Damage to the optic nerve. Optic neuritis: types, symptoms and treatment. Clinic of damage to the optic nerve

Content

The eyes are an important organ, thanks to which people learn about the world around them, perceive a huge amount of information. It has a complex structure. A significant role is played by the optic nerve, which helps to perceive information from the retina in the form of impulses sent to the brain. A common disease is inflammation of the optic nerve, the symptoms and treatment of which you will learn below. This disease can lead to temporary loss of vision. However, with timely treatment, the function of the nerve is fully restored.

Symptoms of inflammation of the optic nerve

The defeat of the optic nerve is a pathology that is characterized by inflammation of the nerve sheaths or fibers. Its symptoms can be: soreness when moving the eyeballs, blurred vision, changes in color perception, photopsia, the eye may swell. Patients may complain of a decrease in the peripheral field of vision, vomiting, nausea, darkening in the eyes, fever. Each form of damage to the optic nerve has its own symptoms.

Intrabulbar neuritis develops suddenly and acutely, and the nerve is completely or partially affected. Total inflammation greatly impairs vision, sometimes blindness occurs. A characteristic sign of the disease is the formation of cattle. A person has impaired adaptation in the dark, the perception of colors. After a month, the symptoms may subside, and in severe cases, blindness and atrophy of nerve fibers develop.

Low vision is considered the most important clinical sign of intracranial retrobulbar inflammation. Symptoms include decreased ability to see, pain in the eye socket. The transversal form of retrobulbar neuritis is severe. In many cases, the person goes blind. During the first three weeks of the course of the disease, changes in the fundus are not observed, but they manifest themselves later.

Symptoms may vary depending on the causes that caused inflammation of the nerve:

• If the disease is caused by rhinitis, then the patient complains of a deterioration in visual acuity, poor perception of bright colors, and a change in the size of the blind spot.
• With syphilis, minor defects are observed in the form of reddening of the disc. In a severe form of the disease, sharpness and peripheral vision worsen.
• Neuritis caused by tuberculosis is characterized by the development of a tumor-like formation that completely covers the optic disc. Sometimes it goes to the retina.
• Damage to the optic nerve in typhus is considered dangerous. If the disease is neglected, then after a few weeks, nervous atrophy occurs.
• With malaria, one optic nerve suffers, swelling develops.

The reasons

One of the factors that can provoke diseases of the optic nerve is multiple sclerosis. This affects the myelin that covers the nerve cells of the spinal cord and brain. Damage to the brain immune system develops. People with brain disorders are at risk. Damage to the optic nerve is caused by autoimmune diseases such as sarcoidosis, lupus erythematosus.

Optic neuromyelitis leads to the development of neuritis. This happens because the disease is accompanied by inflammation of the spinal cord and optic nerve, but damage to brain cells does not occur. The appearance of neuritis is provoked by other factors:

• The presence of cranial arteritis, characterized by inflammation of the intracranial arteries. Violations occur in the blood circulation, the supply of the required amount of oxygen to the cells of the brain and eyes is blocked. Such phenomena provoke a stroke, loss of vision in the future.
• Viral, infectious, bacterial diseases, measles, syphilis, cat scratch disease, herpes, rubella, Lyme disease, neuroretinitis lead to inflammation of the nerve, the development of chronic or purulent conjunctivitis.
• Long-term use of certain drugs that can provoke the development of nerve inflammation (Ethambuton, prescribed in the treatment of tuberculosis).
• radiation therapy. It is prescribed for certain diseases that are difficult.
• A variety of mechanical effects - severe intoxication of the body, tumors, insufficient supply of nutrients to the cornea, retina.

Diagnostic methods

Methods for detecting inflammation of the optic nerve are based on clinical manifestations, since in most cases the pathology is not detected when examining the fundus. To exclude the presence of multiple sclerosis, a study of cerebrospinal fluid, MRI (magnetic resonance imaging) is performed. With the help of timely diagnosis, you can prevent and cure this disease, otherwise blindness and nerve atrophy will develop.

This diagnostic method refers to objective research methods when contrasting vessels inside the eye with fluorescein, which is administered intravenously. In pathological conditions, eye barriers that work normally are destroyed, and the bottom of the eye takes on a form that is characteristic of a particular process. The interpretation of fluorescein angiograms is based on a comparison of the characteristics of the passage of fluorescein through the wall of the retina and choroidal vessels with the clinical picture of the disease. The price of the study is 2500-3000 rubles.

Electrophysiological study

Such a diagnostic procedure is a series of highly informative methods for studying the functions of the retina, optic nerve, and areas of the cerebral cortex. An electrophysiological study of the eye is based on recording its response to specific stimuli. The ophthalmologist and the doctor who conducts the study work closely with each other to set the right task and decide on the diagnostic method. This study is considered the most informative and effective. The cost of diagnostics is 2500-4000 rubles.

Treatment

If inflammation is suspected, the patient requires urgent hospitalization. While the cause of the disease remains unknown, therapy is carried out to suppress the infection, reduce the intensity of the inflammatory process. Tablets are prescribed for desensitization, dehydration, improving metabolic processes in nerve fibers and tissues, and increasing the body's immune forces. Medical staff prescribe a course of antibiotics or sulfonamide solutions intramuscularly for up to seven days.

Treatment of neuritis involves the use of corticosteroids simultaneously with Prednisolone. Diacarb is taken orally, which reduces the severity of edema. At the same time, "Panangin" is prescribed to reduce symptoms, "Trental" or "Nicotinic acid" - to improve blood supply. Piracetam, a complex of vitamins of group B, is taken inside, injections of Actovegin are prescribed. For several months, "Dibazol" is prescribed.

When the cause of the development of the pathology is clarified, therapy is carried out aimed at its eradication (the use of antiviral drugs, anti-tuberculosis, etc.), further rehabilitation, prevention with the use of tablets and ointments. If bilateral toxic retrobulbar neuritis is diagnosed, which occurs in response to the administration of methyl alcohol, a similar treatment is prescribed without antibacterial drugs.

Which doctors should be contacted

With a decrease in vision, the occurrence of pain during the movement of the eyeballs, with narrowing and loss of parts of the field of vision, you should immediately contact an ophthalmologist. He deals with the treatment, diagnosis, and prevention of eye diseases. During the appointment, the ophthalmologist will carefully listen to your complaints, determine visual acuity, examine the transparent media of the eye, the fundus, and measure intraocular pressure. After that, he will prescribe additional diagnostic methods and treatment.

Where to treat eye disease

When choosing a clinic for the treatment of vision pathologies, pay attention to the ability of a medical institution to provide complete and timely diagnostics, effective and modern methods of therapy, and their cost. Consider the level of equipment of the hospital, the professionalism of specialists. The experience of doctors helps to achieve better results in the treatment of eye diseases. Below you will find a list of clinics in Moscow and St. Petersburg, where you can go for inflammation of the optic nerve:

• Clinic "Echinacea", Moscow, st. Skladochnaya, d. 6, p. 7. Treatment of neuritis is carried out here in four directions: examination, elimination of the factor that caused harm, stopping the destruction of the nerve, blocking the activity of the infection, stimulating regeneration.
• Moscow Eye Clinic, Moscow, Semenovsky lane, 11. This is a high-level ophthalmological center that provides treatment, prevention, and diagnosis of eye diseases. The clinic employs leading ophthalmologists who have extensive practical experience and scientific achievements. The medical institution is equipped with innovative world-class operating and diagnostic equipment, which allows complex operations and diagnostics to be carried out.
• Center for Eye Surgery, Moscow, Smolensky Boulevard, 2. The staff of this institution consists of international experts. The latest technology has been put into practice. The participation of specialists in pathology conferences, the study of new ophthalmological trends helps to ensure the safety and quality of services.
• Ophthalmological center ARTOKS, Moscow, st. Gilyarovsky, 39. This medical institution combines the main methods of traditional ophthalmology and modern technologies.
• Clinic "Medinef", St. Petersburg, st. Botkinskaya, 15, building. 1. A multidisciplinary highly professional medical institution that owns a unique method of preventing and predicting the early stages of diseases. The clinic cooperates with many medical institutes, leading medical institutions in Russia.
• Ophthalmological clinic "Excimer", St. Petersburg, Apraskin pereulok, 6. This medical institution has been operating for 17 years. Offers a full range of high-tech services for children and adults. The clinic has modern diagnostic equipment, unique microsurgical systems, uses advanced technologies and methods for solving various eye problems. It employs high-class ophthalmologists of various specializations.
• Eleos Medical Center, St. Petersburg, Bolshevik Ave., 25/1. The activity of this institution is based on the organization of the work of a wide range of specialists who are proficient in modern instrumental and clinical research methods.

