Symptoms and causes of optic nerve atrophy. Optic nerve atrophy: symptoms and treatment. Partial optic nerve atrophy Central retinal degeneration Partial optic nerve atrophy

A rapid decrease in vision may indicate various eye diseases. But rarely does anyone think that it can be caused by such a dangerous disease as optic nerve atrophy. The optic nerve is an important component in the perception of light information. Therefore, it is worth considering this disease in more detail so that it is possible to determine the symptoms in the early stages.

What it is?

The optic nerve is a nerve fiber responsible for processing and transmitting light information. The main function of the optic nerve is the delivery of nerve impulses to the region of the brain.

The optic nerve is attached to the ganglionic neurocytes of the retina, which make up the optic nerve head. Light rays, converted into a nerve impulse, are transmitted along the optic nerve from retinal cells to the chiasm (the segment where the optic nerves of both eyes intersect).

Where is the optic nerve

Its integrity provides high. However, even the smallest injury to the optic nerve can lead to serious consequences. The most common disease of the optic nerve is its atrophy.

Optic nerve atrophy is an eye disease in which degradation of the optic nerve occurs, followed by a decrease in vision. With this disease, the optic nerve fibers completely or partially die off and are replaced by connective tissue. As a result, the light rays falling on the retina of the eye are converted into an electrical signal with distortions, which narrows the field of view and reduces its quality.

Depending on the degree of damage, atrophy of the optic nerve is partial or complete. Partial atrophy of the optic nerve differs from complete atrophy by a less pronounced manifestation of the disease and the preservation of vision at a certain level.

Vision correction by traditional methods (, contact lenses) for this disease is absolutely ineffective, since they are aimed at correcting the refraction of the eye and have nothing to do with the optic nerve.

The reasons

Optic nerve atrophy is not an independent disease, but is a consequence of any pathological process in the patient's body.

optic nerve atrophy

The main causes of the disease include:

Eye diseases (diseases of the retina, eyeball, eye structures).
Pathologies of the central nervous system (brain damage due to syphilis, brain abscess, skull trauma, brain tumors, multiple sclerosis, encephalitis, meningitis, arachnoiditis).
Diseases of the cardiovascular system (atherosclerosis of cerebral vessels, arterial hypertension, vasospasm).
Long-term toxic effects of alcohol, nicotine and drugs. Alcohol poisoning with methyl alcohol.
hereditary factor.

Optic nerve atrophy can be congenital or acquired.

Congenital atrophy of the optic nerve occurs as a result of genetic diseases (in most cases, Leber's disease). In this case, the patient has a poor quality of vision from birth.

Acquired atrophy of the optic nerve appears due to certain diseases at an older age.

Symptoms

The main symptoms of partial atrophy of vision can be:

Deterioration of the quality of vision and the inability to correct it with traditional methods of correction.
Pain on moving the eyeballs.
Changing the perception of colors.
Narrowing of the visual fields (up to the manifestation of a tunnel syndrome, in which the ability to peripheral vision is completely lost).
The appearance of blind areas in the field of view (scotomas).

Laser vision correction methods can be seen in.

Stages of optic nerve atrophy

Diagnostics

Usually, the diagnosis of this disease does not cause much difficulty. As a rule, the patient notices a significant decrease in vision and turns to an ophthalmologist who establishes the correct diagnosis. Of great importance is the identification of the cause of the disease.

To detect atrophy of the optic nerve in a patient, a complex of diagnostic methods is performed:

(study of visual acuity).
Spheroperimetry (determination of visual fields).
Ophthalmoscopy (detection of blanching of the optic disc and narrowing of the vessels of the fundus).
Tonometry (measurement of intraocular pressure).
Video ophthalmography (examination of the relief of the optic nerve).
(examination of areas of the affected nerve).
Computed tomography and magnetic nuclear resonance (a study of the brain to identify possible causes that caused atrophy of the optic nerve).

Read what computer perimetry in ophthalmology determines.

