even stop the course of the pathological process. To treat patients, doctors use different groups of drugs that improve blood circulation. Most often, vasodilators are used ("Papaverine", "Amilnitrite", "Compalamine", "No-shpa", "Stugeron", "Galidor", "Eufilin", "Sermion", "Trental", "Dibazol"), anticoagulants (" Heparin, Calcium Nadroparin, Ticlid), vitamins (thiamine, riboflavin, pyridoxine, cyanocobalamin, ascorutin), enzymes (lidase, fibrinolysin), amino acids (glutamic acid), hormones (Prednisolone, Dexametazole) and immunomodulators ("Eleutherococcus", "Ginseng").

Many experts recommend using Cavinton as a vasodilator of intraocular vessels. This medication does not increase ophthalmotonus, so it can be used to treat patients with normal blood pressure, as well as moderate hypertension.

Biogenic preparations (Peat, Aloe, Peloid distillate, FiBS), angioprotectors (Emoxipin, Mildronate, Doxium), water-soluble vitamins are now actively used. Good results are obtained by combining the drug "Emokchipin" with vitamin E (tocopherol). As immunocorrective agents, the drugs "Decaris", "Sodium Nucleinate", "Timalin" are prescribed.

Traditional drug regimens for the treatment of the disease are ineffective, therefore, complex therapy in combination with surgical and physiotherapeutic methods has been actively introduced recently. Practitioners recommend that patients with a diagnosis of "optic nerve atrophy" be treated in combination with blockade of the pterygopalatine ganglion. Despite the widespread use of drug therapy, there are some disadvantages that are revealed when drugs are introduced into the body. A number of complications can also occur when using para- and retrobulbar injections.

Physiotherapy treatments

In modern ophthalmology, much attention is paid to drug-free methods of treatment. For this, laser, electro- and reflexotherapy are used. The use of electric current is associated with the excitation of the activity of certain systems of the human body. Magnetic therapy has found wide application in ophthalmology. The passage of a magnetic field through tissues enhances the movement of ions in them, the formation of intracellular heat, and activates redox and enzymatic processes. To eliminate the disease, several sessions should be completed.

Complex therapy of optic nerve atrophy involves the use of phonophoresis, electrophoresis and ultrasound. Although according to the literature, the effectiveness of such treatment is only 45-65%. In addition to the above methods of therapy, doctors also use galvanization, hyperbaric oxygenation and drug electrophoresis (iontophoresis, ionotherapy, ionogalvanization, dielectrolysis, ionoelectrotherapy). Even if a positive result is obtained after a few months, the course of treatment must be repeated.

Therapeutic methods are constantly being improved. Recently, stem cells and tissue regenerative microsurgery have been used to combat nerve fiber atrophy. The degree of improvement in visual acuity is different and varies in the range from 20% to 100%, which depends on various factors (the degree of damage to the optic nerve, the nature of the process, etc.).

Surgical methods for correcting hemodynamics

If you have been diagnosed with optic nerve atrophy, surgery in combination with drug therapy is the most effective treatment for the disease. There are several ways to surgically improve blood circulation in the caudal eyeball. All methods of surgical intervention are divided into several groups:

• extrascleral;
• vasoconstructive;
• decompression.

Extrascleral operations

This type of surgical intervention is aimed at creating aseptic inflammation in the Tenon space. There are a huge number of ways in which scleroplastic materials are injected into the Tenon's space. To achieve the desired result, the sclera, collagen sponge, cartilage, brefotissue, dura mater, autofascia, etc. are used. Most of these operations improve metabolism and stabilize hemodynamics in the posterior part of the eye. To strengthen the sclera and improve blood circulation in the eye, autologous blood, blood proteinases, hydrocortisone, talc, and a 10% solution of trichloroacetic acid are injected into the Tenon space.

Vasoconstructive operations

These methods are aimed at the redistribution of blood flow in the eye area. This effect was achieved due to the ligation of the external carotid artery (arteria carotis externa). To apply this technique, you need to perform carotid angiography.

