Chazn reasons. Partial atrophy and restoration of the optic nerve

Optic nerve atrophy is clinically a set of symptoms: visual impairment (decreased visual acuity and development of visual field defects) and blanching of the optic nerve head. Optic nerve atrophy is characterized by a decrease in the diameter of the optic nerve due to a decrease in the number of axons.

Optic nerve atrophy occupies one of the leading places in the nosological structure, second only to glaucoma and degenerative myopia. Optic nerve atrophy is considered to be the complete or partial destruction of its fibers with their replacement by connective tissue.

According to the degree of decrease in visual functions, atrophy can be partial or complete. According to research data, it is clear that 57.5% of men and 42.5% of women suffer from partial atrophy of the optic nerve. Most often, bilateral damage is observed (in 65% of cases).

The prognosis for optic atrophy is always serious, but not hopeless. Due to the fact that pathological changes are reversible, treatment of partial optic nerve atrophy is one of the important areas in ophthalmology. With adequate and timely treatment, this fact makes it possible to achieve an increase in visual functions even with a long-term existence of the disease. Also in recent years, the number of this pathology of vascular origin has increased, which is associated with the growth of general vascular pathology - atherosclerosis, coronary heart disease.

Etiology and classification

By etiology
- hereditary: autosomal dominant, autosomal recessive, mitochondrial;
- non-hereditary.
According to the ophthalmoscopic picture - primary (simple); secondary; glaucomatous.
According to the degree of damage (preservation of functions): initial; partial; incomplete; complete.
According to the topical level of the lesion: descending; ascending.
By degree of progression: stationary; progressive.
According to the localization of the process: one-sided; bilateral.

There are congenital and acquired optic atrophy. Acquired optic atrophy develops as a result of damage to the optic nerve fibers (descending atrophy) or retinal cells (ascending atrophy).

Congenital, genetically determined optic nerve atrophy is divided into autosomal dominant, accompanied by an asymmetric decrease in visual acuity from 0.8 to 0.1, and autosomal recessive, characterized by a decrease in visual acuity, often to the point of practical blindness already in early childhood.

Descending acquired atrophy is caused by processes that damage the fibers of the optic nerve at various levels (orbit, optic canal, cranial cavity). The nature of the damage is different: inflammation, trauma, glaucoma, toxic damage, circulatory disorders in the vessels supplying the optic nerve, metabolic disorders, compression of the optic fibers by a space-occupying formation in the orbital cavity or in the cranial cavity, degenerative process, myopia, etc.).

Each etiological factor causes optic nerve atrophy with certain ophthalmoscopic features typical for it. However, there are characteristics common to optic atrophy of any nature: blanching of the optic disc and impaired visual function.

The etiological factors of optic nerve atrophy of vascular origin are diverse: these are vascular pathology, acute vascular neuropathies (anterior ischemic neuropathy, occlusion of the central artery and vein of the retina and their branches), and a consequence of chronic vascular neuropathies (with general somatic pathology). Optic nerve atrophy occurs as a result of obstruction of the central and peripheral retinal arteries that supply the optic nerve.

Ophthalmoscopically, narrowing of the retinal vessels and blanching of part or all of the optic nerve head are detected. Persistent blanching of only the temporal half occurs with damage to the papillomacular bundle. When atrophy is a consequence of disease of the chiasm or optic tracts, then there are hemianopic types of visual field defects.

Depending on the degree of damage to the optic fibers, and, consequently, on the degree of decrease in visual functions and blanching of the optic nerve head, initial, or partial, and complete atrophy of the optic nerve is distinguished.

Diagnostics

Complaints: a gradual decrease in visual acuity (of varying severity), changes in the field of vision (scotomas, concentric narrowing, loss of visual fields), impaired color vision.

Anamnesis: the presence of space-occupying lesions of the brain, intracranial hypertension, demyelinating lesions of the central nervous system, lesions of the carotid arteries, systemic diseases (including vasculitis), intoxication (including alcohol), history of optic neuritis or ischemic neuropathy, occlusion of retinal vessels, taking medications, having a neurotoxic effect, within the last year; head and neck injuries, cardiovascular diseases, hypertension, acute and chronic cerebrovascular accidents, atherosclerosis, meningitis or meningoencephalitis, inflammatory and volumetric processes of the paranasal sinuses, profuse bleeding.