In addition to an ophthalmological examination, the patient may be prescribed an examination by a neuropathologist or neurosurgeon. This is necessary for the reason that the symptoms of optic nerve atrophy may be symptoms of an incipient intracranial pathological process.

Treatment

Treatment of optic nerve atrophy is quite complicated. Destroyed nerve fibers cannot be restored, therefore, first of all, it is necessary to stop the process of changes in the tissues of the optic nerve. Since the nervous tissue of the optic nerve cannot be restored, visual acuity cannot be raised to its previous level. However, the disease must be treated to avoid its progression and the occurrence of blindness. The prognosis of the disease depends on the start of treatment, so it is advisable to immediately contact an ophthalmologist when the first symptoms of the disease are detected.

The difference between partial atrophy of the optic nerve and complete atrophy is that this form of the disease is treatable and it is still possible to restore vision. The main goal in the treatment of partial optic nerve atrophy is to stop the destruction of the tissues of the optic nerve.

The main efforts should be aimed at eliminating. Treatment of the underlying disease will stop the destruction of the tissues of the optic nerve and restore visual function.

Against the background of treatment of the underlying disease that caused atrophy of the optic nerve, complex therapy is carried out. Additionally, in the treatment, drugs can be used to improve blood supply and nutrition of the optic nerve, improve metabolism, eliminate swelling and inflammation. It will not be superfluous to use multivitamins and biostimulants.

As the main drugs use:

Vasodilator drugs. These drugs improve blood circulation and trophism in the tissues of the optic nerve. Complamin, papaverine, dibazol, no-shpu, halidor, eufillin, trental, sermion can be distinguished among the drugs of this group.
Drugs that stimulate the restoration of altered tissues of the optic nerve and improve metabolic processes in it. These include biogenic stimulants (peat, aloe extract), amino acids (glutamic acid), vitamins and immunostimulants (eleuthorococcus, ginseng).
Drugs that resolve pathological processes and metabolism stimulants (phosphaden, pyrogenal, preductal).

It must be understood that drug therapy does not cure optic nerve atrophy, but only improves the condition of the nerve fibers. To cure optic nerve atrophy, it is necessary to first cure the underlying disease.

Physiotherapeutic procedures are also important, which are used in combination with other methods of treatment. Also, methods of magnetic, laser and electrical stimulation of the optic nerve are effective. They help to improve the functional state of the optic nerve and visual functions.

As an additional treatment, the following procedures are used:

Magnetostimulation. In this procedure, the optic nerve is affected by a special device that creates an alternating magnetic field. Magnetostimulation helps to improve blood supply, saturate the tissues of the optic nerve with oxygen, and activate metabolic processes.
Electrical stimulation. This procedure is carried out using a special electrode, which is inserted behind the eyeball to the optic nerve and electrical impulses are applied to it.
Laser stimulation. The essence of this method is non-invasive stimulation of the optic nerve through the cornea or pupil using a special emitter.
ultrasound therapy. This method effectively stimulates blood circulation and metabolic processes in the tissues of the optic nerve, improves the permeability of the hematoophthalmic barrier and the sorption properties of eye tissues. If the cause of optic nerve atrophy is encephalitis or tuberculous meningitis, then the disease will be quite difficult to treat with ultrasound.
Electrophoresis. This procedure is characterized by the effect on the tissues of the eye of a direct current of low power and medicines. Electrophoresis promotes the expansion of blood vessels, improves cell metabolism and normalizes metabolism.
Oxygen therapy. This method consists in saturating the tissues of the optic nerve with oxygen, which helps to improve their metabolic processes.

During the treatment of optic nerve atrophy, it is imperative to observe the full quality of nutrition, saturated with various vitamins and minerals. It is necessary to use fresh vegetables and fruits, cereals, meat, dairy products more often.

What products improve eyesight, see.

It is not recommended to treat the disease with folk remedies, since in this case they are ineffective. If you rely only on folk remedies, you can lose precious time, when you could still save the quality of vision.

Complications

It must be remembered that optic nerve atrophy is a serious disease and should not be treated on its own. Improper self-treatment can lead to sad consequences - complications of the disease.