Decompression operations

This method is used to reduce venous stasis in the vessels of the optic nerve. The technique of dissection of the scleral canal and the bone canal of the optic nerve is very difficult to perform and is currently only beginning to develop, therefore it is rarely used.

Folk methods of treatment

With partial atrophy, it is advisable to use plants that exhibit an anti-sclerotic effect: hawthorn, orange, wild rose, seaweed, blueberries, corn, chokeberry, strawberries, soybeans, garlic, buckwheat, coltsfoot, onions. Carrots are rich in beta-carotene, water-soluble vitamins (ascorbic, pantothenic, folic acids, thiamine, pyridoxine), contain a significant amount of macro- (potassium, sodium, calcium, phosphorus, chlorine, sulfur) and microelements (copper, chromium, zinc, iron, iodine, molybdenum, boron). It improves vision, increases the body's immune resistance. For better absorption of vitamin A, carrots should be taken grated along with fats (for example, with sour cream or cream).

Recall that partial atrophy of the optic nerve, which is treated using traditional medicine, has its drawbacks. With such a serious pathology, doctors highly do not recommend self-medication. If you still decide to use folk recipes, then you should consult with specialists: an ophthalmologist, therapist, herbalist or neurosurgeon.

Prevention

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

• regularly undergo an examination by an oncologist and an ophthalmologist;
• timely treat infectious diseases;
• do not abuse alcohol;
• monitor blood pressure;
• prevent eye and craniocerebral injuries;
• repeated blood transfusion for profuse bleeding.

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 tissues.

Types of disease

Atrophy of the optic disc, depending on its etiology, is divided into several types. These include:

1. Primary form (ascending and descending atrophy of the optic nerve). This pathological process develops as an independent disease. The descending type is diagnosed much more often than the ascending one. Such a disease is usually observed in males, since it is linked only to the X chromosome. The first manifestations of the disease occur at about 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 violation may be due to a failure in the flow of blood to the nerve. A disease of this nature can appear in any person, regardless of his age and gender.

According to the nature of the course, the following types of this disease are distinguished:

1. Partial atrophy of the optic nerve (initial). The main difference of this type is the partial preservation of visual ability, which is most important in case of impaired vision (which is why wearing glasses or contact lenses is not able to improve the quality of vision). Although residual visual ability is usually salvageable, failures in color vision often occur. Those portions of the fields of view that have been saved will still be available.
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 that 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 there is a rapid loss of vision, which, as a rule, cannot be restored. This greatly complicates the diagnostic process.

Symptoms

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

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 it 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 ceases to decrease.

Signs of optic nerve atrophy often appear in the form. Usually there is their narrowing, which is characterized by loss of lateral vision. This symptom can be almost imperceptible, but sometimes tunnel vision occurs, that is, when the patient is able to see only those objects that are localized 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 before the eyes (both closed and open) indicates that the destruction process affects the nerve fibers that are located in the central part of the retina or very close to it. The narrowing of the visual fields begins if the peripheral nerve tissues have been affected.

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

Causes

The causes of optic nerve atrophy can be different. Both acquired diseases and congenital ones, 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) of the retina;
• inflammatory processes;
• optic nerve dystrophy (ODN) of a congenital nature;
• fluid retention and swelling;
• toxic effects of certain chemicals;
• impaired access of blood to nerve tissues;
• compression of certain parts 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 a different nature 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. This is followed by ophthalmoscopy. 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).

Mandatory laboratory diagnostic methods are carried out, in particular, general and biochemical blood tests.

Methods of treatment

Treatment for atrophy of the optic nerve 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 that affect one or another part of the visual organ. Therefore, in order to cure optic nerve atrophy, it is necessary first of all to eliminate the provoking factor.

In most cases, complex therapy is used, involving 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);
• immunity boosters (Eleutherococcus extract);
• hormonal anti-inflammatory drugs (Dexamethasone);
• drugs that improve the functioning of the central nervous system (Nootropil, Emoksipin).

The listed medicines can be used in the form of tablets, solutions, eye drops and injections. In the most severe cases, surgery is needed. Many are interested in whether such a 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 drug should be taken only after the appointment of the attending physician, observing the prescribed dosage. It is strictly forbidden to choose drugs on your own.