Physical examination :

external examination of the eyeball (limited mobility of the eyeball, nystagmus, exophthalmos, ptosis of the upper eyelid)
study of the corneal reflex - may be reduced on the affected side

Laboratory research

biochemical blood test: blood cholesterol, low-density lipoproteins, high-density lipoproteins, triglycerides; ·
coagulogram;
ELISA for herpes simplex virus, cytomegalovirus, toxoplasmosis, brucellosis, tuberculosis, rheumatic tests (if indicated, to exclude an inflammatory process)

Instrumental studies

visometry: visual acuity can range from 0.7 to practical blindness. When the papillomacular bundle is damaged, visual acuity is significantly reduced; with minor damage to the papillomacular bundle and involvement of peripheral nerve fibers of the optic nerve in the process, visual acuity decreases slightly; when only peripheral nerve fibers are affected, it does not change. ·
refractometry: the presence of refractive errors will allow a differential diagnosis with amblyopia.
Amsler test - distortion of lines, clouding of the pattern (damage to the papillomacular bundle). ·
perimetry: central scotoma (with damage to the papillomacular bundle); various forms of narrowing of the visual field (with damage to the peripheral fibers of the optic nerve); with damage to the chiasm - bitemporal hemianopsia, with damage to the optic tracts - homonymous hemianopsia. When the intracranial part of the optic nerve is damaged, hemianopia occurs in one eye.
- Kinetic perimetry for colors - narrowing the field of vision to green and red, less often to yellow and blue.
- Computer perimetry - determination of the quality and quantity of scotomas in the field of view, including 30 degrees from the point of fixation.
Dark Adaptation Study: Dark Adaptation Disorder. · study of color vision: (Rabkin tables) - disturbance of color perception (increased color thresholds), more often in the green-red part of the spectrum, less often in the yellow-blue.
tonometry: possible increase in IOP (with glaucomatous optic atrophy).
biomicroscopy: on the affected side - afferent pupillary defect: decreased direct pupillary reaction to light while maintaining the congenital pupillary reaction.
ophthalmoscopy:
- initial atrophy of the optic disc – against the background of the pink color of the optic disc, blanching appears, which subsequently becomes more intense.
- partial atrophy of the optic disc – pallor of the temporal half of the optic disc, Kestenbaum’s symptom (decrease in the number of capillaries on the optic disc from 7 or less), arteries are narrowed,
- incomplete optic optic atrophy – uniform pallor of the optic nerve, moderately expressed Kestenbaum’s symptom (reduction in the number of capillaries on the optic disc), arteries are narrowed,
- complete atrophy of the optic nerve – total pallor of the optic nerve, vessels are narrowed (arteries are narrowed more than veins). Kestenbaum's symptom is pronounced (reduction in the number of capillaries on the optic disc - up to 2-3 or capillaries may be absent).

With primary atrophy of the optic disc, the boundaries of the optic disc are clear, its color is white, grayish-white, bluish or slightly greenish. In red-free light, the contours remain clear, whereas the contours of the optic disc normally become blurred. In red light, with atrophy of the optic disc disc, it is blue. With secondary atrophy of the optic disc, the boundaries of the optic disc are unclear, blurred, the optic disc is gray or dirty gray, the vascular infundibulum is filled with connective or glial tissue (in the long term, the boundaries of the optic disc become clear).

optical coherence tomography of the optic disc (in four segments - temporal, superior, nasal and inferior): reduction in the area and volume of the neuroretinal rim of the optic disc, reduction in the thickness of the layer of nerve fibers of the optic disc and in the macula.
Heidelberg retinal laser tomography – decreasing the depth of the optic nerve head, the area and volume of the neuroretinal belt, increasing the excavation area. In case of partial atrophy of the optic nerve, the depth range of the optic nerve head is less than 0.52 mm, the rim area is less than 1.28 mm 2, the excavation area is more than 0.16 mm 2.
fluorescein angiography of the fundus: hypofluorescence of the optic nerve head, narrowing of the arteries, absence or decrease in the number of capillaries on the optic disc;
electrophysiological studies (visual evoked potentials) - decreased VEP amplitude and prolonged latency. When the papillomacular and axial bundles of the optic nerve are damaged, electrical sensitivity is normal; when peripheral fibers are damaged, the electrical phosphene threshold is sharply increased. Lability decreases especially sharply with axial lesions. During the period of progression of the atrophic process in the optic nerve, the retino-cortical and cortical time increases significantly;
Doppler ultrasound of the vessels of the head, neck, eye: decreased blood flow in the orbital, supratrochlear artery and intracranial part of the internal carotid artery;
MRI of brain vessels: foci of demyelination, intracranial pathology (tumors, abscesses, brain cysts, hematomas);
MRI of the orbit: compression of the orbital part of the optic nerve;
X-ray of the orbit according to Riese - a violation of the integrity of the optic nerve.