Video

With untimely treatment of eye diseases, serious complications can develop. Neuritis has several forms, which are divided according to ophthalmoscopic and etiological classifications. The first is based on data obtained by examining the fundus, and the second is based on the cause that caused the dysfunction of the optic nerve. There are the following types of neuritis: retrobulbar form, neuroretinitis, papillitis. Each of these inflammations has symptoms and treatment, which you will learn about in the YouTube video below.

Damage to the optic nerve leads to loss of permanent vision. Depending on the degree of damage, people may experience partial or complete loss of vision in that eye. This damage is usually not reversible, so it is important to be proactive about eye health to prevent injury to the optic nerve as much as possible. Some people are born with damage to the optic nerve, resulting in developmental problems and may have limited or non-existent vision from birth.
The optic nerve transmits information from the retina to the brain and is part of the central nervous system. It consists of dense bundles of individual nerve cells that are very densely grouped to convey extremely detailed information. When damage to the optic nerve occurs, people may notice problems with their field of vision such as blackouts, mottling, complete darkness in one area, or blind spots. Problems such as blur and floaters are usually the result of eye problems.

One potential cause of damage to the optic nerve is inflammation caused by optic neuritis. Persistent untreated inflammation can cause nerve cells to begin to break down, hindering their ability to transmit information. Glaucoma, a condition people commonly associate with high pressure in the eyes, can also damage the optic nerve. Tumors can grow or press against a nerve, causing injury. Interruption of blood supply caused by vascular disease can also be a source of injury to this nerve.

Blunt head trauma can sometimes cause damage to the optic nerve. Although this nerve is isolated in the skull, penetrating damage to the eyeball can affect the nerve, or crush part of the head due to the injury, and this can compress the nerve, cut off the blood supply, and cause cells to die because they cannot get enough oxygen and nutrients. . Damage to the optic nerve can also be the result of mistakes made during surgery, although care must be taken during surgery to avoid this nerve, if at all possible in surgical procedures.

When patients experience problems with their vision, a physical examination to check for damage to the optic nerve is an important step in resolving the problem. The doctor can determine what's going on inside the eye and start developing plans to deal with the problem. People at higher risk of optic nerve damage, such as those with diabetes and high blood pressure, should see a doctor regularly to identify any early warning signs, with the goal of stopping the damage as soon as it starts to appear.

Update: December 2018

The quality of life is primarily affected by the state of our health. Free breathing, clear hearing, freedom of movement - all this is very important for a person. Violation of the work of even one organ can lead to a change in the usual way of life in a negative direction. For example, a forced refusal from active physical activity (jogging in the morning, going to the gym), eating delicious (and fatty) foods, intimate relationships, etc. This is most clearly manifested in the defeat of the organ of vision.

Most eye diseases proceed quite favorably for a person, since modern medicine is able to cure them or reduce the negative effect to nothing (correct vision, improve color perception). Complete and even partial atrophy of the optic nerve does not belong to this "majority". With this pathology, as a rule, the functions of the eye are significantly and irreversibly impaired. Often patients lose the ability to perform even daily activities and become disabled.

Can this be prevented? Yes, you can. But only with the timely detection of the cause of the disease and adequate treatment.

What is optic nerve atrophy

This is a condition in which the nervous tissue experiences an acute lack of nutrients, due to which it ceases to perform its functions. If the process continues long enough, neurons begin to gradually die off. Over time, it affects an increasing number of cells, and in severe cases, the entire nerve trunk. It will be almost impossible to restore the function of the eye in such patients.

To understand how this disease manifests itself, it is necessary to imagine the course of impulses to brain structures. They are conditionally divided into two portions - lateral and medial. The first one contains a “picture” of the surrounding world, which is seen by the inner side of the eye (closer to the nose). The second is responsible for the perception of the outer part of the image (closer to the crown).

Both parts are formed on the back wall of the eye, from a group of special (ganglion) cells, after which they are sent to various brain structures. This path is quite difficult, but there is only one fundamental point - almost immediately after leaving the orbit, a crossover occurs with internal portions. What does this lead to?

• The left tract perceives the image of the world from the left half of the eyes;
• The right one carries the "picture" from the right halves to the brain.

Therefore, damage to one of the nerves after it has left the orbit will result in a change in the function of both eyes.

The reasons

In the vast majority of cases, this pathology does not occur on its own, but is a consequence of another eye disease. It is very important to take into account the cause of optic nerve atrophy, or rather the place of its occurrence. It is from this factor that the nature of the symptoms in the patient and the characteristics of therapy will depend.

There may be two options:

1. Ascending type - the disease occurs from that part of the nerve trunk that is closer to the eye (before the crossover);
2. Descending form - the nervous tissue begins to atrophy from top to bottom (above the decussation, but before entering the brain).

The most common causes of these conditions are presented in the table below.

Treatment of optic nerve atrophy is closely related to identifying the cause. Therefore, close attention should be paid to its clarification. The symptoms of the disease can help in the diagnosis, which make it possible to distinguish the ascending form from the descending one.

Symptoms

Regardless of the level of the lesion (above the chiasm or below), there are two reliable signs of optic nerve atrophy - a loss of visual fields ("anopsia") and a decrease in visual acuity (amblyopia). How they will be expressed in a particular patient depends on the severity of the course of the process and the activity of the cause that caused the disease. Let's take a closer look at these symptoms.

Loss of visual fields (anopsia)

What does the term "field of view" mean? In fact, this is just a zone that a person sees. To imagine it, you can close half of the eye on either side. In this case, you see only half of the picture, since the analyzer cannot perceive the second part. We can say that you have “dropped out” one (right or left) zone. This is what anopsia is - the disappearance of the field of vision.

Neurologists divide it into:

• temporal (half of the image, located closer to the temple) and nasal (the other half from the side of the nose);
• right and left, depending on which side the zone falls on.

With partial atrophy of the optic nerve, there may be no symptoms, as the remaining neurons transmit information from the eye to the brain. However, if a lesion occurs through the entire thickness of the trunk, this sign will definitely appear in the patient.

What areas will fall out of the patient's perception? It depends on the level at which the pathological process is located and on the degree of cell damage. There are several options:

This neurological symptom seems difficult to perceive, but thanks to it, an experienced specialist can identify the site of the lesion without any additional methods. Therefore, it is very important that the patient speaks openly to his doctor about any signs of visual field loss.

Decreased visual acuity (amblyopia)

This is the second sign that is observed in all patients without exception. Only the degree of its severity varies:

1. Light - characteristic of the initial manifestations of the process. The patient does not feel a decrease in vision, the symptom manifests itself only when carefully examining distant objects;
2. Medium - occurs when a significant part of neurons is damaged. Distant objects are practically invisible, at a short distance the patient does not experience difficulties;
3. Severe - indicates the activity of the pathology. The sharpness is reduced so much that even nearby objects become difficult to distinguish;
4. Blindness (synonymous with amorrhosis) is a sign of complete atrophy of the optic nerve.

As a rule, amblyopia occurs suddenly and gradually increases, without adequate treatment. If the pathological process proceeds aggressively or the patient did not seek help in a timely manner, there is a possibility of developing irreversible blindness.

Diagnostics

As a rule, problems with the detection of this pathology are rare. The main thing is that the patient seeks medical help in a timely manner. To confirm the diagnosis, he is sent to an ophthalmologist for an examination of the fundus. This is a special technique with which you can examine the initial section of the nerve trunk.

How is ophthalmoscopy performed?. In the classic version, the doctor examines the fundus in a dark room, using a special mirror device (ophthalmoscope) and a light source. The use of modern equipment (electronic ophthalmoscope) allows you to conduct this study with greater accuracy. The patient does not require any preparation for the procedure and special actions during the examination.

Unfortunately, ophthalmoscopy does not always detect changes, since the symptoms of the lesion occur earlier than tissue changes. Laboratory studies (blood, urine, cerebrospinal fluid tests) are non-specific and have only auxiliary diagnostic value.

How to act in this case? In modern multidisciplinary hospitals, to detect the cause of the disease and changes in the nervous tissue, there are the following methods:

Therapy of the disease begins from the moment the patient contacts, since it is irrational to wait for the results of the diagnosis. During this time, the pathology may continue to progress, and changes in the tissues will become irreversible. After clarifying the cause, the doctor adjusts his tactics in order to achieve the optimal effect.

Treatment

It is widely believed in society that "nerve cells do not regenerate." This is not entirely correct. Neurocytes can grow, increase the number of connections with other tissues and take on the functions of dead "comrades". However, they do not have one property that is very important for complete regeneration - the ability to reproduce.

Can optic nerve atrophy be cured? Definitely not. With partial damage to the trunk, medications can improve visual acuity and visual fields. In rare cases, even virtually restore the patient's ability to see to normal levels. If the pathological process has completely disrupted the transmission of impulses from the eye to the brain, only surgery can help.

