Partial atrophy of the optic nerve (chazn) causes, diagnosis and treatment. Atrophy of the optic nerve: treatment, symptoms, causes of complete or partial damage Atrophy of the optic nerves of both eyes treatment is possible

Under the atrophy of the optic nerve understand the gradual death of the optic nerve and its replacement with connective tissue. A whole group of various pathological conditions can lead to this disease. From what degree of damage to the optic nerve and how much vision is reduced, partial or complete atrophy of the optic nerve is distinguished. With partial atrophy, residual vision is preserved, but color perception suffers, visual fields are narrowed, it cannot be corrected with glasses or lenses. However, the process stops there.

Causes of the disease

Causes of incomplete atrophy of the optic nerve can be:

Eye diseases (damage to the retina, optic nerve fibers, glaucoma, inflammatory diseases, myopia, compression of the optic nerve by a tumor);

Brain damage with;

Infectious diseases (meningitis, encephalitis, arachnoiditis, brain);

Diseases of the central nervous, cardiovascular systems (multiple sclerosis, granulomas, cerebral vessels, cysts, hypertension);

Burdened heredity;

Various intoxications, poisoning with alcohol surrogates;

Consequences of trauma.

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.

Symptoms of partial atrophy of the optic nerve

Manifestations of the disease can have varying degrees of severity. The main manifestations of partial atrophy of the optic nerve will be:

Decreased visual acuity;

The appearance of pain when trying to move the eyeballs;

Narrowing or loss of visual fields, may be before the appearance of tunnel syndrome (a person sees only what is directly in front of the eyes and nothing on the sides);

Blind spots (scotomas) appear.

Diagnosis of the disease

Usually the diagnosis of the disease is not difficult. With a decrease in vision, a person most often turns to an ophthalmologist himself, who makes the correct diagnosis, prescribing treatment.

When examining the optic nerve, the doctor will certainly see changes in the nerve disk and its blanching. To clarify the diagnosis, more detailed studies of visual functions are prescribed, visual fields are studied, intraocular pressure is measured, fluorescent angiographic, radiological, electrophysiological studies are used. It is very important to find the cause of the disease, because in some situations the patient will need to undergo surgery.

Treatment of partial atrophy of the optic nerve

The prognosis for the treatment of partial atrophy of the optic nerve is favorable. The main goal of treatment is to stop the change in the tissues of the optic nerve, in order to be able to save what is left. It is impossible to completely restore visual acuity, but without treatment, the disease will lead to blindness. The main method of therapy will depend on what is the cause of the atrophy of the optic nerve.

Drugs that are used in treatment are drugs to improve the blood supply to the nerve, improve metabolism, vasodilators, multivitamins, biostimulants. These funds reduce swelling, inflammation in the area of the optic nerve head, improve its nutrition, blood supply, stimulate the activity of the remaining nerve fibers.

If the patient needs surgical treatment, then it will be the main method of therapy. The emphasis is on the treatment of the underlying disease, the elimination of the cause, which led to partial atrophy of the optic nerve. To achieve a better result, magneto-, electro-, 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.

Prognosis for optic nerve atrophy

Any disease, if its treatment is started as early as possible, is better amenable to therapy. The same can be said about optic nerve atrophy. With timely treatment, it is possible to restore the nerve, avoid consequences and preserve vision. An advanced disease can lead to blindness, therefore, at the first signs of a decrease in visual acuity, narrowing of the visual fields, changes in color perception, you should immediately contact an ophthalmologist. And the doctor will do everything possible in the treatment to save your vision with your help.

Expert editor: Mochalov Pavel Alexandrovich| MD general practitioner

Education: Moscow Medical Institute. I. M. Sechenov, specialty - "Medicine" in 1991, in 1993 "Occupational diseases", in 1996 "Therapy".

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

Causes

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

Lesions of the central nervous system are considered to be the main "culprits" of the development of atrophy, these include: tumors, syphilitic lesions, meningitis, brain abscesses, encephalitis, skull injuries, disseminated. In addition, the causes of the development of such an anomaly can be atherosclerosis, hypertension, quinine poisoning, profuse bleeding, beriberi.

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

Manifestations of the disease

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

A characteristic symptom of this pathology is considered to be an intractable decrease in vision. Such a symptom can manifest itself in various ways, depending on the type of atrophy. The progress of the disease leads to a non-stop decrease in vision due to the death of the optic nerve, which ultimately leads to complete blindness. This process proceeds, as a rule, either rapidly - in a few days, or gradually - over the course of months.