Differential diagnosis

The degree of decrease in visual acuity and the nature of visual field defects are determined by the nature of the process that caused the atrophy. Visual acuity can range from 0.7 to practical blindness.

Optic atrophy with tabes develops in both eyes, but the extent of damage to each eye may not be the same. Visual acuity decreases gradually, but because... The process with tabes is always progressive, then ultimately bilateral blindness occurs at different times (from 2-3 weeks to 2-3 years). The most common form of change in the visual field in tabetic atrophy is a gradually progressive narrowing of the boundaries in the absence of scotomas within the remaining areas. Rarely, with tabesa, bitemporal scotomas, bitemporal narrowing of the boundaries of the visual field, as well as central scotomas are observed. The prognosis for tabetic optic atrophy is always poor.

Optic nerve atrophy can be observed with deformations and diseases of the skull bones. Such atrophy is observed with a tower-shaped skull. Decreased vision usually develops in early childhood and rarely after 7 years. Blindness in both eyes is rare; sometimes blindness in one eye is observed with a sharp decrease in vision in the other eye. From the side of the visual field, there is a significant narrowing of the boundaries of the visual field along all meridians; there is no scotoma. Atrophy of the optic nerve with a tower-shaped skull is considered by most to be a consequence of congestive nipples, developing due to increased intracranial pressure. Among other deformations of the skull, atrophy of the optic nerves is caused by dysostosis craniofacialis (Crouzon's disease, Apert's syndrome, marble disease, etc.).

Optic nerve atrophy can occur due to poisoning with quinine, plasmacide, fern when expelling worms, lead, carbon disulfide, botulism, and methyl alcohol poisoning. Methyl alcohol optic atrophy is not so rare. After drinking methyl alcohol, within a few hours paralysis of accommodation and dilation of the pupils appears, central scotoma occurs, and vision sharply decreases. Then vision is partially restored, but atrophy of the optic nerve gradually increases and irreversible blindness occurs.

Optic nerve atrophy can be congenital and hereditary, due to birth or postpartum head injuries, prolonged hypoxia, etc.