The most serious complication can be complete loss of vision. Ignoring treatment leads to further development of the disease and a steady decrease in visual acuity, as a result of which the patient will no longer be able to lead a former lifestyle. Very often, with atrophy of the optic nerve, the patient receives a disability.

Prevention

To avoid the occurrence of optic nerve atrophy, it is necessary to treat diseases in a timely manner, contact an ophthalmologist in time with a decrease in visual acuity, and not expose the body to alcohol and drug intoxication. Only if you treat your health with due attention can you reduce the risk of disease.

Video

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

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

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

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

Causes of optic nerve atrophy

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

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

Primary optic nerve atrophy

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

Secondary optic nerve atrophy

Pathology occurs as a result of edema of the optic disc in diseases of the retina or the nerve itself (inflammation, swelling, poisoning with surrogate alcohol, quinine, trauma, etc.).

Symptoms

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

Diagnostics

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

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

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

Treatment of partial atrophy of the optic nerve

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

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

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

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

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

Causes of optic nerve atrophy

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

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

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

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

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

Consider the most common causes of AD:

Primary diseases affecting the optic nerve: chronic glaucoma, retrobulbar neuritis, traumatic optic neuropathy, formations that compress the optic nerve (eg, tumors, aneurysms).
Primary diseases of the retina, for example, occlusion of the central artery or central retinal vein.
Secondary diseases of the optic nerve: ischemic optic neuropathy, chronic neuritis or edema of the optic nerve.

Less common causes of AD:

Hereditary optic neuropathy (for example, Leber's optic neuropathy).
Toxic neuropathy, which can be caused by exposure to methanol, certain drugs (disulfiram, ethambutol, isoniazid, chloramphenicol, vincristine, cyclosporine, and cimetidine), alcohol and tobacco abuse, metabolic disorders (eg, severe renal failure).
Retinal degeneration (for example, retinitis pigmentosa).
Retinal storage diseases (eg, Tay-Sachs disease)
radiation neuropathy.
Syphilis.

Classification of optic nerve atrophy

There are several classifications of ADS.

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

The ascending ADS looks like this:

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

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

According to the ophthalmoscopic classification, there are:

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

According to the degree of damage to the nerve fibers, there are:

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

Symptoms of optic nerve atrophy

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

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

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

If a young patient complains of pain in the eyes associated with their movement, the presence of neurological symptoms (for example, paresthesia, ataxia, weakness in the limbs), this may indicate the presence of demyelinating diseases.

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

In children, a recent history of flu-like symptoms or recent vaccination suggests parainfectious or post-vaccination optic neuritis.

Diplopia and facial pain suggest multiple cranial nerve neuropathy seen in inflammatory or neoplastic lesions of the posterior orbit and the anatomical region around the sella turcica.

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

Diagnosis of optic nerve atrophy

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

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

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

How to treat optic nerve atrophy?

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

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

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

Treatment of descending optic nerve atrophy caused by an intracranial tumor or hydrocephalus is aimed at eliminating compression of the nerve fibers by the neoplasm.
In the case of inflammatory diseases of the optic nerve (neuritis) or ischemic neuropathy, intravenous corticosteroids are used.
With toxic neuropathy, antidotes are prescribed for those substances that caused damage to the optic nerves. In the event that atrophy is caused by drugs, their administration is stopped or the dose is adjusted.
Neuropathy due to nutritional deficiencies is treated with dietary modifications and the administration of multivitamin preparations that contain micronutrients necessary for good vision.
With glaucoma, conservative treatment is possible, aimed at lowering intraocular pressure, or performing a surgical operation.

In addition, there are methods of physiotherapy, magnetic, laser and electrical stimulation of the optic nerve, which are aimed at the maximum possible preservation of the functions of nerve fibers.

There are also scientific works that have shown the effectiveness of the treatment of AD with the introduction of stem cells. With the help of this still experimental technique, it is possible to partially restore vision.