For successful treatment of this disease, it is necessary, first of all, to eliminate the cause of its occurrence. This will prevent/reduce cell damage and stabilize the pathology. Since there are a large number of factors that cause atrophy, the tactics of doctors can differ significantly in various conditions. If it is not possible to cure the cause (malignant tumor, hard-to-reach abscess, etc.), you should immediately start restoring the working capacity of the eye.

Modern methods of nerve restoration

Even 10-15 years ago, the main role in the treatment of optic nerve atrophy was assigned to vitamins and angioprotectors. Currently, they only have an additional meaning. Drugs that restore the metabolism in neurons (antihypoxants) and increase blood flow to them (nootropics, antiaggregants, and others) come to the fore.

The modern scheme for restoring the functions of the eye includes:

• Antioxidant and antihypoxant (Mexidol, Trimetazidine, Trimectal and others) - this group is aimed at restoring tissues, reducing the activity of damaging processes, and eliminating the "oxygen starvation" of the nerve. In a hospital, they are administered intravenously; in outpatient treatment, antioxidants are taken in the form of tablets;
• Microcirculation correctors (Actovegin, Trental) - improve metabolic processes in nerve cells and increase their blood supply. These drugs are one of the most important components of treatment. Available also in the form of solutions for intravenous infusions and tablets;
• Nootropics (Piracetam, Cerebrolysin, Glutamic acid) - stimulators of neurocyte blood flow. Accelerate their recovery;
• Drugs that reduce vascular permeability (Emoxipin) - protects the optic nerve from further damage. It was introduced into the treatment of eye diseases not so long ago and is used only in large ophthalmological centers. It is injected parabulbarno (a thin needle is passed along the wall of the orbit into the surrounding tissue of the eye);
• Vitamins C, PP, B 6 , B 12 are an additional component of therapy. These substances are believed to improve metabolism in neurons.

The above is a classic treatment for atrophy, but in 2010 ophthalmologists proposed fundamentally new methods for restoring the work of the eye, using peptide bioregulators. At the moment, only two drugs are widely used in specialized centers - Cortexin and Retinalamin. In the course of studies, it has been proven that they improve the condition of vision by almost two times.

Their effect is realized through two mechanisms - these bioregulators stimulate the restoration of neurocytes and limit damaging processes. The method of their application is quite specific:

• Cortexin - is used as an injection into the skin of the temples or intramuscularly. The first method is preferred, since it creates a higher concentration of the substance;
• Retinalamin - the drug is injected into the parabulbar tissue.

The combination of classical and peptide therapy is quite effective for nerve regeneration, but even it does not always achieve the desired result. Additionally, recovery processes can be stimulated with the help of directed physiotherapy.

Physiotherapy for optic nerve atrophy

There are two physiotherapy methods, whose positive effect is confirmed by scientific research:

• Pulsed magnetotherapy (PMT) - this method is not aimed at restoring cells, but at improving their work. Due to the directed action of magnetic fields, the contents of neurons “thicken”, which is why the generation and transmission of impulses to the brain is faster;
• Bioresonance therapy (BT) - its mechanism of action is associated with the improvement of metabolic processes in damaged tissues and the normalization of blood flow through microscopic vessels (capillaries).

They are very specific and are used only in large regional or private ophthalmological centers, due to the need for expensive equipment. As a rule, for most patients, these technologies are paid, so BMI and BT are used quite rarely.

Surgical treatment of atrophy

In ophthalmology, there are special operations that improve visual function in patients with atrophy. They can be divided into two main types:

1. Redistributing blood flow in the eye area - in order to increase the flow of nutrients to one place, it is necessary to reduce it in other tissues. For this purpose, part of the vessels on the face is tied up, which is why most of the blood is forced to go through the ophthalmic artery. This type of intervention is performed quite rarely, as it can lead to complications in the postoperative period;
2. Transplantation of revascularizing tissues - the principle of this operation is to transplant tissues with abundant blood supply (parts of the muscle, conjunctiva) into an atrophic area. New vessels will grow through the graft, which will ensure adequate blood flow to the neurons. Such an intervention is much more widespread, since other tissues of the body practically do not suffer from it.

A few years ago, methods of stem cell treatment were actively developed in the Russian Federation. However, an amendment to the country's legislation made these studies and the use of their results in humans illegal. Therefore, at present, technologies of this level can only be found abroad (Israel, Germany).

Forecast

The degree of vision loss in a patient depends on two factors - the severity of the damage to the nerve trunk and the time of initiation of treatment. If the pathological process has affected only part of the neurocytes, in some cases, it is possible to almost completely restore the functions of the eye, against the background of adequate therapy.

Unfortunately, with atrophy of all nerve cells and the cessation of impulse transmission, the patient is likely to develop blindness. The way out in this case may be surgical restoration of tissue nutrition, but such treatment is not a guarantee of restoration of vision.

FAQ

Question:
Could this disease be congenital?

Yes, but very rarely. In this case, all the symptoms of the disease described above appear. As a rule, the first signs are found at the age of up to a year (6-8 months). It is important to contact an ophthalmologist in a timely manner, since the greatest effect of the treatment is observed in children under 5 years of age.

Question:
Where can optic nerve atrophy be treated?

It should be emphasized once again that it is impossible to completely get rid of this pathology. With the help of therapy, it is possible to control the disease and partially restore visual functions, but it cannot be cured.

Question:
How often does the pathology develop in children?

No, these are quite rare cases. If a child has a diagnosed and confirmed diagnosis, it is necessary to clarify whether it is congenital.

Question:
What is the most effective treatment with folk remedies?

Atrophy is difficult to treat even with highly active drugs and specialized physiotherapy. Folk methods will not have a significant impact on this process.

Question:
Do disability groups give for atrophy?

It depends on the degree of vision loss. Blindness is an indication for the appointment of the first group, acuity from 0.3 to 0.1 - for the second.

All therapy is taken by the patient for life. In order to control this disease, short-term treatment is not enough.

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, neurons begin to gradually die off. Over time, it affects an increasing number of cells, and in severe cases, the entire nerve trunk. It will be almost impossible to restore the function of the eye in such patients.

What is the optic nerve?

The optic nerve belongs to the cranial peripheral nerves, but in essence it is not a peripheral nerve, neither in origin, nor in structure, nor in function. This is the white matter of the cerebrum, 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 whole process of converting light information. Its first and most significant function is to deliver visual messages from the retina to the areas of the brain responsible for vision. Even the smallest injury to this area can have serious complications and consequences.

The reasons

The development of optic nerve atrophy is caused by 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.

There are the following types of disease:

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

Factors leading to optic nerve atrophy can be eye diseases, CNS 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 feed the optic nerve, and also it 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, retinitis pigmentosa)
• Intoxication (quinine, nicotine and other drugs)
• Alcohol poisoning (more precisely, alcohol surrogates)
• Viral infections (ARI, 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 pathology.

Lead to secondary atrophy:

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

Atrophy of the optic nerve can be provoked by inflammation or dystrophy of the optic nerve, its compression or injury, which led to damage to the nerve tissues.

Types of disease

Atrophy of the optic nerve of the eye is:

• Primary atrophy (ascending and descending), as a rule, develops as an independent disease. Descending optic nerve atrophy is the most commonly diagnosed. This type of atrophy is a consequence of the fact that the nerve fibers themselves are affected. It is transmitted by recessive type by inheritance. This disease is linked exclusively to the X chromosome, which is why only men suffer from this pathology. It manifests itself in flight.
• Secondary atrophy usually develops after the course of a 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 such variants of this pathology:

Partial atrophy of the optic nerve

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 with reduced visual acuity (due to which the use of lenses or glasses does not improve the quality of vision). Residual vision, although it is subject to preservation in this case, however, there are violations in terms of color perception. Saved areas in the field of view remain accessible.

Complete atrophy

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 in a non-progressive form), which indicates a stable state of actual visual functions, as well as in the opposite, progressive form, in which the quality of visual acuity inevitably decreases.

Symptoms of atrophy

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 may 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 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 livestock;
• manifestation of the afferent pupillary effect.

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

Complications

The diagnosis of optic nerve atrophy is very serious. At the slightest decrease in vision, you should immediately consult a doctor so as not to miss your chance for recovery. In the absence of treatment and with the progression of the disease, 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, undergo regular examinations by specialists (rheumatologist, endocrinologist, neurologist, ophthalmologist). At the first sign of visual impairment, you should consult an ophthalmologist.

Diagnostics

Optic nerve atrophy is a rather 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 for the treatment of 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 (expand with special drops) of the entire fundus;
• spheroperimetry (accurate determination of the boundaries of the field of view);
• laser dopplerography;
• assessment of color perception;
• craniography with a picture of the Turkish saddle;
• computer perimetry (allows you to identify which part of the nerve is affected);
• video ophthalmography (allows you to identify the nature of damage to the optic nerve);
• computed tomography, as well as magnetic nuclear resonance (clarify the cause of the disease of the optic nerve).