Diagnosis	Rationale for differential diagnosis	Surveys	Diagnosis exclusion criteria
Amblyopia	Significant decrease in vision in the absence of pathology from the anterior segment of the eye and retina.	Physical examinations	A small child has strabismus, nystagmus, and the inability to clearly fix his gaze on a bright object. In older children - decreased visual acuity and lack of improvement from its correction, impaired orientation in an unfamiliar place, squint, the habit of closing one eye when looking at an object or reading, tilting or turning the head when looking at an object of interest.
		Refractometry	Anisometropic amblyopia develops with uncorrected high degree anisometropia in the eye with more pronounced refractive errors (myopia more than 8.0 diopters, hyperopia more than 5.0 diopters, astigmatism more than 2.5 diopters in any meridian), refractive amblyopia - with a long-term absence of optical correction of hypermetropia , myopia or astigmatism with a difference in refraction of both eyes: hyperopia more than 0.5 diopters, myopia more than 2.0 diopters, astigmatic 1.5 diopters.
		HRT OCT	According to NRT: the depth range of the optic nerve head is more than 0.64 mm, the area of the optic nerve rim is more than 1.48 mm 2, the excavation area of the optic nerve is less than 0.12 mm 2.
Leber's hereditary atrophy	A sharp decrease in vision in both eyes in the absence of pathology from the anterior segment of the eye and retina.	Complaints and anamnesis	The disease develops in male members of the same family aged 13 to 28 years. Girls get sick very rarely and only if the mother is a proband and the father suffers from this disease. Heredity is associated with the X chromosome. A sharp decrease in vision in both eyes over several days. The general condition is good, sometimes patients complain of headache.
		Ophthalmoscopy	Initially, hyperemia and slight blurring of the optic disc borders appear. Gradually, the optic discs become waxy and pale, especially in the temporal half.
		Perimetry	In the field of view there is a central absolute scotoma, white, the peripheral borders are normal.
Hysterical amblyopia (amaurosis)	Sudden deterioration of vision or complete blindness in the absence of pathology from the anterior segment of the eye and retina.	Complaints and anamnesis	Hysterical amblyopia in adults is a sudden deterioration of vision that lasts from several hours to several months, developing against the background of severe emotional shocks. It is more often observed in women aged 16-25 years.
		Physical examinations	There may be a complete lack of reaction of the pupils to light.
		Visometry	Reduced visual acuity to varying degrees, up to blindness. With repeated studies, the data may be completely different from previous ones.
		Ophthalmoscopy	The optic disc is pale pink, the contours are clear, the Kestenbaum sign is absent.
		Perimetry	Concentric narrowing of the field of vision, characterized by a violation of the normal type of boundaries - the widest field of vision is red; less commonly, hemianopsia (homonymous or heteronymous).
		VEP	VEP data is normal.
Optic nerve hypoplasia	Bilateral decrease or complete loss of vision in the absence of pathology from the anterior segment of the eye and retina.	Visometry	Optic nerve hypoplasia is accompanied by bilateral vision loss (in 80% of cases from moderate to complete blindness).
		Physical examinations	The afferent pupillary reflex is absent. Unilateral optic disc changes are often associated with strabismus and can be seen by a relative afferent pupillary defect and unilateral weak or absent fixation (instead of positional nystagmus).
		Ophthalmoscopy	The optic disc is reduced in size, pale, surrounded by a faint pigment ring. The outer ring (about the size of a normal disc) consists of the lamina cribrosa, pigmented sclera and choroid. Options: yellow-white, small disc with a double ring or complete absence of nerve and vascular aplasia. With a bilateral process, the disc is often difficult to detect; in this case, it is determined along the course of the vessels.
		Perimetry	If central vision is preserved, defects in the visual fields may be detected.
		Consultation with a neurologist, endocrinologist, laboratory tests	Optical hypoplasia of the nerve is rarely combined with septo-optic dysplasia (Morsier syndrome: absence of the transparent septum (septum pellucidum) and pituitary gland, which is accompanied by disorders of the thyroid gland and other hormonal disorders: possible growth retardation, hypoglycemia attacks, combination with mental retardation and malformations of brain structures) .
Coloboma of the optic nerve head	Pathology of the optic nerve	Ophthalmoscopy	With ophthalmoscopy, the optic disc is enlarged in size (elongation of the vertical size), deep excavation or local excavation and increased crescent-shaped pigmentation with partial involvement of the lower nasal part of the optic disc in the process. When the choroid is also involved in the process, a line of demarcation appears, represented by bare sclera. Lumps of pigment may mask the boundary between normal tissue and coloboma. There may be glial tissue on the surface of the optic disc.
Coloboma of the optic nerve head	Pathology of the optic nerve	MRI	MRI - the membranes of the optic canal are weakly expressed or absent.
Morning glow syndrome	Pathology of the optic nerve	Physical examinations	Almost all patients with unilateral pathology have strabismus and high myopia in the affected eye.
		Visometry	Visual acuity is often reduced, but can also be very high.
		Refractometry	Often with a unilateral process there is high myopia of the affected eye.
		Ophthalmoscopy	On ophthalmoscopy, the optic disc is enlarged and is located as if in a funnel-shaped cavity. Sometimes the head of the optic disc is raised; it is also possible to change the position of the head of the optic disc from a staphylomatous depression to its prominence; Around the nerve there are areas of transparent grayish retinal dysplasia and pigment clumps. The demarcation line between the optic disc tissue and the normal retina is indistinguishable. Many abnormally branching vessels are identified. Most patients have areas of local retinal detachment and radial retinal folds within the excavation.
		Perimetry	Possible defects in the visual field: central scotomas and enlargement of the blind spot.
		Consultations with an otolaryngologist	Morning glow syndrome occurs as an independent manifestation or can be combined with hypertelorism, cleft lip, palate and other anomalies.

Treatment

Treatment of optic nerve atrophies is a very difficult task. In addition to pathogenetic therapy, tissue therapy, vitamin therapy, spinal puncture in combination with osmotherapy, vasodilators, B vitamins, especially B1 and B12, are used. Currently, magnetic, laser and electrical stimulation are widely used.

In the treatment of partial optic nerve atrophy, pharmacotherapy is usually used. The use of drugs makes it possible to influence various parts of the pathogenesis of optic nerve atrophy. But do not forget about physical therapy methods and various routes of drug administration. The issue of optimizing routes of drug administration has also become relevant in recent years. Thus, parenteral (intravenous) administration of vasodilators can promote systemic vasodilation, which, in some cases, can lead to steal syndrome and impair blood circulation in the eyeball. It is generally accepted that the therapeutic effect is greater when drugs are used topically. However, in diseases of the optic nerve, local use of drugs is associated with certain difficulties caused by the existence of a number of tissue barriers. Creation of a therapeutic concentration of a drug in a pathological focus is achieved more successfully with a combination of drug therapy and physical therapy.