Prognosis for ASD

The optic nerve is part of the central rather than peripheral nervous system, which makes it impossible to regenerate after damage. Thus, AD is irreversible. Treatment of this pathology is aimed at slowing down and limiting the progression of the degeneration process. Therefore, every patient with optic nerve atrophy should remember that the only place where you can cure this pathology or stop its development is the ophthalmology departments in medical institutions.

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

Prevention

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

Atrophy of the optic nerve is a consequence of the degeneration of its fibers. It can be caused by many diseases, from glaucoma and circulatory disorders (ischemic neuropathy) to inflammation (eg, multiple sclerosis) and nerve-compressing masses (eg, intracranial tumors). Effective treatment is possible only at the stage of partial atrophy of the optic nerve. The choice of method of therapy depends on etiological factors. In this regard, it is necessary to establish the correct diagnosis in time and direct all efforts to preserve vision.

Useful video about optic nerve atrophy

Optic nerve atrophy is the destruction of the nerve fibers that perceive visual stimuli through the retina and send them to the brain. The destruction of fibers can be not only complete, but also partial. With this pathology, vision is reduced or lost completely. The observed fields may narrow, color perception may be disturbed, the optic disk of the optic disc may turn pale.

The ophthalmologist makes such a diagnosis after examination with an ophthalmoscope, color perception testing, perimeter testing, craniography, visual acuity testing, CT, brain, eye scanning with ultrasound, etc.

Treatment of the disease will be aimed at eliminating the cause that led to such serious consequences. Restoration of the optic nerve is a complex process that requires a competent approach. With some types of pathology, this is not possible. Especially dangerous is atrophy of the optic nerves of both eyes.

What is atrophy

Diseases of the optic nerve are diagnosed by ophthalmologists less often (1-1.5%). Only a fifth of them eventually lead to complete blindness.

The essence of the problem is that during the destruction of the optic nerve, the axons of the cells that form the retina are destroyed. The cells themselves are deformed, and the nerve becomes thinner, its capillaries are destroyed. More often than not, adults suffer from this disease. In infants, it is caused by infectious diseases, hydrocephalus, hereditary syndromes, and autoimmune diseases.

The process itself can develop in different ways, it can be quite fast or relatively slow. Often there is a blockage of blood vessels, which has an extremely negative effect on the condition of the nerve tissues. A person loses visual acuity, and this happens quite abruptly. If it is possible to achieve an improvement in the blood supply to the nerve tissues, they cease to be destroyed and even partially restored.

Please note that such negative factors can lead to atrophy: severe alcohol poisoning, damage to the body by viral infections, eye diseases, hereditary predisposition, severe profuse bleeding, hypertension, atherosclerosis, tumors.

Atrophy is the result of many diseases in which swelling, inflammation, compression, damage to blood vessels or nerve fibers of the eyes appear. You can restore vision if you immediately start treatment, until the atrophy itself has completely affected the nerve.

Let's understand the reasons

The causes of optic nerve atrophy are quite diverse. The most common are tumors, neurological pathologies, infections, diseases of large and small vessels.

All factors are divided into several groups:

diseases of the eyes themselves;
dysfunction of the central nervous system;
intoxication;
injury;
general diseases, etc.

Often, atrophy can be caused by ophthalmic causes:

glaucoma;
occlusion of the artery that feeds the retina;
death of retinal tissue;
uveitis;
myopia;
neuritis, etc.

A tumor or disease of the orbit can damage the nerve.

If we talk about diseases of the central nervous system, then pituitary tumors, inflammatory diseases (meningitis, encephalitis, arachnoiditis, abscess), multiple sclerosis, (head injuries), and injury to the optic nerve when the face is damaged are in the lead.

Even prolonged hypertension, beriberi, starvation, intoxication can cause atrophy. Among the latter, poisoning with technical alcohol, chlorophos, nicotine, etc. is very dangerous. Sudden blood loss, anemia, diabetes can also adversely affect the condition of the optic nerve fibers.