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

Treatment of atrophy of the optic nerve of the eye

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

In the treatment of optic nerve atrophy, the following actions are performed:

1. Biogenic stimulants are prescribed (vitreous body, aloe extract, etc.), amino acids (glutamic acid), immunostimulants (eleutherococcus), vitamins (B1, B2, B6, ascorutin) to stimulate the restoration of altered tissue, as well as to improve metabolic processes are prescribed
2. Vasodilators are prescribed (no-shpa, diabazol, papaverine, sermion, trental, zufillin) - to improve blood circulation in the vessels that feed the nerve
3. Phezam, emoxipin, nootropil, cavinton are prescribed to maintain the work of the central nervous system.
4. To accelerate the resorption of pathological processes - pyrogenal, preductal
5. Hormonal drugs are prescribed to stop the inflammatory process - dexamethasone, prednisone.

Drugs are taken only as directed 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 sight or have lost it to a significant extent are assigned an appropriate course of rehabilitation. It is focused on compensating and, if possible, eliminating all the restrictions that arise in life after suffering atrophy of the optic nerve.

The main physiotherapeutic methods of therapy:

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

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

The earlier treatment is started, the better the prognosis of the disease. Nervous tissue is practically unrecoverable, so the disease cannot be started, it must be treated in a timely manner.

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

The prognosis of optic nerve atrophy is 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.

Prevention

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

• Consultation with a specialist at the slightest doubt in the visual acuity of the patient;
• Prevention of various types of intoxication
• timely treat infectious diseases;
• do not abuse alcohol;
• monitor blood pressure;
• prevent eye and craniocerebral injuries;
• repeated blood transfusion for profuse bleeding.

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

Discussion: 4 comments

My brother was diagnosed with this 5 years ago. Today I'll send him an article, let him read how dangerous it is

And my hooligan neighbor put her head against the wall with her head ... This is a frequent thing with mine. atrophy, which is still fresh after completed neuritis. ((((What will happen to me now ....

My husband is diagnosed with secondary atrophy of both eyes, alas, doctors cannot help us with anything. Is there a cure for this disease please help. Where can you get treatment?

Very clearly explained, thanks

Add a comment Cancel reply

© All information on the "Symptoms and Treatment" website is provided for informational purposes only. Do not self-medicate, but consult an experienced doctor. | User Agreement |

Optic nerve damage

Damage to the optic nerve most often occurs as a result of a violation of its integrity or infringement by bone fragments, hematoma of the orbit, hemorrhage between the sheaths of the optic nerve. Infringement or rupture is possible at different levels: in the orbit, in the optic nerve canal, in the cerebral zone. Symptoms of damage to the optic nerve - a decrease in visual acuity and a change in the field of view.

Infringement of the optic nerve is characterized by a decrease in visual acuity, a picture of thrombosis of the central retinal vein can be determined in the fundus, and in the case of a more severe injury, occlusion of the central retinal artery.

The rupture of the optic nerve may be partial or complete. In the first days after the injury, the fundus of the eye may be unchanged. Therefore, the patient's complaints about a sharp decrease or complete loss of vision may cause the physician to suspect aggravation. In the future, a picture of optic nerve atrophy develops in the fundus. The closer the gap is localized to the eyeball, the earlier changes occur in the fundus. With incomplete atrophy of the optic nerve, reduced vision and part of the visual field may be preserved.

Detachment of the optic nerve occurs in the case of severe blunt trauma in the medial part of the orbit (with the end of a stick, etc.), if the posterior part of the eye suddenly shifts strongly outward. The detachment is accompanied by a complete loss of vision, a large hemorrhage is first determined in the fundus, and subsequently a tissue defect in the form of a depression surrounded by hemorrhage.

Treatment. Assign hemostatic and dehydration therapy; if there is a suspicion of a hematoma of the orbit, a surgical incision is possible - orbitotomy. In the future, in conditions of partial atrophy of the optic nerve, repeated courses of ultrasound, vasodilating and stimulating therapy are carried out.

Wounds of the organ of vision. Damage to the organ of vision is divided into injuries of the orbit, appendages of the eye and the eyeball.

Wounds of the orbit, especially gunshot wounds, in their complexity, variety and characteristics, belong to extremely severe injuries. They can be isolated - with or without a foreign body in the orbit, combined - with simultaneous damage to the eyeball, combined - if the injury to the orbit is accompanied by injury to the craniocerebral region, face, paranasal sinuses.

All patients with injuries of the orbit are given x-rays in two projections.

Depending on the type of weapon (heavy blunt object, knife, glass, awl) that was injured, damage to the soft tissues of the orbit can be torn, cut, or stabbed.

Features of lacerations: loss of fatty tissue, damage to the external muscles of the eye, injury to the lacrimal gland, ophthalmoplegia, exophthalmos may occur.

Treatment. First, the wound is revised - its size and depth are determined, as well as its relation to the bone walls of the orbit. The ophthalmologist must first of all find out if it extends deep into the cranial cavity and paranasal sinuses. Then they resort to preliminary surgical treatment of the soft tissues of the orbit - the contaminated edges of the wound are economically cut off within 0.1-1 mm, the wound is washed with a solution of furacillin, antibiotics or hydrogen peroxide. According to indications, wound plasty is performed with adjacent tissues, catgut or other absorbable sutures are applied to damaged fascia, ligaments or muscles, silk sutures are applied to the skin.

Signs of stab wounds: exophthalmos, ophthalmoplegia, ptosis, which indicate a deep wound channel and trauma to the nerve trunks and vessels near the top of the orbit. One of the factors that determine the severity of stab wounds is damage to the optic nerve.

Treatment involves, first of all, a thorough revision of the wound channel and preliminary surgical treatment. Soft tissues are cut into 2-2.5 cm, the wound channel is examined carefully, in compliance with the principle of maximum tissue preservation. In the absence of a foreign body in the orbit and, after excluding the penetration of the wound channel into the cranial cavity or paranasal sinuses, the wound is sutured.

In case of incised wounds, the wound is revised and preliminary surgical treatment is carried out with the restoration of the anatomical ratios of the soft tissues of the orbit. The presence of a foreign body in the orbit significantly complicates the course of the traumatic process. Severe inflammatory tissue edema, exophthalmos, the presence of a wound passage from which pus is released indicate a possible entry of a wooden foreign body into the orbit. To determine its localization, an X-ray examination or computed tomography is performed, additional data can be obtained by ultrasound, including ultrasound scanning of the orbit.

After clarifying the localization of the foreign body in the orbit, it is removed by a simple orbitotomy, in the presence of magnetic fragments, magnets are used.

Fractures of the bony walls of the orbit are observed in almost half of all injuries of the orbit in peacetime. Fracture treatment is carried out jointly by an ophthalmologist, a neurosurgeon, an otolaryngologist and a dentist. Surgical treatment of wounds of the orbit in the early stages after injury makes it possible not only to eliminate the cosmetic defect, but also to restore the patient's vision.

Classification of damage to the optic nerve

1) Open damage - damage to the optic nerve with penetrating wounds of the skull and / or orbit.

2) Closed damage - damage to the optic nerve as a result of blunt trauma to the skull and facial skeleton.

1) Direct damage occurs as a result of direct contact of the traumatic agent with the ON.

2) Indirect damage occurs as a result of shock or compression effect of a traumatic agent on distant or surrounding bone structures. Characteristic is the decrease in vision after injury in the absence of signs of damage to the eyeball, which could lead to a decrease in visual functions.

1) Primary damage - damage in which there are morphological changes caused by mechanical energy, and occurred at the time of injury:

1.1. Hemorrhages in the nerve, membranes and intershell spaces of the nerve;

1.2. Contusion necrosis; 1.3 Gap:

a) anatomical (full or partial);

2.2. Necrosis due to local compression of the vessel or circulatory vascular insufficiency;

2.3. Nerve infarction due to vascular occlusion (spasm, thrombosis).

1) Anterior damage - damage to the intraocular region (ON disk) and part of the intraorbital region to the point of entry into it of the central retinal artery (RAS), while pathology is always detected in the fundus.

1) Unilateral damage to the AP.

2) Damage to the visual pathway at the base of the brain:

2.1. Bilateral damage to the optic nerve;

2.2. Chiasm damage;

2.3. Combined damage to the ON and chiasm;

2.4. Combined damage to the ON, chiasm and optic tract.

1) Damage with the presence of a fracture of the walls of the optic canal.

2) Damage with the presence of fractures of adjacent bone structures (the wall of the orbit, the anterior clinoid process, the lesser wing of the sphenoid bone).

3) Damage against the background of fractures of distant bone structures of the skull and facial skeleton.