Drug treatment (depending on the severity of the disease)
Conservative (neuroprotective) treatment is aimed at increasing blood circulation and improving the trophism of the optic nerve, stimulating vitally active nerve fibers that have survived and/or are in the stage of apoptosis.
Drug treatment includes neuroprotective drugs of direct (directly protect the retinal ganglia and axons) and indirect (reduce the effect of factors causing the death of nerve cells) action.

Retinoprotectors: ascorbic acid 5% 2 ml intramuscularly once a day for 10 days, in order to reduce the permeability of the vascular wall and stabilize endothelial cell membranes
Antioxidants: tocopherol 100 IU 3 times a day – 10 days, in order to improve oxygen supply to tissues, collateral circulation, strengthen the vascular wall
Drugs that improve metabolic processes (direct neuroprotectors): retinalamin for intramuscular 1.0 ml and/or parabulbar administration 5 mg 0.5 ml parabulbar 1 time per day for 10 days
List of additional medicines:
- vinpocetine – adults 5-10 mg 3 times a day for 2 months. Has vasodilating, antihypoxic and antiplatelet effects
- cyanocobalamin 1 ml intramuscularly once a day for 5/10 days

Electrical stimulation is also used - it is aimed at restoring the function of nerve elements that were functional, but did not transmit visual information; the formation of a focus of persistent excitability, which leads to the restoration of the activity of nerve cells and their connections, which were previously weakly functioning; improvement of metabolic processes and blood circulation, which contributes to the restoration of the myelin sheath around the axial cylinders of the optic nerve fibers and, accordingly, leads to an acceleration of the action potential and the revival of the analysis of visual information.

Indications for consultation with specialists:

consultation with a therapist - to assess the general condition of the body;
consultation with a cardiologist – high blood pressure is one of the main risk factors for the development of vascular occlusions of the retina and optic nerve;
consultation with a neurologist - to exclude demyelinating disease of the central nervous system and clarify the topical zone of damage to the visual pathways;
consultation with a neurosurgeon - if the patient develops signs of intracranial hypertension or symptoms characteristic of a space-occupying tumor of the brain;
consultation with a rheumatologist - in the presence of symptoms characteristic of systemic vasculitis;
consultation with a vascular surgeon to decide on the need for surgical treatment if there are signs of an occlusive process in the system of the internal carotid and orbital arteries (the appearance of scotoma fugax in the patient);
consultation with an endocrinologist - in the presence of diabetes mellitus/other pathology of the endocrine system;
consultation with a hematologist (if blood diseases are suspected);
consultation with an infectious disease specialist (if vasculitis of viral etiology is suspected).
consultation with an otolaryngologist - if inflammation or neoplasm is suspected in the maxillary or frontal sinus.

Indicators of treatment effectiveness:

an increase in the electrical sensitivity of the optic nerve by 2-5% (according to computer perimetry),
increase in amplitude and/or decrease in latency by 5% (according to VEP data).

Optic nerve atrophy develops as a result of complete or partial death of the fibers of this nerve. Necrotic processes in tissues arise as a result of past pathologies of an infectious and non-infectious nature.

Optic nerve atrophy: causes

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

Optic nerve atrophy is accompanied by inflammatory reactions and circulatory dysfunction, which ultimately leads to the destruction of neurocytes and their replacement with glial tissue. In addition, with increased intraocular pressure, collapse of the optic nerve head membrane develops.

Optic nerve atrophy: symptoms

Clinical signs of pathology depend on the form of atrophy. Without appropriate and timely treatment, optic nerve atrophy progresses and can provoke the development of complete blindness. The main clinical sign of the presented pathology is a sharp decrease in visual acuity that cannot be corrected.

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

color perception changes;
decreased visual acuity;
the appearance of “tunnel vision”;
violation of orientation in space;
decreased peripheral and central vision;
the appearance of scotomas (blind spots);
problems with reading or other visual work.

Objective symptoms of the above pathology are determined only during an ophthalmological examination.