Quite often, physiotherapy procedures are performed during the treatment of optic nerve atrophy. Especially effective are acupuncture or laser and magnetic stimulation of the optic nerve.

In some cases, treatment with folk remedies can 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.

Surgical intervention is usually prescribed in the presence of neoplasms of a different nature and hereditary atrophy of the optic nerve. Surgery is required if there are congenital anomalies in the development of the visual organ, such as Leber's optic nerve atrophy.

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

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

With this pathology, the symptoms and treatment are interrelated, since the doctor prescribes therapy depending on the symptoms and the 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 you can cure the disease most effectively.

Forecast and prevention

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

The lack of timely treatment can provoke very serious complications that lead not only to a decrease in 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 an examination by a doctor and carry out all the necessary diagnostic measures for the 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 second pair of cranial nerves is the most important element of the visual system, because through it the relationship between the retina and the brain is carried out. Although the rest of the structures continue to work correctly, any deformation of the nervous tissue affects the properties of vision. Optic nerve atrophy cannot be cured without a trace, nerve fibers cannot be restored to their original state, so it is better to carry out prevention in time.

Basic information on the disease

Optic nerve atrophy or optic neuropathy is a severe process of destruction of axons (nerve tissue fibers). Extensive atrophy thins the nerve column, healthy tissues are replaced by glial tissues, small vessels (capillaries) are blocked. Each of the processes causes certain symptoms: visual acuity decreases, various defects appear in the field of vision, the shade of the optic nerve head (OND) changes. All pathologies of the optic nerves account for 2% of the statistics of eye diseases. The main danger of optic neuropathy is absolute blindness, which is present in 20-25% of people with this diagnosis.

Optic neuropathy does not develop by itself, it is always the consequences of other diseases, so a person with atrophy is examined by different specialists. Usually, optic nerve atrophy is a complication of a missed ophthalmic disease (inflammation in the structures of the eyeball, swelling, compression, damage to the vascular or nervous network).

Causes of optic neuropathy

Despite the many causes of optic nerve atrophy known to medicine, in 20% of cases they remain unexplained. Usually these are ophthalmic pathologies, diseases of the central nervous system, autoimmune failures, infections, injuries, intoxications. Congenital forms of AD are often diagnosed together with skull defects (acrocephaly, microcephaly, macrocephaly) and hereditary syndromes.

Causes of atrophy of the optic nerve from the side of the visual system:

• neuritis;
• obstruction of the artery;
• myopia;
• retinitis;
• oncological damage to the orbit;
• unstable eye pressure;
• local vasculitis.

Injury to nerve fibers can occur at the time of a craniocerebral injury or even the slightest injury to the facial skeleton. Sometimes optic neuropathy is associated with the growth of meningioma, glioma, neuroma, neurofibroma and similar formations in the thickness of the brain. Optical disturbances are possible in osteosarcoma and sarcoidosis.

Causes from the side of the central nervous system:

• neoplasms in the pituitary gland or cranial fossa;
• squeezing of chiasms;
• multiple sclerosis.

Atrophic processes in the second pair of cranial nerves often develop as a result of purulent-inflammatory conditions. The main danger is brain abscesses, inflammation of its membranes.

Systemic risk factors

• diabetes;
• atherosclerosis;
• anemia;
• avitaminosis;
• hypertension;
• antiphospholipid syndrome;
• Wegener's granulomatosis;
• systemic lupus erythematosus;
• giant cell arteritis;
• multisystem vasculitis (Behçet's disease);
• nonspecific aortoarteritis (Takayasu's disease).

See also: Danger and prognosis for the optic nerve.

Significant nerve damage is diagnosed after prolonged starvation, severe poisoning, and volumetric blood loss. Alcohol and its surrogates, nicotine, chloroform and some groups of medicines have a negative effect on the structures of the eyeball.