Serious damage to the body by infection can lead to atrophy. Dangerous and toxocariasis and toxoplasmosis.

Atrophy is also congenital, and in an infant it may not be detected immediately. This reduces his chances of restoring visual function. Often this disease appears in premature babies, it can also be inherited from parents. A newborn cannot say that he sees poorly or that something hurts him, therefore parents should carefully monitor the behavior of the crumbs. At the first suspicion, you should consult a doctor.

Acrocephaly, macrocephaly, microcephaly, dysostosis, hereditary syndromes lead to the congenital form. In a fifth of cases of visual atrophy, its causes cannot be determined at all.

Classification

Optic nerve atrophy can be both acquired and hereditary. In the latter case, deafness often joins. It can be relatively light or heavy.

Acquired ailment can be primary, secondary, glaucomatous. In primary atrophy, the peripheral neurons of the optic nerve are compressed. The boundaries of the ONH remain clear.

With atrophy of the secondary optic disc, edematous, a pathological process occurs in the retina or nerve. Nerve fibers are eventually replaced by neuroglia, which causes the diameter of the optic disc to grow, and its boundaries become blurred.

With glaucomatous optic atrophy, due to high intraocular pressure, collapse and death of the cribriform plate of the sclera occurs.

The ophthalmologist can determine, as the color of the optic disc changes, at what stage the pathological process is (initial stage, partial, complete atrophy). At the initial stage, the optic disc becomes slightly pale, the nerve itself retains the correct color. If the atrophy is partial, only part of the nerve (segment) turns pale. At full - the entire disk turns pale and thinner, the vessels of the fundus narrow, can be damaged.

According to the location, atrophy is distinguished:

ascending and descending;
unilateral and bilateral.

As it progresses, it happens:

stationary;
progressive.

Symptoms

Symptoms may vary in their manifestation. It all depends on the root cause of the disease. The main symptom is reduced vision, and this process cannot be corrected either with lenses or with glasses. How quickly vision is lost depends on the type of atrophy, its cause. If it is a progressive type, then vision may decrease in just a few days. The result can be total blindness.

With partial atrophy of the optic nerves, pathological changes reach a certain limit and then stop in development. A person loses sight partially.

With atrophy, visual function is impaired. Fields of vision may narrow (peripheral vision disappears), tunnel vision may appear, the patient may perceive colors inadequately, dark spots may appear before the eyes. On the affected side, the pupil stops responding to light.

The so-called blind or dark spots are a typical manifestation of optic nerve atrophy. Often, patients complain that they see dark spots before their eyes.

Secondary atrophy can manifest itself in different ways. One of the common causes of the secondary process is tabes. This is a late manifestation of syphilis, in which many organs and systems are affected. Also, the disease can manifest itself due to paralysis, which progresses. Fields of vision begin to narrow, visual function suffers greatly.

If the cause is sclerosis of the carotid artery, the patient develops hemianopsia - blindness of half of the visual field. After profuse bleeding, with unfavorable development, blindness can also occur. It is characterized by the fact that the lower fields of vision fall out.

To find out exactly whether it is atrophy, you need to undergo a complete examination by an ophthalmologist.

Atrophy in children

If there are suspicions that the child has a visual impairment, he must be examined by an ophthalmologist. It is extremely important to identify such a lesion at an early stage, then the prognosis will be as favorable as possible.

The development of atrophy in children is often associated with a hereditary factor. It is also caused by intoxication, inflammation of the brain tissues, their swelling, damage to the eyeball, pathology of pregnancy, problems with the National Assembly, tumors, hydrocephalus, injuries, etc.

Manifestation in children

It is difficult to identify such a serious pathology in a child, especially when it comes to infants. All hope for the vigilance of doctors. They are able to identify the pathology in the first days of the child's life during the examination. Be sure the doctor must examine the pupils of the crumbs, determine how they react to light, how the eyes follow the movement of the object.

If the pupil does not react to light, is dilated, and the child does not follow the object, this is considered a bone sign of the presence of a pathological process.