Features of the development of the disease in childhood

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

Diagnosis of the disease

If you notice any vision problems, you should consult an ophthalmologist. It is important to find out what exactly caused the development of the disease. In order to establish a diagnosis of “optic atrophy of the eye”, you need to do the following:

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

Conservative treatment

Once a diagnosis of optic atrophy is made, treatment should be immediate. Unfortunately, it is impossible to completely cure this disease, but in some cases it is possible to slow down and even stop the pathological process. To treat patients, doctors use different groups of drugs that improve blood circulation. The most commonly used drugs are vasodilators ("Papaverine", "Amylnitrite", "Compalamin", "No-shpa", "Stugeron", "Galidor", "Eufilin", "Sermion", "Trental", "Dibazol"), anticoagulants (" Heparin", "Nadroparin calcium", "Tiklid"), vitamins (thiamine, riboflavin, pyridoxine, cyanocobalamin, ascorutin), enzymes (lidase, fibrinolysin), amino acids (glutamic acid), hormones (Prednisolone, Dexamethasole) and immunomodulators (“Eleutherococcus”, “Ginseng”).

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

Nowadays, biogenic preparations (Peat, Aloe, Peloid distillate, FiBS), angioprotectors (Emoxipin, Mildronate, Doxium), and water-soluble vitamins are actively used. Good results are obtained by combining the drug “Emokchipin” with vitamin E (tocopherol). The medications “Dekaris”, “Sodium Nucleinate”, “Timalin” are prescribed as immunocorrective agents.

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

Physiotherapeutic treatments

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

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

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

Surgical methods for hemodynamic correction

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

extrascleral;
vasoconstructive;
decompression

Extrascleral operations

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

Vasoconstructive operations

These methods are aimed at redistributing blood flow in the eye area. This effect was achieved through ligation of the external carotid artery (arteria carotis externa). To apply this technique, carotid angiography must be performed.

Decompression operations

This method is used to reduce venous stasis in the vessels of the optic nerve. The technique of dissecting the scleral canal and the bony canal of the optic nerve is very difficult to perform and is currently just beginning to develop, so it is rarely used.

Traditional methods of treatment

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

Let us remember that partial atrophy of the optic nerve, which is treated using traditional medicine, has its drawbacks. With such a serious pathology, doctors strongly discourage self-medication. If you still decide to use traditional recipes, then you should consult with specialists: an ophthalmologist, therapist, herbalist or neurosurgeon.

Prevention

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

undergo regular examinations with an oncologist and ophthalmologist;
promptly treat infectious diseases;
do not abuse alcohol;
monitor blood pressure;
prevent eye and traumatic brain injuries;
repeated blood transfusion for profuse bleeding.

2708 08/02/2019 6 min.

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

Definition of disease

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

The transmission of images from the retina to the visual analyzer in the brain occurs through a kind of “cable”, consisting of many nerve fibers and packed in “insulation”. The thickness of the optic nerve is no 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 image perceived by the eye.

When nerve fiber cells die, they are gradually replaced by connective tissue or nerve auxiliary 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 an affected X chromosome, so only men aged 15-25 years are affected. The pathology develops in a recessive manner and is inherited;
Secondary. It occurs as a consequence of an ocular or systemic disease associated with impaired blood supply or congestion of the optic nerve. This pathological condition can appear at any age.

Classification is also carried out according to the location 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 of occurrence

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

The cause 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: retinal pigmentary dystrophy, etc.;
Glaucoma and increased IOP;
Systemic diseases: hypertension, atherosclerosis, vascular spasms;
Toxic effects: smoking, alcohol, quinine, drugs;
Brain diseases: abscess, multiple sclerosis, arachnoiditis;
Traumatic injuries;
Infectious diseases: meningitis, encephalitis, syphilitic lesions, tuberculosis, influenza, measles, etc.

Is it possible to cure glaucoma?

Whatever the reason for the onset of optic nerve atrophy, the nerve fibers die irrevocably, and the main thing is to quickly diagnose it 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 cannot be corrected by conventional methods.

Visual functions are gradually lost:

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

Possible complications

The diagnosis of “optic atrophy” must be made as early as possible, otherwise vision 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 causes 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 begins to develop in patients with vision indicators below 0.01, then treatment measures will most likely not give any result.

Diagnostics

A targeted ophthalmological examination is the first mandatory step if a disease is suspected. In addition, consultation with a neurosurgeon or neurologist may be required.

The following types of examinations may be performed to detect optic nerve atrophy:

Fundus examination (or biomicroscopy);
– determination of the degree of visual perception impairment (myopia, farsightedness, astigmatism);
– visual field examination;
Computer perimetry – allows you to determine the affected area of nervous tissue;
Assessment of color perception - determination of the localization of nerve fiber lesions;
Video-ophthalmography – identifying the nature of the damage;
Craniography (x-ray of the skull) - the main object is the area of the sella turcica.