Partial atrophy of the optic nerve in its course always has a stop in the process of visual impairment at some stage, after which vision stabilizes. This makes it possible to isolate progressive and complete atrophy.

Visual disturbances during the course of the disease are of the most diverse nature, including changes in visual fields (as a rule, narrowing with loss of "lateral vision"), up to "tunnel vision", when a person sees as if through a tube, i.e. only those objects that are directly in front of it. Such a condition is associated with the appearance of - dark spots in any part of the field of view, any disorder of color perception.

With PAIS, the change in visual fields is not only "tunnel", which is due to the localization of the pathological process. Thus, development in front of the eyes of cattle may indicate a change in the nerve fibers of the central section of the retina or the zone directly close to it. When the nerve fibers of the periphery are affected, a narrowing of the visual fields develops, and when the lesions are deep enough, the disappearance of half of the visual field is observed. These changes may develop in either one or both eyes.

Diagnosis

It is unacceptable to engage in self-diagnosis, and even more so self-treatment with atrophy of the optic nerve, since similar symptoms are also observed in peripheral, in which, at first, lateral vision undergoes a change, with the involvement of the central departments at later stages. It must be remembered that optic nerve atrophy is not always an independent disease. Often, this is a manifestation of a serious disease of the nervous system. Therefore, the establishment of its causes at an early stage is especially important.

The symptoms described above are the reason for the immediate appeal to specialists (including an ophthalmologist and a neurologist).

Diagnosis of optic nerve atrophy is usually not difficult. To identify it, an examination is prescribed, including: determination of visual acuity, its fields, as well as tests for color perception. At the same time, they must be carried out, which can reveal the characteristic pallor of the optic nerve head and some narrowing of the bottom. Measure intraocular pressure.

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

Laboratory tests are also needed - a complete blood count, its biochemistry, a test for borreliosis, as well as syphilis.

Video about the latest developments in the treatment of PONS

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

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

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

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

As noted above, the main thing is the treatment of the disease that caused the atrophy, therefore complex therapy is prescribed with various forms of drugs: eye drops, injections (general and local), tablets, physiotherapy. This treatment aims to:
Improving blood circulation, feeding the nerve vessels. To do this, use vasodilators (complamin, no-shpu, nicotinic acid, papaverine, dibazol, halidor, eufillin, sermion, trental), as well as anticoagulants (heparin or tiklid);
Improving the processes of tissue metabolism and activating the regeneration of affected tissues. For this, biogenic stimulants (aloe extract, peat, etc.), tamines (B1, B2, B6, ascorutin), enzymatic agents (fibrinolysin, lidase), essential amino acids (glutamic acid), as well as immunostimulants (ginseng, eleutorococcus);
Relief of inflammatory processes through hormonal drugs (dexamethasone,);
Improving the functions of the central nervous system (cerebrolysin, nootropil, phezam, emoxipin, cavinton).

Any drugs must be taken strictly according to the scheme prescribed by the attending physician, after the diagnosis is established. Since, only a specialist is able to choose the optimal treatment, taking into account concomitant diseases.

At the same time, physiotherapeutic procedures and acupuncture can be prescribed; sessions of laser, magnetic, as well as electrical stimulation of the tissues of the optic nerve.

Such treatment must be repeated courses several times a year.

With an obvious drop in vision, a disability group can be assigned.

Blind due to illness and visually impaired, rehabilitation courses are prescribed, which aim to eliminate or compensate for the limitations of life that have arisen due to loss of vision.

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

Where to treat?

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

Optic nerve atrophy (optic neuropathy) is partial or complete destruction of nerve fibers that transmit visual stimuli from the retina to the brain. During atrophy, the nervous tissue experiences an acute lack of nutrients, which is why it ceases to perform its functions. If the process continues long enough, 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.

Optic nerve atrophy according to ICD has ICD code 10

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 diseases:

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 (influenza)
Pathology of the central nervous system (brain abscess, syphilitic lesion, skull trauma, multiple sclerosis, tumor, syphilitic lesion, skull trauma, encephalitis)
Atherosclerosis
Hypertonic disease
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 tissue.

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 15-25 years.
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.

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 or for 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:

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
Vasodilators are prescribed (no-shpa, diabazol, papaverine, sermion, trental, zufillin) - to improve blood circulation in the vessels that feed the nerve
Phezam, emoxipin, nootropil, cavinton are prescribed to maintain the work of the central nervous system.
To accelerate the resorption of pathological processes - pyrogenal, preductal
Hormonal drugs are prescribed to stop the inflammatory process - dexamethasone, prednisolone.