Optic nerve atrophy in a child

In half of all cases of optic neuropathy in children, the cause is inflammatory infections of the central nervous system, brain tumors and hydrocephalus. Less commonly, the state of destruction is caused by skull deformity, cerebral anomalies, infections (mainly "children's"), and metabolic disorders. Particular attention should be paid to congenital forms of childhood atrophy. They indicate that the baby has brain diseases that arose even at the stage of intrauterine development.

Classification of optic neuropathy

All forms of optic nerve atrophy are hereditary (congenital) and acquired. Congenital are divided according to the type of inheritance, they often indicate the presence of genetic abnormalities and hereditary syndromes that require in-depth diagnosis.

Hereditary forms of AD

1. Autosomal dominant (juvenile). Predisposition to destruction of nerves is transmitted in a heterogeneous way. Usually the disease is detected in children under 15 years of age, it is recognized as the most common, but the weakest form of atrophy. It is always bilateral, although sometimes symptoms appear asymmetrically. Early signs are revealed by 2-3 years, and functional disorders only at 6-20 years. Possible combination with deafness, myopathy, ophthalmoplegia and distraction.
2. Autosomal recessive (infantile). This type of AD is diagnosed less often, but much earlier: immediately after birth or during the first three years of life. The infantile form is bilateral in nature, it is often detected in Kenny-Coffey syndrome, Rosenberg-Chattorian, Jensen or Wolfram disease.
3. Mitochondrial (Leber's atrophy). Mitochondrial optic atrophy is the result of a mutation in mitochondrial DNA. This form is classified as a symptomatology of Leber's disease, it occurs suddenly, reminiscent of external neuritis in the acute phase. Most of the patients are men aged 13-28.

Forms of acquired atrophy

• primary (squeezing of neurons in the peripheral layers, the optic disc does not change, the boundaries have a clear appearance);
• secondary (swelling and enlargement of the optic disc, blurred boundaries, replacement of axons with neuroglia is quite pronounced);
• glaucomatous (destruction of the lattice plate of the sclera due to surges in local pressure).

Destruction is ascending, when the axons of specifically cranial nerves are affected, and descending, with the involvement of the nerve tissues of the retina. According to the symptoms, one-sided and bilateral ADD are distinguished, according to the degree of progression - stationary (temporarily stable) and in constant development.

Types of atrophy according to the color of the optic disc:

• initial (slight blanching);
• incomplete (noticeable blanching of one segment of the optic disc);
• complete (change in shade over the entire area of ​​the optic disc, severe thinning of the nerve pillar, narrowing of the capillaries).

Symptoms of optic nerve atrophy

The degree and nature of optical disorders directly depends on which segment of the nerve is affected. Visual acuity can critically decrease very quickly. Complete destruction ends with absolute blindness, blanching of the optic disc with white or gray patches, narrowing of the capillaries in the fundus. With incomplete AZN, vision stabilizes at a certain time and no longer deteriorates, and optic disc blanching is not so pronounced.

If the fibers of the papillomacular bundle are affected, visual impairment will be significant, and the examination will show a pale temporal zone of the ONH. In this case, optical disorders cannot be corrected with glasses or even contact lenses. The defeat of the lateral zones of the nerve does not always affect vision, which complicates the diagnosis and worsens the prognosis.

ASD is characterized by a variety of visual field defects. The following symptoms allow suspecting optic neuropathy:, concentric constriction, effect, weak pupil reaction. In many patients, the perception of colors is distorted, although more often this symptom develops when axons die after neuritis. Often the changes affect the green-red part of the spectrum, but the blue-yellow parts of it can also be distorted.

Diagnosis of optic nerve atrophy

An expressive clinical picture, physiological changes and functional disorders greatly simplify the diagnosis of AD. Difficulties may arise when actual vision does not match the degree of destruction. For an accurate diagnosis, an ophthalmologist must study the patient's history, establish or refute the fact of taking certain medications, contact with chemical compounds, injuries, and bad habits. Differential diagnosis is carried out for peripheral lens opacity and amblyopia.

Ophthalmoscopy

Standard ophthalmoscopy allows to establish the presence of ASD and accurately determine the degree of its spread. This procedure is available in many conventional clinics and is inexpensive. The results of the study may differ, however, some signs are detected in any form of neuropathy: a change in the shade and contour of the ONH, a decrease in the number of vessels, narrowing of the arteries, and various defects in the veins.