4) Damage without the presence of fractures of the bone structures of the skull and facial skeleton.

1) For anterior injuries:

1.1. Violation of blood circulation in PAS;

1.2. Anterior ischemic neuropathy;

1.3. Evulsion (separation of the optic nerve from the eyeball);

2) For posterior injuries:

Concussion is defined as "a clinical syndrome characterized by an immediate and transient impairment of neurological function associated with exposure to a mechanical factor."

Contusion is defined histologically as "a structural tissue injury characterized by extravasation of blood and cell death".

The structure of the morphological substrate is dominated by secondary (ischemic) damage due to mechanical compression of the nerve. The compression of the ON is characterized by a progressive or delayed deterioration of visual functions after injury. With a delayed type of vision loss, visual functions are not changed immediately after the injury, and their primary deterioration is noted only after a while. In the progressive type of visual loss, the primary deterioration in visual function occurs immediately after the injury, while there is a partial visual deficit, which increases over time (secondary impairment). The period of time from the moment of injury to the primary or secondary deterioration of visual function (the "luminous gap") can take from several minutes and hours to several days after injury. A “light gap”, regardless of its duration, is an indication of the absence of an anatomical break in the ON and the presence of potentially reversible morphological changes.

1) the upper wall of the orbit;

2) The walls of the visual canal;

3) Anterior inclined process.

1.1. Retrobulbar hematoma;

1.2. Subperiosteal hematoma of the orbit.

2) Shell hematoma of the ON.

3.1. Frontobasal hematoma;

3.2. Convexital hematoma of the frontotemporal region.

1) Callus;

2) Scar tissue;

3) Adhesive arachnoiditis.

Injury to the optic nerve - direct damage to the optic nerve resulting from direct contact with a traumatic agent. Wounding of the optic nerve usually leads to its complete irreversible damage, with an anatomical interruption and the development of immediate amaurosis. However, partial damage is also possible. In this case, there is irreversible damage to some of the optic fibers, but intact fibers retain the potential to restore their function. In those cases where the direct impact of a traumatic agent on the ON does not lead to a violation of its integrity, a tangential wound occurs.

Currently, in most cases, the establishment of clinical forms of damage to the ON is very difficult. There is much in common in the presented characteristics of clinical manifestations. There are certain difficulties in their differentiation. At the same time, for practical purposes (indications for ON decompression, prognosis, rehabilitation potential, expert assessment, determination of the severity of TBI, etc.), clear gradations are required according to unified criteria. As the latter, visual impairments can serve. Considering that they vary widely, all damage to the ON is divided into three degrees of severity according to the severity of visual impairment: mild, moderate, severe (Tables 2-2).

Criteria for assessing the severity of damage to the ON

In the case of an immediate type of visual impairment, the severity of the optic nerve damage is assessed by the initial level of visual functions immediately after the injury. The severity of progressive or delayed types of visual disturbances must be assessed in dynamics according to their maximum severity in the acute period of injury.

2.1. Partial excitation conduction block;

2.2. Complete excitation conduction block.

3.1. Reversible - functional interruption of the ON;

3.2. Partially reversible - morpho-functional interruption of the ON;

3.3. Irreversible - morphological interruption of the ON.

Rice. 2 - 28. Classification of damage to the optic nerve.

Examples of formulations of the diagnosis in relation to damage to the ON:

Closed indirect light damage to the right optic nerve;

Closed indirect severe damage to the right ON and chiasm;

Closed indirect severe damage to the ON from 2 sides;

Closed indirect severe injury (contusion) of the intracanalicular part of the right ON, linear fracture of the upper wall of the right visual canal;

Closed indirect severe injury (contusion and compression) of the intracanalicular part of the right ON;

Closed indirect severe dislocation injury (compression) of the intracranial part of the right ON;

Open direct severe damage (wound) of the intraorbital part of the right ON with a complete anatomical break;

Open indirect severe injury (contusion) of the intraorbital part of the right ON.

To bruises of the brain include focal macrostructural damage to its substance resulting from an injury.

According to the unified clinical classification of TBI adopted in Russia, focal brain contusions are divided into three degrees of severity: 1) mild, 2) moderate, and 3) severe.

Diffuse axonal brain injuries include complete and / or partial widespread ruptures of axons in frequent combination with small-focal hemorrhages, caused by an injury of a predominantly inertial type. At the same time, the most characteristic territories of the axonal and vascular beds.

In most cases, they are a complication of hypertension and atherosclerosis. Less commonly, they are caused by diseases of the valvular apparatus of the heart, myocardial infarction, severe anomalies of the cerebral vessels, hemorrhagic syndrome and arteritis. There are ischemic and hemorrhagic strokes, as well as p.

Video about the sanatorium Hunguest Helios Hotel Anna, Heviz, Hungary

Only a doctor can diagnose and prescribe treatment during an internal consultation.

Scientific and medical news about the treatment and prevention of diseases in adults and children.

Foreign clinics, hospitals and resorts - examination and rehabilitation abroad.

When using materials from the site, the active reference is obligatory.

With traumatic brain injury (TBI), damage to the optic nerve (ON) often occurs. The human eye is a very fragile instrument that can be easily damaged. And we are talking not only about its external part, but also about its internal. Most often, injury occurs as a result of a strong mechanical impact on the head area. This leads to many negative consequences, the degree of complexity of which depends on the level of damage and the type of TBI.

general information

Experts note that such a problem as damage to the optic nerve is observed in approximately 5% of victims with traumatic brain injury. Most often, there is a lesion of the intracanal nerve section.

Basically, this type of injury occurs after a blow in the frontal or frontal-temporal part of the head. At the same time, experts note that the severity of skull damage does not always correlate with the level of damage to the optic nerve.

Therefore, it cannot be said that a strong blow to the head will necessarily lead to complete or partial loss of vision. In turn, even an injury that is insignificant at first glance can cause a strong deterioration in the visual process if the blow falls on a certain area.

The greatest danger is the injury to the frontal part of the head. Therefore, such blows must be avoided without fail so as not to lose sight.

Professionals argue that with a severe lesion of the fronto-orbital region, maximum nerve damage is possible, resulting in complete loss of vision and even amaurosis.

Some patients also suffer from loss of consciousness. But for some, blows to the frontal part of the head are reflected only by a deterioration in the visual process. This is a clear sign of damage to the AP.

Causes of damage to the optic nerve

ZN plays a very important role in the human body. This is a special transmitter that moves signals from the retina to the brain. The optic nerve is made up of millions of fibers, which in total are 50 mm long. This is a very vulnerable, but important structure that can be easily damaged.

As already noted, the most common cause of damage to the optic nerve is head trauma. However, this is far from the only possible factor in the disruption of signal transport. This may be the problem of intrauterine development, when the fetus, under the influence of certain processes, has an incorrect formation of the organs of vision.

In addition, inflammation can lead to damage to the optic nerve, which can concentrate in the area of ​​​​the eyes or brain. Both stagnation and atrophy have a negative impact on the ON. The latter may have a different origin.

Most often, it becomes a complication after a traumatic brain injury. But sometimes atrophic processes in the eyes occur due to poisoning and severe intoxication of the body.

Intrauterine damage to the ON

There can be many reasons for the appearance of lesions of the optic nerve. Therefore, if your vision deteriorates, you should definitely consult a specialist. The doctor prescribes a qualitative examination, and then determines the cause of the pathology.

With the right approach and appropriate treatment, you can achieve good results and restore the visual process to normal limits. The diagnosis is made only after a thorough examination of the patient and all the necessary tests. Each type of optic nerve injury has its own symptoms.

In the case when a patient has a traumatic brain injury, the cause of damage to the optic nerve can be easily determined. In this case, the patient must receive the correct treatment, otherwise the visual function may no longer be restored.

But there are situations when it is very difficult to determine the cause of damage to the AP. For example, when a patient suffers from a pathology that originates even during fetal development, it can be difficult to immediately make a diagnosis.

The formation of the optic nerve and many other elements responsible for the process of vision occurs in the period from 3 to 10 weeks of pregnancy. If the expectant mother at this time suffers any disease or her body is exposed to certain negative factors, the baby may develop congenital atrophy of the optic nerve.

Experts share 6 forms of this disease. Almost all of them have similar general symptoms. Initially, there is a strong drop in visual functions. In addition, the patient is always diagnosed with a change in the structure of small vessels, that is, patients suffer from microangiopathy.

Color perception and peripheral vision with abnormal development of the optic nerve will differ significantly from how people without such pathologies see the world.

With abnormal intrauterine development of MN, problems with the visual process remain for life, and it is impossible to completely cure the pathology. People with this diagnosis often suffer from various complications.

Incorrect visual perception of the external world makes patients nervous and irritable, as well as prone to migraines.