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.

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 the 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 occur.

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 complete blindness.

With partial atrophy of the optic nerves, pathological changes reach a certain limit and then stop in development. A person loses his 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, looked at objects, bumped 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, it is necessary to avoid poisoning, work carefully with chemicals, 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.

- a process characterized by the gradual death of fibers.

Pathology is often caused by ophthalmic diseases.
The disease is diagnosed when the fibers are damaged. Nervous tissues are located in almost all human organs.

What it is

The optic nerve is a kind of transmission channel. With its help, the image enters the retina, then to the brain compartment.

The brain reproduces the signal, turning the description into a clear picture. The optic nerve is connected to many blood vessels from which it receives its nourishment.

In a number of processes, this relationship is violated. There is a death of the optic nerve, in the future comes blindness and disability.

Causes of pathology

In the course of scientific experiments, it was found that 2/3 of cases of optic nerve atrophy were bilateral. The cause is intracranial tumors, edema and vascular disorders, especially in patients aged 42-45 years.

The causes of the disease are:

Nerve damage. These include: chronic glaucoma, neuritis, neoplasms.
Neuropathy (ischemic), chronic neuritis, edema - a secondary pathology.
Hereditary neuropathy (Leber).
Neuropathy (toxic). The disease is caused by methanol. This component is found in surrogate alcoholic beverages and drugs (Disulfiram, Ethambutol).

The causes of the disease include: retinal damage, TEI-SAXA pathology, syphilis.

The development of atrophy in children is affected by a congenital anomaly, a negative hereditary factor, and malnutrition of the optic nerve. Pathology entails disability.

The main classification of the disease

Atrophy of the optic nerve is determined by pathological and ophthalmoscopic signs.

Acquired and congenital form

The acquired form is primary or secondary. Due to the influence of etiological factors. The process occurs as a result of: inflammation, glaucoma, myopia, in violation of metabolic processes in the body.

Congenital form: occurs against the background of a genetic pathology. There are 6 types of hereditary atrophy: infantile (from birth to 3 years), dominant (juvenile blindness from 3 to 7 years), opto-oto-diabetic (from 2 to 22 years), Beer's syndrome (complicated form, appears from 1 year) , growing (from an early age, gradually progressive), Lester's disease (hereditary), occurs at the age of 15 - 35 years.

Primary and secondary atrophy

The primary form is localized in a healthy eyeball. Occurs when microcirculation and nutrition of nerve fibers are disturbed.

The occurrence of secondary atrophy is due to various eye pathologies.

Descending and ascending form

Descending atrophy is characterized by an inflammatory process in the proximal zone of the axon. There is damage to the retinal disc.

With the ascending form, the retina is initially affected. Gradually, the destructive process is directed to the brain. The rate of degeneration will depend on the thickness of the axons.

Partial and full degree

Diagnosing the degree of damage:

initial (damage to some fibers);
partial (diameter damaged);
incomplete (the disease progresses, but vision is not completely lost);
complete (loss of visual functions in full).

There is unilateral and bilateral atrophy. In the first case, there is damage to the innervation of one eye, in the second - two.

Localization and intensity of optic disc pathology

Visual acuity is affected by the localization and intensity of the atrophic process:

Modification of the field of view. Violation is determined by topical diagnostics. The process is affected by localization, not intensity. The defeat of the papillomacular bundle provokes the occurrence of central scotoma. Damaged optic fiber contributes to the narrowing of the peripheral limits of the field of view.
Violation of colors. This symptomatology is clearly expressed in the descending form of the visual disc. The course of the process is due to the transferred neuritis or swelling. At the first stages of the disease, the visible outlines of green and red shades are lost.
Pale color of the optic disc. An additional examination using campimetry is required. It is necessary to collect information about the initial visual acuity of the patient. In some cases, visual sharpness exceeds one.

If unilateral atrophy is diagnosed, a second examination will be required to avoid damage to the other eye (bilateral atrophy).

Symptoms of eye disease

The main symptoms of the onset of atrophy are expressed by a progressive deterioration in vision in one or two eyes. Vision cannot be treated or improved by ordinary methods of correction.

Symptoms are expressed:

loss of lateral visibility (fields narrow);
the emergence of tunnel visibility;
the formation of dark spots;
a decrease in the pupil's reflex to light rays.

When the optic nerve is damaged, optic neuropathy develops, which leads to partial or complete blindness.