It is important for parents to respond in time to the onset of symptoms and immediately show the child to an ophthalmologist. Untimely treatment or its absence can lead to partial or complete blindness.

congenital atrophy

This form is the most difficult to treat. It accompanies many congenital pathological syndromes.

If atrophy is detected, the doctor must establish its degree, cause, find out how damaged the nerve fiber is.

If we talk about the diagnosis of children, then it is complicated by the fact that the child cannot tell about his subjective sensation or visual impairment. This is where preventive care comes into play. They will help to identify the pathology at an early stage.

It is also important that the parents themselves carefully monitor the state of the child. It is they who can notice that the child began to behave unusually, stopped responding to movement around the periphery, looks closely at objects, bumps into them, etc.

Treatment of optic nerve atrophy in children is not much different from getting rid of pathology in adults. The drugs and their doses can only differ. In some cases, emergency surgery is indicated. Among drugs, it is important to use those that improve blood circulation, constrict blood vessels. Along with them, vitamins, drugs to stimulate metabolic processes are prescribed.

Diagnostics

At first glance, this diagnosis leaves no chance of restoring vision, but this is a delusion. In four cases out of five, vision can be restored at least partially. During the diagnosis, the ophthalmologist must definitely find out what concomitant diseases the patient has, whether he is taking medication, whether he can come into contact with chemicals, whether he has bad habits. All this can cause damage to the optic nerve.

Visually, the doctor can determine whether the patient's eyeball is protruding, whether it is mobile (the patient must look down, up, left, right), how correctly the pupils react, and whether there is a corneal reflex. He must check visual acuity, color perception, perimeter.

The main diagnostic method is ophthalmoscopy. It helps to examine the optic nerve disc in detail, to find out if it has turned pale, if its contours and color are blurred. The number of small vessels on the disk may decrease, the caliber of the arteries on the retina may narrow, and the veins may change. To confirm or refute the diagnosis, tomography can additionally be used.

With EVP (electrophysiological examination), the doctor may detect increased sensitivity of the optic nerve. If we are talking about glaucomatous form, the doctor can use a tonometer.

Plain radiography is used to study the orbit. Doppler ultrasound is used to study blood flow. Often, additional consultations with a neurologist, x-ray of the skull, MRI, CT scan of the brain are required. If a neoplasm of the brain, increased intracranial pressure was detected, a consultation with a neurosurgeon will also be needed.

Consultation with a rheumatologist is required for systemic vasculitis. With tumors of the orbit, the help of an ophthalmo-oncologist is needed. If damage to large blood vessels is detected, you need to contact a vascular surgeon, an ophthalmologist. If there is a suspicion that an infection is present, PCR and ELISA tests are prescribed.

It is important to exclude amblyopia, peripheral cataract, as their symptoms are very similar to signs of atrophy.

Treatment

If atrophy of the optic nerve is detected, the treatment rests solely with the ophthalmologist. At his disposal are many modern methods of treatment and quite effective drugs. The main thing is not to get rid of the atrophy itself, as a consequence, but to fight its cause.

Attempts to treat such a serious pathology at home with the help of dubious folk remedies look sad. The patient thus loses precious time and chances for recovery. It is impossible to get rid of optic nerve atrophy if its cause is not eliminated!

Most often, optic nerve atrophy is not an independent disease, but a consequence of the development of some pathological process. Diseases, including infectious ones, can lead to atrophy. Infections quickly damage the optic nerve. Injuries, dysfunction of large vessels, genetic abnormalities, autoimmune lesions, etc. are also dangerous.

If it is precisely established that the cause is a tumor, hypertension, neurosurgical intervention is performed. A successful operation will save the patient's vision, and in some cases life.

With conservative treatment, every effort should be made to preserve the remaining vision as much as possible. The treatment regimen is selected exclusively by an ophthalmologist. Sometimes he works with other specialists.

It is very important to ensure the removal of infiltrate during the inflammatory process, improve blood circulation, the state of blood vessels, and nerve trophism. It is necessary to monitor the indicators of intraocular pressure.