Ophthalmoscopic picture of optic neuropathy:

1. Primary: clear disc borders, normal or reduced size of the ONH, there is a saucer-shaped excavation.
2. Secondary: grayish tint, blurred disc borders, enlargement of the optic disc, no physiological excavation, peripapillary reflex to light sources.

Coherence tomography

To study the nerve disk in more detail allows optical coherence or laser scanning tomography. Additionally, the degree of mobility of the eyeballs is assessed, the reaction of the pupils and the corneal reflex are checked, they are carried out with tables, visual field defects are examined, color perception is checked, and eye pressure is measured. Visually, the oculist establishes the presence.

Plain radiography of the orbit reveals the pathology of the orbit. Fluorescein angiography shows dysfunction of the vasculature. Doppler ultrasound is used to study local blood circulation. If the atrophy is due to infection, laboratory tests such as enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR) are performed.

Electrophysiological tests play a key role in confirming the diagnosis. Atrophy of the optic nerve changes the threshold sensitivity and lability of the nervous tissue. The rapid progression of the disease increases the indicators of retino-cortical and cortical time.

The level of reduction depends on the localization of neuropathy:

• when the papillomacular bundle is destroyed, the sensitivity remains at a normal level;
• damage to the periphery causes a sharp increase in sensitivity;
• atrophy of the axial bundle does not change sensitivity, but sharply reduces lability.

If necessary, check the neurological status (X-ray of the skull, CT or MRI of the brain). When a patient is diagnosed with a neoplasm in the brain or unstable intracranial pressure, a consultation with an experienced neurosurgeon is prescribed. With tumors of the orbit, it is necessary to include in the course of an ophthalmo-oncologist. If the destruction is associated with systemic vasculitis, you need to contact a rheumatologist. Pathologies of the arteries are dealt with by an ophthalmologist or vascular surgeon.

How is optic nerve atrophy treated?

The treatment regimen for each patient with optic neuropathy is always individual. The doctor needs to get all the information about the disease in order to make an effective plan. People with atrophy require urgent hospitalization, others are able to maintain outpatient treatment. The need for surgery depends on the cause of AD and symptoms. Any therapy will be ineffective when vision is weakened to 0.01 units and below.

It is necessary to begin treatment of optic nerve atrophy by identifying and eliminating (or stopping) the root cause. If cranial nerve injury is due to intracranial tumor growth, an aneurysm, or unstable cranial pressure, neurosurgery should be performed. Endocrine factors affect the hormonal background. Post-traumatic compression is corrected surgically by removing foreign bodies, removing chemicals, or limiting hematomas.

Conservative therapy for optic neuropathy is primarily aimed at inhibiting atrophic changes, as well as maintaining and restoring vision. Drugs are shown to expand the vasculature and small vessels, reducing capillary spasm and accelerating blood flow through the arteries. This allows all layers of the optic nerve to be supplied with sufficient nutrients and oxygen.

Vascular Therapy for AD

• intravenously 1 ml of nicotinic acid 1%, glucose for 10-15 days (or orally 0.05 g three times a day after meals);
• Nikoshpan tablet three times a day;
• intramuscularly 1-2 ml No-shpy 2% (or 0.04 g orally);
• intramuscularly 1-2 ml Dibazol 0.5-1% daily (or inside 0.02 g);
• 0.25 g of Nigexin three times a day;
• subcutaneously, 0.2-0.5-1 ml of sodium nitrate in an ascending concentration of 2-10% in a course of 30 injections (increase every three injections).

Decongestants are needed to reduce swelling, which helps reduce nerve and vascular compression. Anticoagulants are used to prevent thrombosis, the vasodilator and anti-inflammatory Heparin is recognized as the best. It is also possible to prescribe antiplatelet agents (prevention of thrombosis), neuroprotectors (protection of nerve cells), glucocorticosteroids (fight against inflammatory processes).