Inflammatory damage

Acquired vision problems can be caused by inflammation. The optic nerve is a very fragile structure, therefore, under the influence of certain factors, it suffers very much and quickly fails. If a person encounters a serious inflammatory process that will be localized in the head, the optic nerve may be injured, which will cause a deterioration in the visual function of the body.

Any inflammation is dangerous for vision. It can be a lesion of the brain, and the eyeball, and even the nose. Experts strongly recommend not to ignore the symptoms of the pathological process in the sinuses, throat and ear. Incorrect or missing treatment can cause damage to the optic nerve.

In medical practice, there were also such situations when banal caries led to blindness. Therefore, any inflammation must be treated, and this must be done in a timely manner in order to prevent complications.

Dangerous microorganisms can penetrate the vitreous body, and then move on. As a result, the inflammatory process passes to the eyes, and this can lead to complete damage to the optic nerve and total blindness. If the ON is partially damaged, the patient is likely to be diagnosed with atrophy.

A similar phenomenon is expressed in a strong deterioration or complete loss of vision. In addition, injury to blood vessels always occurs due to tissue swelling. But similar phenomena are also characteristic of many other diseases, so it is often difficult to make a correct diagnosis.

However, if the patient has caries, otitis media, sinusitis, or other inflammatory processes, it can be assumed that vision problems are associated with this.

Non-inflammatory damage

If any stagnant phenomenon occurs in the human body, which is most often associated with a violation of pressure, the patient may experience nerve damage, followed by atrophy. An increase in intracranial pressure can occur for several reasons.

One of the most dangerous factors causing congestion in the skull is an oncological neoplasm. But even benign tumors can put pressure on the organs of vision, which will lead to pinching and damage to the optic nerve.

The cause of a non-inflammatory process that provokes an injury to the optic nerve may be swelling of the brain, a violation of the structure of the bone structure, and even cervical osteochondrosis. All this can increase intracranial pressure. If it is too high, nerve damage will occur.

Experts note that partial atrophy is most often a symptom of a non-inflammatory lesion of the ON. That is, vision deteriorates, but does not disappear completely. As a rule, the patient feels problems with the visual process intermittently.

Complaints occur only at the stage when there is a strong increase in intracranial pressure. On examination, specialists often note hemorrhages that appear with strokes. However, if the pressure is very high, the eyes may turn completely red.

The danger of this phenomenon lies in the fact that its symptoms are rather mild at the first stage. Therefore, a person can simply ignore them. But already at this time damage and atrophy of the optic nerve will be noted. Therefore, when the first problems with vision appear, you should definitely consult a doctor.

If you do not solve the problem of intracranial pressure in a timely manner and do not get rid of the negative factor that provokes this process, you should not count on a complete restoration of vision. Ignoring unpleasant symptoms often causes complete blindness, so it is imperative to treat non-inflammatory damage to the optic nerve and prevent its atrophy.

Mechanical damage

Such phenomena are very dangerous for the visual process. They meet quite often. For example, people who get into car accidents often suffer from this. Here, in most cases, there is such an injury as a blow to the forehead, and this can threaten with complete loss of vision.

However, experts attribute not only craniocerebral injuries to mechanical damage to the optic nerves, but also exposure to toxins. Intoxication of the body, poisoning with alcohol, nicotine and various poisons is considered very dangerous. These cases are characterized by certain types of symptoms.

Exposure to harmful substances causes stomach problems, leading to nausea and vomiting, hearing loss and permanent damage to the optic nerve. Such changes in the body occur quickly and in a complex.

In addition, damage to the optic nerve can also be associated with previous diseases or chronic illnesses. If the patient suffers from diabetes or hypertension, or has recently suffered syphilis, it is possible that nerve damage will be one of the complications. That is why, with such diagnoses, patients often notice a sharp deterioration in visual function.

Initially, peripheral vision is damaged. The patient may not immediately pay attention to this problem, but already at this stage there is a serious damage to the nerve and its gradual atrophy. If you ignore the initial symptoms, over time, a person will no longer see the full picture normally.

Certain areas simply fall out of sight, and when you try to move your eyes, a strong pain symptom will be noted. Complications can be severe headaches and color blindness.

Such phenomena indicate that a person has big problems that need to be urgently treated. If the patient is diagnosed with damage to the ON, it is important for him to receive the correct therapy. It should be aimed primarily at eliminating the cause of the pathology. Until recently, people with such a diagnosis could not count on a complete restoration of vision.

Modern medicine offers effective solutions to eliminate pathology. However, some patients cannot be helped. Most often, congenital damage to the optic nerve and the most neglected cases are not subject to treatment. Therefore, do not delay with an appeal to an ophthalmologist. Self-diagnosis and ignoring the recommendations of a specialist can lead to complete atrophy of the optic nerve and total blindness.

Treatment

In order to eliminate the problem with damage to the optic nerve, it is necessary to conduct a comprehensive diagnosis. Based on the data obtained and after identifying the main cause of the pathology, it will be possible to prescribe the correct treatment procedures.

It must be borne in mind that nerve damage is not an independent disease. This problem always has an additional cause that must be eliminated. Otherwise, you should not count on improving visual function.

Experts strongly recommend that at the first deterioration of vision immediately undergo a diagnosis and begin treatment. This is the only opportunity not to miss the moment when you can solve the problem with medication. Most often, therapeutic therapy is aimed at removing puffiness and reducing intracranial pressure.

Basically, to stimulate blood circulation in the brain and reduce edema, No-shpu, Papaverine, Eufilin or Galidol are prescribed. In addition, anticoagulants such as Ticlid and Heparin can be used. Vitamin complexes and biogenic stimulants have a positive effect.

However, if the optic nerve lesion was caused by a traumatic brain injury, the patient may need surgery. Without surgery, it is impossible to get rid of a pinched nerve. Also, the problem cannot be solved without surgery if the damage to the optic nerve is caused by pressure on the organs of vision by the tumor.

Any medications for damage to the optic nerve should be prescribed by a doctor only after a thorough examination of the patient. Self-treatment for such a complex problem as visual impairment due to trauma to the optic nerve is categorically unacceptable. You need to be very careful with folk remedies. Their reception may not give the desired result, and the time that could be spent on a full-fledged treatment will be lost.

This is a condition in which the nervous tissue experiences an acute lack of nutrients, due to which it ceases to perform its functions. If the process continues long enough, neurons begin to gradually die off. Over time, it affects an increasing number of cells, and in severe cases, the entire nerve trunk. It will be almost impossible to restore the function of the eye in such patients.

To understand how this disease manifests itself, it is necessary to imagine the course of impulses to brain structures. They are conditionally divided into two portions - lateral and medial. The first one contains a “picture” of the surrounding world, which is seen by the inner side of the eye (closer to the nose). The second is responsible for the perception of the outer part of the image (closer to the crown).

Both parts are formed on the back wall of the eye, from a group of special (ganglion) cells, after which they are sent to various brain structures. This path is quite difficult, but there is only one fundamental point - almost immediately after leaving the orbit, a crossover occurs with internal portions. What does this lead to?

• The left tract perceives the image of the world from the left half of the eyes;
• The right one carries the "picture" from the right halves to the brain.

Therefore, damage to one of the nerves after it has left the orbit will result in a change in the function of both eyes.

The reasons

One of the factors that can provoke diseases of the optic nerve is multiple sclerosis. This affects the myelin that covers the nerve cells of the spinal cord and brain. Damage to the brain immune system develops. People with brain disorders are at risk. Damage to the optic nerve is caused by autoimmune diseases such as sarcoidosis, lupus erythematosus.

Optic neuromyelitis leads to the development of neuritis. This happens because the disease is accompanied by inflammation of the spinal cord and optic nerve, but damage to brain cells does not occur. The appearance of neuritis is provoked by other factors:

• The presence of cranial arteritis, characterized by inflammation of the intracranial arteries. Violations occur in the blood circulation, the supply of the required amount of oxygen to the cells of the brain and eyes is blocked. Such phenomena provoke a stroke, loss of vision in the future.
• Viral, infectious, bacterial diseases, measles, syphilis, cat scratch disease, herpes, rubella, Lyme disease, neuroretinitis lead to inflammation of the nerve, the development of chronic or purulent conjunctivitis.
• Long-term use of certain drugs that can provoke the development of nerve inflammation (Ethambuton, prescribed in the treatment of tuberculosis).
• radiation therapy. It is prescribed for certain diseases that are difficult.
• A variety of mechanical effects - severe intoxication of the body, tumors, insufficient supply of nutrients to the cornea, retina.

What can provoke the development of eye pathology? By and large, these are both congenital / inherited pathologies, and ordinary trauma in childhood. There are cases when people suffered a certain inflammatory disease, after which atrophy began to develop.

You should not exclude such factors as inflammation of the eyeball and its dystrophy, swelling and congestion, damage and subsequent compression of a certain part of the nerve, unexpected hemorrhage.