Proper medical diagnosis

An ophthalmological examination determines the presence and degree of the disease. The patient should be consulted by a neurosurgeon and a neurologist.

To establish the correct diagnosis, you need to go through:

ophthalmoscopy (viewing the fundus);
visometry (the degree of damage to visual perception is determined);
perimetry (fields of vision are examined);
computer perimetry (the affected department is determined);
evaluation score of color readings (determined by the location of the fiber);
video - ophthalmography (the nature of the pathology is revealed);
craniography (an x-ray of the skull is made).

Additional examinations may be prescribed, which consist in the passage of CT, magnetic nuclear resonance, laser dopplerography.

Treatment of the disease - prevent disability

After the diagnosis, the specialist prescribes intensive therapy. The task of the doctor is to eliminate the causes of the pathology, stop the progression of the atrophic process, and prevent complete blindness and disability of the patient.

Effective medical treatment of the patient

It is impossible to restore dead nerve fibers. Therefore, therapeutic measures are aimed at stopping inflammatory processes with the help of drugs.

This ophthalmic disease is treated:

Vasodilators. The drugs stimulate blood circulation. The most effective: No-shpa, Dibazol, Papaverine.
Anticoagulants. The action of drugs is aimed at preventing blood clotting and the formation of thrombosis. The specialist is appointed: Heparin, Ticlid.
Biogenic stimulants. The process of metabolism in the nervous tissue structures is enhanced. This group of funds includes: Peat, Aloe Extract.
Vitamin complex. Vitamins are a catalyst for biochemical reactions that occur in the eye tissue structures. For the treatment of pathology, Ascorutin, B1, B6, B12 are prescribed.
Immunostimulators. Promote cell regeneration, suppress inflammatory processes (in case of infection). The most effective: Ginseng, Eleutherococcus.
Hormonal medications. Relieve inflammatory symptoms. Assigned: Dexamethasone, Prednisolone individually (in the absence of contraindications).

The patient receives certain results from acupuncture and physiotherapy (ultrasound, electrophoresis).

Surgical intervention - the main types of operations

The surgical event is indicated for patients with an unfavorable prognosis: optic nerve atrophy with the possibility of blindness.

Operation types:

Vasoconstructive. The temporal or carotid arteries are tied up, the blood flow is redistributed. Improves blood supply to the ophthalmic arteries.
Extrascleral. Transplanted own tissues. An antiseptic effect is created on the affected areas, a therapeutic effect is caused, blood supply is stimulated.
Decompression. The scleral or bone tubule of the optic nerve is dissected. There is an outflow of venous blood. The pressure on the beam section is reduced. Result: the functional abilities of the optic nerve are improved.

After medical or surgical treatment, it will be advisable to use alternative medicine.

Folk medicines stimulate metabolism and increase blood circulation. It is allowed to use folk remedies after consulting the attending physician (ophthalmologist).

Fighting illness in children

Therapy in children is aimed at saving nerve fibers and stopping the process. Without adequate treatment, the child will become completely blind and will become disabled.

Despite the measures taken at the beginning of treatment, atrophy of the optic nerve often progresses and develops. In some cases, the duration of therapy will be from 1 to 2 months. With advanced forms of atrophy, treatment lasts from 5 to 10 months.

After the examination, the doctor prescribes to the child:

magnetic stimulation;
electrical stimulation;
vasodilators;
biostimulating drugs;
vitamin cocktail;
enzymes.

If the medication does not bring results and the disease continues to progress, a course of laser therapy or surgical measures is prescribed.

Tabetic nerve atrophy

Tabes - a disease of the nervous system against the background of infection with syphilis. If timely treatment was not applied, the disease progresses, causing ocular trophic disorders.

Tabetic atrophy of the optic nerve is the only manifestation of tabes (an early symptom of neurosyphilis). The tabetic form of atrophy is characterized by a bilateral decrease in vision.

A sign of the disease is reflex immobility of the pupils. The optic nerve papilla becomes discolored, becomes gray-white.

There is a sharp drop in vision, the pathology is difficult to treat. Therapy is prescribed by a venereologist and a neuropathologist (treatment of the primary infection is mandatory). Initially, medications and vitamin preparations are prescribed that stimulate metabolic processes in tissue structures.

Assigned inside:

vitamin A;
vitamin C;
a nicotinic acid;
calcium (pangamat);
riboflavin.

After three days, intramuscular injections are prescribed: vitamin B, B6, B12. The preparations are combined with aloe or vitreous extract. Treatment is carried out under the strict supervision of a specialist in a medical institution.