To maximize the effect of the treatment, the doctor may prescribe acupuncture, physiotherapy, magnetotherapy.

If vision falls below 0.01, treatment will not be effective.

Forecast

What will be the prognosis of treatment is affected by how timely it is started and adequately selected. It is extremely important to start it at the earliest stage of development of the pathological process. With a favorable course, vision can not only be restored, but even slightly improved. But it should be understood that it will not be possible to completely restore it.

If the atrophy is progressive, even with very active treatment, it can end in complete blindness.

Prevention

This pathology largely depends on the attitude of a person to his health. Often, the death of the tissues of the optic nerve manifests itself as a complication after the flu, acute respiratory viral infections, it often happens at a late stage in the development of syphilis.

It is extremely important to take care of the timely prevention of such a dangerous pathology. It is necessary to treat eye, endocrine, neurological, infectious diseases, inflammatory processes in the body in time. Since intoxication is very dangerous, poisoning should be avoided, work with chemicals carefully, and do not drink alcoholic beverages.

In the event of profuse bleeding, it is necessary to immediately provide a blood transfusion of the desired group.

It is important to immediately consult an ophthalmologist in case of visual impairment.

So, atrophy of the optic nerve is not so common. The current level of development of medicine, ophthalmology, can quite successfully deal with this disease. With proper treatment, partially visual functions can be restored. It is important not only to choose the right drugs and take them according to the prescribed scheme, but also to eliminate the cause that led to atrophy.

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

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

Classification of optic nerve atrophy

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

primary atrophy. It occurs due to disruptions in the nutrition of nerve fibers and circulatory disorders. The disease has an independent nature.
secondary atrophy. A mandatory factor in the existence of a disease is the presence of other diseases. In particular, these are deviations associated with the optic nerve head.
congenital atrophy. The tendency of the organism to the appearance of the disease is observed from birth.
glaucomatous atrophy. Vision remains at a stable level for a long time. The cause of the disease is vascular insufficiency of the cribriform plate as a result of increased intraocular pressure.
partial atrophy. Part of the optic nerve is affected, which ends the spread of the disease. Vision is deteriorating.
complete atrophy. The optic nerve is completely affected. If the development of the disease is not stopped, blindness may occur.
complete atrophy. The deviation has already formed. The spread of the disease stopped at a certain stage.
progressive atrophy. The rapid development of the atrophic process, which can lead to complete blindness.
descending atrophy. Irreversible changes in the optic nerves develop slowly.

An explanation of how partial atrophy differs from complete we see here:

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

Optic nerve atrophy ICD-10 code

H47.2 Optic nerve atrophy
Paleness of the temporal half of the optic disc

Causes of atrophy

Despite the fact that there are a lot of causes of optic nerve atrophy, in 20% of cases the exact factor that results in the development of the disease cannot be established. The most influential causes of atrophy include:

Pigmentary retinal dystrophy.
Inflammation of nerve tissues.
Defects of blood vessels located in the retina.
Increased intraocular pressure.
Spasmodic manifestations related to the vessels.
Purulent inflammation of the brain tissue.
Inflammation of the spinal cord.
Multiple sclerosis.
Diseases of an infectious type (from simple SARS to more serious diseases).
Malignant or benign tumors.
Various injuries.

Primary descending atrophy can be caused by hypertension, atherosclerosis, or deviations in the development of the spine. The causes of the secondary type of the disease are poisoning, inflammation and injury.

Why does atrophy occur in children

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

Genetic deviation.
Intrauterine and other types of poisoning.
Wrong course of pregnancy.
Hydrocephalus of the brain.
Deviations in the development of the central nervous system.
Diseases affecting the apple of the eye.
Skull deformed from birth.
Inflammatory processes in the brain.
The formation of tumors.

As we can see, the main causes of damage to the nerve cells of the visual organs in children are genetic abnormalities and the wrong way of life of the mother during pregnancy.

