Optic nerve atrophy: what causes it, how it manifests itself and is treated. Partial and complete optic nerve atrophy: what is it, does it happen in both eyes and how to treat What is optic nerve atrophy

Update: December 2018

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

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

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

What is optic nerve atrophy

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

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

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

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

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

The reasons

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

There may be two options:

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

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

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

Symptoms

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

Loss of visual fields (anopsia)

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

Neurologists divide it into:

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

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

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

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

Decreased visual acuity (amblyopia)

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

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

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

Diagnostics

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

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

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

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

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

Treatment

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

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

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

Modern methods of nerve restoration

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

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

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

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

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

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

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

Physiotherapy for optic nerve atrophy

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

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

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

Surgical treatment of atrophy

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

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

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

Forecast

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

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

FAQ

Question:
Could this disease be congenital?

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

Question:
Where can optic nerve atrophy be treated?

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

Question:
How often does the pathology develop in children?

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

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

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

Question:
Do disability groups give for atrophy?

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

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

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 this 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:

1. diseases of the eyes themselves;
2. dysfunction of the central nervous system;
3. intoxication;
4. injury;
5. general diseases, etc.

Often, atrophy can be caused by ophthalmic causes:

1. glaucoma;
2. occlusion of the artery that feeds the retina;
3. death of retinal tissue;
4. uveitis;
5. myopia;
6. 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 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.

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

Atrophy of the optic nerve can be caused by a variety of reasons, 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, examination of the fundus, perimetry, determination of visual acuity, measurement of intraocular pressure are used.

The main diagnostic sign of optic nerve atrophy is a violation of the visual fields, detected during an appropriate 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).

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 disease:

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

Factors leading to optic nerve atrophy can be eye diseases, CNS lesions, mechanical damage, intoxication, general, infectious, autoimmune diseases, etc. Optic nerve atrophy appears as a result of obstruction of the central and peripheral retinal arteries that feed the optic nerve, and also it is the main symptom of glaucoma.

The main causes of atrophy are:

• Heredity
• congenital pathology
• Eye diseases (vascular diseases of the retina, as well as the optic nerve, various neuritis, glaucoma, retinitis pigmentosa)
• Intoxication (quinine, nicotine and other drugs)
• Alcohol poisoning (more precisely, alcohol surrogates)
• Viral infections (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 tissues.

Types of disease

Atrophy of the optic nerve of the eye is:

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

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

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

Disease Definition

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

The transmission of an image from the retina to the visual analyzer in the brain occurs along a kind of "cable" consisting of many nerve fibers and packed in "insulation". The thickness of the optic nerve is not more than 2 mm, but it contains more than a million fibers. Each section of the image corresponds to a certain part of them, and when some of them cease to function, “silent zones” (image disturbance) appear in the picture perceived by the eye.

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

Kinds

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

• Primary. The disease is caused by the affected X-chromosome, so only men aged 15-25 years are ill. Pathology develops in a recessive type and is inherited;
• Secondary. Occurs as a result of an eye or systemic disease associated with impaired blood supply or stagnation of the optic nerve. This pathological condition can appear at any age.

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

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

Causes

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

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

• Eye pathologies: retinitis pigmentosa, etc.;
• Glaucoma and elevated IOP;
• Systemic diseases: hypertension, atherosclerosis, vasospasm;
• Toxic effects: smoking, alcohol, quinine, drugs;
• Brain diseases: abscess, multiple sclerosis, arachnoiditis;
• Traumatic injuries;
• Infectious diseases: meningitis, encephalitis, syphilis, tuberculosis, influenza, measles, etc.

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

Symptoms

The main sign of the onset of pathology can be a steadily progressive deterioration of vision in one or both eyes, and it is not amenable to conventional methods of correction.

Visual functions are gradually lost:

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

Possible Complications

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

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

If the disease began to develop in patients with visual indicators below 0.01, then therapeutic measures will most likely not give any result.

Diagnostics

Targeted ophthalmological examination is the first mandatory step in case of suspected disease. In addition, you may need to consult a neurosurgeon or neurologist.

To detect optic nerve atrophy, the following types of examinations can be performed:

• Examination of the fundus (or biomicroscopy);
• - determination of the degree of visual impairment (nearsightedness, farsightedness, astigmatism);
• – study of visual fields;
• Computer perimetry - allows you to determine the affected area of ​​\u200b\u200bthe nervous tissue;
• Assessment of color perception - determination of the localization of lesions of nerve fibers;
• Video ophthalmography - identification of the nature of damage;
• Craniography (x-ray of the skull) - the main object in this case is the region of the Turkish saddle.

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

Treatment

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

Medical therapy

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

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

Heparin ointment is used in the treatment of optic nerve arthrosis

• Vitamins: Askorutin, B1, B6, B2. They are catalysts for most of the biochemical reactions that occur in the tissues of the eyes, just like amino acids and enzymes;
• Immunostimulants: Ginseng, Eleutherococcus. Necessary to stimulate regeneration processes and suppress inflammation in infectious lesions;
• Hormonal agents: Dexamethasone, Prednisolone. They are used in the absence of contraindications to relieve symptoms of inflammation;
• Improving the work of the central nervous system: Nootropil, Cavinton, Cerebrolysin, Phezam.

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Dexamethasone is used in the treatment of optic nerve arthrosis

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

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

• ultrasound;
• electrophoresis;
• Electrical and laser stimulation of the optic nerve;
• Magnetotherapy.

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

Surgically

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

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

Folk remedies

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

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

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

Prevention

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

• Timely treat eye and systemic infectious diseases;
• Prevent eye and craniocerebral injuries;
• Do preventive examinations in the oncology clinic;
• Limit or exclude alcohol from your life;
• Take control of your blood pressure.

An online color blindness test can be found.

Video

conclusions

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

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

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