Read more about How is a fundus examination performed? By .

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

Treatment

If the nerve fibers are partially damaged, 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.

Drug therapy

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

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

Heparin ointment is used in the treatment of optic nerve arthrosis

Vitamins: Ascorutin, B1, B6, B2. They are catalysts for most biochemical reactions occurring in eye tissues, just like amino acids and enzymes;
Immunostimulants: Ginseng, Eleutherococcus. Necessary for stimulating regeneration processes and suppressing inflammation in infectious lesions;
Hormonal agents: Dexamethasone, Prednisolone. Used in the absence of contraindications to relieve symptoms of inflammation;
Improving the functioning of the central nervous system: Nootropil, Cavinton, Cerebrolysin, Phezam.

Instruction D Examethasone for the eyes is located.

Dexamethasone is used in the treatment of optic nerve osteoarthritis.

In each specific 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 physiotherapeutic treatment methods:

Ultrasound;
Electrophoresis;
Electrical and laser stimulation of the optic nerve;
Magnetotherapy.

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

Surgically

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

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

Folk remedies

Optic atrophy should be treated 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 help - after all, the effect of most of them is aimed at stimulating metabolism and increasing blood circulation:

Dissolve 0.2 g of mumiyo in a glass of water, drink before lunch on an empty stomach, and also drink a glass of the product in the evening for 3 weeks (20 days);
Make an infusion of crushed astragalus herb (2 tablespoons of dried raw material per 300 ml of water), leave for 4 hours. Within 2 months. take 100 ml of infusion 3 times. in a day;
Peppermint is called an eye herb, it is useful to eat it, and instill the juice mixed with equal amounts of honey and water into the eyes, morning and evening;
You can eliminate eye fatigue after long-term work on the computer by using lotions from infusions of dill, chamomile, parsley, blue cornflower and regular 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 r. 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 herbal components have an allergenic effect and can have an unexpected effect in the presence of certain systemic pathologies.

Prevention

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

Treat ocular and systemic infectious diseases in a timely manner;
Prevent eye and traumatic brain injuries;
Carry out preventive examinations in an oncology clinic;
Limit your consumption or eliminate alcohol from your life;
Get your blood pressure under control.

You can find a color blindness test online.

Video

conclusions

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

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

Also read about red spots under the eyes in.

Optic nerve atrophy (optic neuropathy) is partial or complete destruction of the 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, the neurons begin to gradually die. Over time, it affects an increasing number of cells, and in severe cases, the entire nerve trunk. It will be almost impossible to restore eye function in such patients.

What is the optic nerve?

The optic nerve belongs to the cranial peripheral nerves, but essentially it is not a peripheral nerve either in origin, or in structure, or in function. This is the white matter of the cerebrum, the 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 entire process of converting light information. Its first and most significant function is the delivery of visual messages from the retina to the areas of the brain responsible for vision. Even the smallest injuries to this area can have serious complications and consequences.

Optic atrophy according to the ICD has ICD code 10

Causes

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

The following types of disease are distinguished:

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

Factors leading to optic nerve atrophy may include eye diseases, central nervous system 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 supply the optic nerve, as well as 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, pigmentary degeneration of the retina)
Intoxication (quinine, nicotine and other drugs)
Alcohol poisoning (more precisely, alcohol surrogates)
Viral infections (flu, flu)
Pathology of the central nervous system (brain abscess, syphilitic lesion, skull injury, 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 pathologies.

Secondary atrophy is caused by:

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

Optic nerve atrophy can be caused by inflammation or dystrophy of the optic nerve, its compression or trauma, leading to damage to the nerve tissue.

Types of disease

Atrophy of the optic nerve of the eye occurs:

Primary atrophy(ascending and descending), as a rule, develops as an independent disease. Descending optic atrophy is most often diagnosed. This type of atrophy is a consequence of the fact that the nerve fibers themselves are affected. It is transmitted in a recessive manner by inheritance. This disease is linked exclusively to the X chromosome, which is why only men suffer from this pathology. It manifests itself at 15-25 years of age.
Secondary atrophy usually develops after the course of any 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 the following variants of this pathology:

Partial optic atrophy

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 when visual acuity is reduced (due to which the use of lenses or glasses does not improve the quality of vision). Although residual vision can be preserved in this case, there are disturbances in color perception. Preserved areas within sight 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 a decrease in the quality of visual acuity inevitably occurs.

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 can 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 between 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 scotomas;
manifestation of the afferent pupillary effect.