One case of infantile atrophy is presented in this commentary:

Symptoms of the disease

Consider the clinical picture for each type of atrophy. The primary form of this disease is characterized by the isolation of the boundaries of the nerves of the disc of the eye, which has acquired an in-depth look. The arteries inside the eye are constricted. With a secondary type of disease, the reverse process is noticeable. Nerve boundaries blur, and blood vessels dilate.

Congenital atrophy is accompanied by an inflammatory process behind the eyeball. In this case, it is impossible to focus vision without the occurrence of unpleasant sensations. The resulting image loses the sharpness of the lines and looks blurry.

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

Common signs for all types of optic nerve atrophy are such manifestations:

Limitation of the functionality of the eyes.
External change of the visual disc.
If the capillaries in the macula are damaged, the disease affects central vision, which is reflected in the appearance of seals.
The field of view narrows.
The perception of color spectra changes. First of all, this problem is associated with green shades, and then with red ones.
If the nerve tissues of the periphery are affected, the eyes do not adapt well to changes in distance and illumination.

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

hereditary atrophy. Types and symptoms

Hereditary atrophy of the optic nerves has several forms of manifestation:

Infantile. Decreased vision in full occurs from 0 to 3 years. The disease is recessive.
Juvenile blindness. The optic disc turns pale. Vision is reduced to 0.1-0.2. The disease develops in the period from 2 to 7 years. She is dominant.
Opto-oto-diabetic syndrome. Appears in the age range from 2 to 20 years. Concomitant diseases - various types of diabetes, deafness, problems with urination, cataracts, pigmented retinal dystrophy.
Ber's syndrome. Severe disease, which is characterized by a decrease in vision in the first year of life to 0.1-0.05. Concomitant deviations - strabismus, symptoms of neurological disorders and mental retardation, damage to the organs of the pelvic region.
Atrophy depending on gender. In most cases, the disease develops in male children. From early childhood, it begins its manifestation and gradually worsens.
Lester's disease. The age from 13 to 30 years is the period in which the disease occurs in 90% of cases.

Symptoms

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

Diagnosis of optic nerve atrophy

Such studies help to identify the presence of atrophy:

Spheroperimetry - determination of the visual field.
Determination of the degree of visual acuity.
Examination of the fundus with a slit lamp.
Measurement of intraocular pressure.
Computer perimetry - helps to determine the damaged tissue area.
Dopplerography using laser equipment - shows the characteristics of blood vessels.

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

Treatment of optic nerve atrophy

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

Stimulant drugs.
Drugs that dilate blood vessels. Among them are Papaverine and Noshpa.
tissue therapy. For these purposes, the use of vitamin B and intravenous administration of nicotinic acid are prescribed.
Medicines against atherosclerosis.
Drugs that regulate blood clotting. This may be Heparin or subcutaneous injections of ATP.
ultrasonic impact.
Reflex therapy in the form of acupuncture.
The use of trypsin enzymes.
Intramuscular administration of Pyrogenal.
The procedure of vagosympathetic blockade according to Vishnevsky. It is an injection of a 0.5% solution of Novocaine into the area of the carotid artery in order to dilate blood vessels and block sympathetic innervation.

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

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

Here is a possible clinical picture with atrophy and a scheme for its treatment:

A complex of medical and physiotherapeutic measures helps to speed up the healing process. Treatment is aimed at improving metabolism and blood circulation. Spasms and thrombosis that disrupt these processes are eliminated.

Some cases of the disease provide for the possibility of surgical intervention. A medical preparation, the patient's own tissues or donor materials are placed in the retrobulbar space, which contribute to the restoration of damaged areas and the growth of new blood vessels. It is also possible to install an electrical stimulator. It remains in the orbit of the eye for several years. In most cases of treatment of a timely noticed disease, vision can be preserved.

Disease prevention

Measures that will minimize the risk of atrophy are a standard list:

Treat diseases of infectious origin in time.
Eliminate the possibility of injury to the brain and visual organs.
Visit the oncologist regularly to notice oncological diseases in time.
Avoid excessive consumption of alcoholic beverages.
Track your blood pressure.

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