Symptoms

The defeat of the optic nerve is a pathology that is characterized by inflammation of the nerve sheaths or fibers. Its symptoms can be: soreness when moving the eyeballs, blurred vision, changes in color perception, photopsia, the eye may swell.

Patients may complain of a decrease in the peripheral field of vision, vomiting, nausea, darkening in the eyes, fever. Each form of damage to the optic nerve has its own symptoms.

Symptoms characteristic of optic nerve atrophy of any etiology:

• decrease in visual acuity in the distance, and patients note that vision has decreased sharply, more often in the morning, can be reduced to hundredths of a unit, but sometimes remains high;
• loss of visual field, which depends on the localization of the pathological process; central scotomas ("spots"), concentric narrowing of the visual field may be observed;
• violation of the perception of colors;
• complaints characteristic of the underlying disease.

Allocate 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 in different ways.

So, with the progression of atrophy, vision gradually decreases, which can lead to complete atrophy of the optic nerve and, accordingly, to complete loss of vision. This process can take from several days to several months.

With partial atrophy, the process stops at some stage and vision ceases to deteriorate. Thus, they distinguish progressive atrophy of the optic nerves and complete.

Visual impairment during atrophy can be very diverse. This can be a change in the fields of vision (more often a narrowing, when “side 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, while scotomas often appear, i.e. dark spots in any part of the field of view; It could also be a color vision disorder.

Since the optic nerve carries visual images, the most common signs of its inflammation are the following phenomena:

• a sharp deterioration in vision in one or both eyes;

• appearance of black and white vision. Color vision, as more perfect, suffers first of all;

• pain when moving the eyes. An optional symptom, may be absent if there are no signs of classic inflammation and swelling of the retrobulbar tissue;

As noted above, the defining symptom here is a sharp decrease in human visual acuity. It can manifest itself in different ways, depending on the type of atrophy. If the form is partial, the deterioration of vision at some stage simply stops, after which it stops falling. Accordingly, the progressive form is characterized by the fact that a person begins to see worse and worse and, in the end, completely loses sight.

Vision in ocular atrophy is impaired in a variety of ways. For example, the field of view changes (as a rule, they begin to narrow), and peripheral vision worsens altogether. A person develops symptoms of "tunnel" vision, when all objects are visible as if through a narrow tube.

The pathogenetic course and symptoms of optic neuropathy directly depend on the etiological factors that caused a particular disorder, and are characterized by some differences in visual impairment.

So, anterior ischemic optic neuropathy is characterized by:

• gradual painless loss of vision, usually aggravated during morning awakening;
• loss of the lower visual fields in the early stages of the disease, then the process includes the loss of the upper regions.

Posterior optic neuropathy is caused by spontaneous and sudden complete loss of vision at a certain point in the development of the pathological process.

Typical symptoms of optic neuritis are:

• sudden decrease in visual acuity;
• loss of color characteristics;
• pain in the eye sockets;
• photopsies;
• phenomena of visual hallucinations.

Optic neuritis is a curable disease with good remission and prognosis. However, in complicated cases, it is able to leave irreversible traces in the visual neurostructure, which can provoke neuropathic progress.

The toxic etiology of neuropathies usually causes acute loss of vision, but with a favorable prognosis in case of immediate medical attention. Irreversible processes of destructive changes in the neurons of the optic nerve begin 15-18 hours after taking methanol, during which time it is necessary to use an antidote, usually ethyl alcohol.

Other types of neuropathic conditions of the optic nerve have identical symptoms of a gradual loss of visual acuity and color qualities. It is worth noting that in the first place, the perception of red shades always decreases, followed by all other colors.

Regardless of the level of the lesion (above the chiasm or below), there are two reliable signs of optic nerve atrophy - a loss of visual fields ("anopsia") and a decrease in visual acuity (amblyopia). How they will be expressed in a particular patient depends on the severity of the course of the process and the activity of the cause that caused the disease. Let's take a closer look at these symptoms.

Loss of visual fields (anopsia)

What does the term "field of view" mean? In fact, this is just a zone that a person sees. To imagine it, you can close half of the eye on either side. In this case, you see only half of the picture, since the analyzer cannot perceive the second part. We can say that you have “dropped out” one (right or left) zone. This is what anopsia is - the disappearance of the field of vision.

Neurologists divide it into:

• temporal (half of the image, located closer to the temple) and nasal (the other half from the side of the nose);
• right and left, depending on which side the zone falls on.

With partial atrophy of the optic nerve, there may be no symptoms, as the remaining neurons transmit information from the eye to the brain. However, if a lesion occurs through the entire thickness of the trunk, this sign will definitely appear in the patient.

Diagnostics

Methods for detecting inflammation of the optic nerve are based on clinical manifestations, since in most cases the pathology is not detected when examining the fundus. To exclude the presence of multiple sclerosis, a study of cerebrospinal fluid, MRI (magnetic resonance imaging) is performed. With the help of timely diagnosis, you can prevent and cure this disease, otherwise blindness and nerve atrophy will develop.

Fundus fluorescein angiography

This diagnostic method refers to objective research methods when contrasting vessels inside the eye with fluorescein, which is administered intravenously. In pathological conditions, eye barriers that work normally are destroyed, and the bottom of the eye takes on a form that is characteristic of a particular process.

The interpretation of fluorescein angiograms is based on a comparison of the characteristics of the passage of fluorescein through the wall of the retina and choroidal vessels with the clinical picture of the disease. The price of the study is 2500-3000 rubles.

Electrophysiological study

Such a diagnostic procedure is a series of highly informative methods for studying the functions of the retina, optic nerve, and areas of the cerebral cortex. An electrophysiological study of the eye is based on recording its response to specific stimuli.

The ophthalmologist and the doctor who conducts the study work closely with each other to set the right task and decide on the diagnostic method. This study is considered the most informative and effective.

The cost of diagnostics is 2500-4000 rubles.

Diagnosis of this disease is carried out by an ophthalmologist together with other specialists. It is performed in several stages, the first of which is an examination by an ophthalmologist, who will refer the patient for additional examinations.

Stages of diagnostics in the office of an ophthalmologist:

1. Determination of visual acuity - the study is carried out using special tables or a projector of signs. In rare cases, visual acuity remains within 0.8-0.9, more often there is a decrease to hundredths of a unit.
2. Kinetic perimetry: in case of optic nerve disease, there will be a narrowing of the visual field to green and red.
3. Computer perimetry: carried out to more accurately determine the presence of livestock ("blind spots"), their number and properties. The light sensitivity and threshold sensitivity of the retina are examined.
4. Examination of the reaction of pupils to light: in the presence of a disease on the side of the lesion, the reaction to light decreases.
5. Tonometry (determination of intraocular pressure) is performed to exclude the glaucomatous process.
6. EFI (electrophysiological examination of the eyes): during this examination, visual evoked potentials are examined; these are signals generated in the nervous tissue in response to stimulation, and with atrophy of the optic nerves, their intensity decreases.
7. Ophthalmoscopy: examination of the fundus and optic disc. During this procedure, the ophthalmologist sees:

• with primary atrophy, the disc is white or grayish-white, the boundaries are clear, a decrease in the number of small vessels on the disc, narrowing of the circumdiscal vessels and thinning of the retinal nerve fiber layer;
• with secondary atrophy, the disc is gray, the boundaries are fuzzy, a decrease in the number of small vessels on the disc;
• with glaucomatous atrophy, the disc is white or gray, the boundaries are clear, pronounced excavation (deepening of the central part of the disc), shift of the vascular bundle.

Consultations of related specialists:

1. A consultation with a therapist is carried out to identify diseases that can cause disturbances in the optic nerve and lead to its atrophy.
2. Consultation with a neurologist to rule out multiple sclerosis.
3. A consultation with a neurosurgeon is prescribed if an increase in intracranial pressure is suspected.
4. A consultation with a rheumatologist is indicated in the presence of complaints characteristic of vasculitis.

The diagnosis of toxic damage to the optic nerve is established on the basis of anamnestic data, studying the reaction of pupils to light, ophthalmoscopy, visometry, perimetry, and computed tomography (CT). In most patients, it is possible to confirm the relationship between the development of symptoms and exposure to toxins.

Ophthalmoscopy can determine the stage of the disease. At stage I, slight hyperemia of the optic nerve head (OND) and vascular injection are visualized.

At stage II, edema of the optical fibers joins. Stage III is characterized by severe ischemia.

Stage IV is considered as terminal, manifested by degenerative and atrophic changes in nerve fibers.

In the acute course of the disease, the reaction to the pupils to light is sluggish. Conducting visiometry indicates a decrease in visual acuity.

The method of ophthalmoscopy allows visualizing the swelling of the ONH. With a complete loss of vision, the white color of the optic disc, vasospasm are determined.