Conservative treatment of AD

1. To reduce inflammation in the nervous tissue and relieve swelling, a solution of dexamethasone is prescribed in the eye, intravenous glucose and calcium chloride, intramuscular diuretics (Furosemide).
2. A solution of strychnine nitrate 0.1% in a course of 20-25 subcutaneous injections.
3. Parabulbar or retrobulbar injections of Pentoxifylline, Atropine, xanthinol nicotinate. These funds help to speed up blood flow and improve the trophism of the nervous tissue.
4. Biogenic stimulants (FiBS, aloe preparations) in a course of 30 injections.
5. Nicotinic acid, sodium iodide 10% or Eufillin intravenously.
6. Vitamins orally or intramuscularly (B1, B2, B6, B12).
7. Antioxidants (glutamic acid).
8. Orally Cinnarizine, Riboxin, Piracetam, ATP.
9. Pilocarpine instillations to reduce eye pressure.
10. Nootropic drugs (Lipocerebrin).
11. Means with an antikinin effect (Prodectin, Parmidin) for symptoms of atherosclerosis.

In addition to medication, physiotherapy is prescribed. Oxygen therapy (administration of oxygen) and blood transfusion (urgent blood transfusion) are effective in AD. In the process of recovery, laser and magnetic procedures are prescribed, electrical stimulation and electrophoresis (administration of drugs using electric current) are effective. If there are no contraindications, acupuncture is possible (use of needles on active points of the body).

Surgical treatment of optic neuropathy

One of the methods of surgical treatment of the optic nerves is the correction of hemodynamics. The procedure can be performed under local anesthesia: a collagen sponge is placed in the sub-Tenon space, which stimulates aseptic inflammation and dilates blood vessels. Thus, it is possible to provoke the growth of connective tissue and a new vascular network. The sponge dissolves on its own after two months, but the effect persists for a long time. The operation can be carried out repeatedly, but with an interval of several months.

New branches in the vascular network help to improve the blood supply to nerve tissues, which stops atrophic changes. Correction of blood flow allows you to restore vision by 60% and eliminate up to 75% of visual field defects with timely treatment to the clinic. If the patient has severe comorbidities or atrophy has developed to a late stage, even hemodynamic correction will be ineffective.

With partial atrophy of the optic nerve, the use of a collagen implant is practiced. It is impregnated with antioxidants or drugs to expand the capillaries, after which it is injected into the eyeball without sutures. This method is effective only with stable eye pressure. The operation is contraindicated in patients over 75 years of age, with diabetes mellitus, severe somatic disorders and inflammation, as well as vision less than 0.02 diopters.

Prognosis for optic nerve atrophy

To prevent AD, it is necessary to regularly check the state of those organs that regulate the functioning of the visual system (CNS, endocrine glands, joints, connective tissue). In a severe case of infection or intoxication, as well as in case of severe bleeding, urgent symptomatic therapy should be carried out.

It is impossible to completely restore your vision after neuropathy even in the best clinic. A successful case is recognized when the patient's condition has stabilized, the ADS does not progress for a long time, and vision is partially restored. In many people, visual acuity remains permanently reduced, and there are also defects in lateral vision.

Some forms of atrophy are constantly progressing even during adequate treatment. The task of the ophthalmologist is to slow down atrophic and other negative processes. Having stabilized the symptoms, it is necessary to constantly carry out the prevention of ischemia and neurodegeneration. For this, long-term maintenance therapy is prescribed, which helps to improve the lipid profile of the blood and prevent the formation of blood clots.

The course of treatment for optic nerve atrophy should be repeated regularly. It is very important to eliminate all factors that can affect the axons of the optic nerve. A patient with optic neuropathy should visit specialists regularly as indicated. It is necessary to constantly carry out the prevention of complications and establish a lifestyle. Refusal of therapy for optic neuropathy inevitably leads to disability due to the total death of the nerves and irreversible blindness.

Any changes in the layers of the optic nerve adversely affect a person's ability to see. Therefore, it is necessary to undergo examinations in time for people with a predisposition and treat all diseases that contribute to optic nerve atrophy. Therapy will not help restore vision to 100% when the optic neuropathy has already developed sufficiently.