Atrophy due to methyl alcohol poisoning

Methyl alcohol and technical alcohol mixtures can cause serious damage to vision. Pathology sometimes occurs when poisoning with methyl alcohol.

The first sign of poisoning is characterized by: migraine, dizziness, nausea, vomiting, diarrhea. The pupil becomes dilated, the clarity of vision is disturbed, light reflections are not distinguished. There is a sharp decrease in vision.

Therapy for this form of atrophy consists in the use of: alkalizing drugs, calcium, B vitamins, ascorbic acid.

In patients diagnosed with methyl arthrosis, the prognosis for recovery is pessimistic. Restoration of vision is observed only in 15% of patients.

Optic nerve atrophy is damage to the nerve fibers. With a prolonged process, neurons die off, which leads to loss of vision.

Diagnosis of atrophy

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

During a physical examination, the ophthalmologist determines the absence or presence of exophthalmos, examines the mobility of the eyeballs, checks the reaction of the pupils to light, the corneal reflex. Be sure to check visual acuity, perimetry, the study of color perception.

Basic information about the presence and degree of optic nerve atrophy is obtained using ophthalmoscopy. Depending on the causes and form of optic neuropathy, the ophthalmoscopic picture will differ, however, there are typical characteristics that occur with various types of optic nerve atrophy.

These include: blanching of the ONH of varying degrees and prevalence, changes in its contours and color (from grayish to waxy), excavation of the disc surface, a decrease in the number of small vessels on the disc (Kestenbaum's symptom), narrowing of the caliber of retinal arteries, changes in veins, etc. Condition The optic disc is refined using tomography (optical coherence, laser scanning).

An electrophysiological study (VEP) reveals a decrease in lability and an increase in the threshold sensitivity of the optic nerve. With the glaucomatous form of optic nerve atrophy, an increase in intraocular pressure is determined using tonometry.

The pathology of the orbit is detected using a plain radiography of the orbit. Retinal vessels are examined using fluorescein angiography. The study of blood flow in the ophthalmic and supratrochlear arteries, intracranial section of the internal carotid artery is performed using Doppler ultrasound.

If necessary, an ophthalmological examination is supplemented by a study of the neurological status, including a consultation with a neurologist, x-rays of the skull and sella turcica, CT or MRI of the brain. If a patient has a brain mass or intracranial hypertension, a neurosurgeon should be consulted.

In the case of a pathogenetic connection between optic nerve atrophy and systemic vasculitis, a consultation with a rheumatologist is indicated. The presence of orbital tumors dictates the need for examination of the patient by an ophthalmic oncologist. Therapeutic tactics for occlusive lesions of the arteries (orbital, internal carotid) is determined by an ophthalmologist or vascular surgeon.

With atrophy of the optic nerve caused by an infectious pathology, laboratory tests are informative: ELISA and PCR diagnostics.

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

Forecast

The degree of vision loss in a patient depends on two factors - the severity of the nerve trunk lesion 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.

Physiotherapy

There are two physiotherapeutic 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.

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.

Complications

Disability

Disability group I is established with IV degree of visual analyzer dysfunction - significantly pronounced dysfunction (absolute or practical blindness) and a decrease in one of the main categories of life activity to degree 3 with the need for social protection.

The main criteria for the IV degree of visual analyzer dysfunction.

blindness (vision is 0) in both eyes;
visual acuity with correction of the best eye is not higher than 0.04;
bilateral concentric narrowing of the boundaries of the field of view up to 10-0° from the point of fixation, regardless of the state of central visual acuity.

II group of disability is established at the III degree of visual analyzer dysfunction - severe functional impairment (low vision of a high degree), and a decrease in one of the main categories of life activity to 2 degrees with the need for social protection.

The main criteria for severe visual impairment are:

visual acuity of the best eye from 0.05 to 0.1;
bilateral concentric narrowing of the boundaries of the field of view up to 10-20° from the point of fixation, when labor activity is possible only in specially created conditions.

III group of disability is established at the II degree - moderate impairment of functions (low vision of an average degree) and a decrease in one of the main categories of life activity to 2 degrees with the need for social protection.

The main criteria for moderate visual impairment are:

decreased visual acuity in the better seeing eye from 0.1 to 0.3;
unilateral concentric narrowing of the boundaries of the field of view from the point of fixation less than 40°, but more than 20°;

In addition, when making a decision on the disability group, all diseases that the patient has are taken into account.