The method of perimetry makes it possible to establish concentrically narrowed visual fields and to uncover central scotomas. In the chronic form of the disease, there is a moderate decrease in visual acuity (0.2-0.3).

Ophthalmoscopically confirmed the waxy hue of the optic disc, pronounced spasm of arterioles. Conducting perimetry indicates a concentric narrowing of the visual field.

On CT, small-focal atrophic changes in the optic nerve head are visualized.

The diagnosis of optic neuropathy includes a sufficient set of methods and tools to determine the nature of the course of the pathology and the prognosis of its cure. As you know, neuropathy is more often a secondary disease caused by individual diseases, so the anamnesis plays a leading role in diagnosing types of neuropathy.

Outpatient ophthalmological examinations include a range of procedures.

• Examination of the fundus.
• Classic visual acuity test.
• Spheroperimetric diagnostics, which allows to determine the boundaries of the visual fields.
• Assessment of color perception.
• X-ray examination of the skull with the obligatory inclusion of the hypothalamic region in the image.
• The methods of computed tomography and cerebral magnetic resonance are of decisive importance in clarifying the local causes that caused the development of optic neuropathy.

Treatment

Treatment of atrophy of the optic nerve drug and physiotherapy:

• Drug treatment is effective only in case of compensation of the underlying disease and visual acuity of at least 0.01. If the cause of atrophy is not eliminated, a decrease in visual functions will also be observed against the background of neuroprotective therapy.
• Physiotherapy is carried out in the absence of contraindications to this type of treatment. Main contraindications: stage 3 hypertension, severe atherosclerosis, fever, neoplasms (tumors), acute pyoinflammatory processes, condition after a heart attack or stroke within 1-3 months.

Stages of treatment:

1. Treatment of the underlying disease, if detected, is carried out by an appropriate specialist, more often in a hospital setting. The prognosis of the course of optic nerve atrophy depends on the timely detection of the disease.
2. Refusal of bad habits allows you to stop the progression of the disease and preserve the visual functions of the patient.
3. Direct acting neuroprotective agents protect the axons (fibers) of the optic nerve. The choice of a specific drug is carried out taking into account the leading role of one or another pathological factor (hemodynamic disturbance or regional ischemia).
4. Neuroprotective agents of indirect action affect the risk factors that contribute to the death of optic nerve cells. The choice of the drug is carried out individually.
5. Magnetotherapy.
6. Electro-laser stimulation of the optic nerve.
7. Acupuncture.

The last three items are physiotherapy procedures. They are prescribed to improve blood circulation, stimulate reduced metabolic processes, increase tissue permeability, improve the functional state of the optic nerve, which ultimately corrects the state of visual functions. All treatment is carried out in a hospital setting.

Neuroprotective agents of direct action:

• methylethylpyridinol (Emoxipin) 1% injection;
• pentahydroxyethylnaphthoquinone (Histochrome) 0.02% injection.

Neuroprotective agents of indirect action:

• Theophylline tablets 100 mg;
• Vinpocetine (Cavinton) 5 mg tablets, injection;
• Pentoxifylline (Trental) injection 2%, tablets 0.1 g;
• Picamilon tablets 20 mg and 50 mg.

Treatment of optic nerve atrophy is a very difficult task for physicians. You need to know that destroyed nerve fibers cannot be restored.

One can hope for some effect from the treatment only when the functioning of the nerve fibers that are in the process of destruction, which still retain their vital activity, is restored. If you miss this moment, then the vision in the sore eye can be lost forever.

When treating atrophy, it must be borne 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, the treatment of optic nerve atrophy must be combined with the elimination of the cause that caused it.

In case of timely elimination of the cause and if atrophy has not yet developed, within 2-3 weeks to 1-2 months, the fundus picture normalizes and visual functions are restored.

The treatment is aimed at eliminating edema and inflammation in the optic nerve, at improving its blood circulation and trophism (nutrition), restoring the conductivity of incompletely destroyed nerve fibers.

But it should be noted that the treatment of optic nerve atrophy is lengthy, the effect of it 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 which complex treatment is carried out directly for atrophy of the optic nerve. To do this, prescribe various forms of drugs: eye drops, injections, both general and local; tablets, electrophoresis. Treatment is aimed at

The tactics of treating toxic damage to the optic nerve depends on the stage and characteristics of the course of the disease. At stage I, patients are shown detoxification therapy.

Intensive dehydration and the appointment of anti-inflammatory drugs are recommended at stage II. At stage III, it is advisable to introduce antispasmodics.

With the development of stage IV, in addition to vasodilators, the complex of therapeutic measures should include immunomodulators, multivitamin complexes and physiotherapeutic methods of treatment (magnetotherapy, physioelectrotherapy in combination with electrolaser therapy).

The most difficult task for the attending physician is competently prescribed treatment. This is due to the fact that it is no longer possible to restore dead nerve fibers, although a certain effect in this area can be achieved. We are talking about fibers that are in the active stage of destruction.

All methods of treatment can be divided into three types:

• Conservative. The doctor prescribes a whole series of drugs with a different spectrum of effects. For example, papaverine and no-shpa improve blood circulation in the affected nerve, nootropil improves the functions of the nervous system, hormonal drugs stop the inflammation process.
• Therapeutic. Patients are prescribed a fairly wide range of procedures, including magnetic stimulation, acupuncture, laser or electric current stimulation. As a rule, patients undergo such treatment every few months in separate courses.
• Surgical. It involves the elimination of pathological formations that compress the patient's nerve, the implantation of biogenic materials and the subsequent ligation of the temporal artery. This improves the overall circulation of the nerve and its further vascularization.

The main direction of therapeutic schemes for the treatment of optic neuropathy is the inhibition of pathological processes developing in the parenchyma of the optic trunk, if possible, their complete exclusion, as well as the restoration of lost visual qualities.

As already mentioned, optic neuropathy is a secondary pathology initiated by other diseases. Proceeding from what, first of all, the treatment of primary diseases is carried out under regular monitoring of the state of the optic nerve and attempts to restore its organic characteristics.

Several methods are available for this purpose.

• Magnetic stimulation of optic nerve neurons using an alternating electromagnetic field.
• Electrical stimulation of the nerve trunk by conducting currents of a special frequency and strength through the parenchyma of the optic nerve. This method is invasive and requires a highly skilled specialist.

The essence of both methods is to stimulate the metabolic processes of the optic nerve fibers, which partially contributes to their regeneration due to the body's own forces.

One of the most effective treatments for optic neuropathy is autologous stem cell transplantation therapy.

The common background of every therapeutic regimen is the traditional conservative support.

• Vasodilator drugs.
• Tonics.
• B group vitamins.
• In some cases, especially in toxic neuropathy, blood transfusions are used.

Surgical treatment is the main method of therapy for squeezing the optic nerve, its traumatism or infiltration.

It is widely believed in society that "nerve cells do not regenerate." This is not entirely correct. Neurocytes can grow, increase the number of connections with other tissues and take on the functions of dead "comrades". However, they do not have one property that is very important for complete regeneration - the ability to reproduce.

Can optic nerve atrophy be cured? Definitely not. With partial damage to the trunk, medications can improve visual acuity and visual fields. In rare cases, even virtually restore the patient's ability to see to normal levels. If the pathological process has completely disrupted the transmission of impulses from the eye to the brain, only surgery can help.

Complications of optic nerve atrophy

Timely diagnosis of optic neuropathy allows you to start treatment at an early stage. This allows you to prevent destructive processes in the optic nerve, maintain and even increase visual acuity. However, it is impossible to fully restore visual function due to damage and death of nerve cells.

Late treatment can lead to threatening consequences: not only loss of visual acuity, color sensitivity, but also the development of complete blindness.

In order to prevent

Prevention of this disease consists in maintaining a healthy lifestyle, timely treatment of concomitant diseases, and avoiding hypothermia.

To prevent the death of the optic nerve, it is necessary:

• prevent the development of inflammatory processes in the body, infectious diseases, stop them;
• avoid eye damage and brain injury;
• regularly visit an oncologist and conduct appropriate studies for the timely diagnosis of the disease and treatment;
• do not drink alcohol, stop smoking;
• monitor daily blood pressure;
• monitor proper nutrition;
• lead a healthy lifestyle with sufficient physical activity.

Forecast and consequences

The degree of vision loss in a patient depends on two factors - the severity of the damage to the nerve trunk and the time of initiation of treatment. If the pathological process has affected only part of the neurocytes, in some cases, it is possible to almost completely restore the functions of the eye, against the background of adequate therapy.

Unfortunately, with atrophy of all nerve cells and the cessation of impulse transmission, the patient is likely to develop blindness. The way out in this case may be surgical restoration of tissue nutrition, but such treatment is not a guarantee of restoration of vision.