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

Complications

In order to prevent the occurrence of pathologies of the optic nerve, it is necessary to carefully monitor your health and undergo regular examinations by specialists (rheumatologist, endocrinologist, neurologist, ophthalmologist). At the first signs of vision deterioration, you should consult an ophthalmologist.

Diagnostics

Optic nerve atrophy is a fairly 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 to treat 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 (diluted with special drops) of the entire fundus of the eye;
spheroperimetry (precise determination of the boundaries of the field of view);
laser dopplerography;
assessment of color perception;
craniography with an image of the sella turcica;
computer perimetry (allows you to identify which part of the nerve is damaged);
video-ophthalmography (allows us to identify the nature of damage to the optic nerve);
computed tomography, as well as magnetic nuclear resonance (clarifies the cause of optic nerve disease).

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

Treatment of optic atrophy of the eye

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

When treating optic nerve atrophy, the following actions are performed:

Biogenic stimulants (vitreous body, aloe extract, etc.), amino acids (glutamic acid), immunostimulants (Eleutherococcus), vitamins (B1, B2, B6, ascorutin) are prescribed to stimulate the restoration of altered tissue, and are also prescribed to improve metabolic processes
Vasodilators are prescribed (no-spa, diabazole, papaverine, sermion, trental, zufillin) to improve blood circulation in the vessels supplying the nerve
To maintain the functioning of the central nervous system, Fezam, Emoxipin, Nootropil, Cavinton are prescribed
To accelerate the resorption of pathological processes - pyrogenal, preductal
Hormonal drugs are prescribed to stop the inflammatory process - dexamethasone, prednisolone.

Medicines are taken only as prescribed 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 vision or have lost it to a significant extent are prescribed an appropriate course of rehabilitation. It is aimed at compensating and, if possible, eliminating all the restrictions that arise in life after suffering optic nerve atrophy.

Basic physiotherapeutic methods of therapy:

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

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

The earlier treatment is started, the more favorable the prognosis of the disease. Nervous tissue is practically irreparable, so the disease cannot be neglected; it must be treated in a timely manner.

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

The prognosis for optic nerve atrophy is always serious. In some cases, you can expect to preserve your vision. If atrophy develops, the prognosis is unfavorable. Treatment of patients with optic atrophy, whose visual acuity has been less than 0.01 for several years, is ineffective.

Prevention

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

Consultation with a specialist if there is the slightest doubt about the patient’s visual acuity;
Prevention of various types of intoxication
promptly treat infectious diseases;
do not abuse alcohol;
monitor blood pressure;
prevent eye and traumatic brain injuries;
repeated blood transfusion for profuse bleeding.

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

Optic nerve atrophy is the complete or partial destruction of its fibers with their replacement by connective tissue.

Causes of optic nerve atrophy

The causes of visual atrophy include heredity and congenital pathology; it can be a consequence of various eye diseases, pathological processes in the retina and optic nerve (inflammation, dystrophy, trauma, toxic damage, swelling, congestion, various circulatory disorders, compression of the optic nerve, etc.), pathology of the nervous system or general diseases.

More often, optic nerve atrophy develops as a result of pathology of the central nervous system (tumors, syphilitic lesions, brain abscesses, encephalitis, meningitis, multiple sclerosis, skull injuries), intoxication, alcohol poisoning with methyl alcohol, etc.

Also, the causes of the development of optic nerve atrophy can be hypertension, atherosclerosis, quinine poisoning, vitamin deficiency, fasting, and profuse bleeding.

Optic nerve atrophy occurs as a result of obstruction of the central and peripheral retinal arteries supplying the optic nerve, and it is also the main symptom of glaucoma.

Symptoms of optic atrophy

There are primary and secondary atrophy of the optic nerves, partial and complete, complete and progressive, unilateral and bilateral.

The main symptom of optic nerve atrophy is a decrease in visual acuity that cannot be corrected. Depending on the type of atrophy, this symptom manifests itself differently. Thus, as atrophy progresses, vision gradually decreases, which can lead to complete atrophy of the optic nerve and, accordingly, to complete loss of vision. This process can take place from several days to several months.

With partial atrophy, the process stops at some stage and vision stops deteriorating. Thus, progressive atrophy of the optic nerves is distinguished and complete.

Visual impairment due to atrophy can be very diverse. This can be a change in visual fields (usually narrowing, when “lateral vision” disappears), up to the development of “tunnel vision”, when a person looks as if through a tube, i.e. sees objects that are only directly in front of him, and scotomas often appear, i.e. dark spots in any part of the visual field; It could also be a color vision disorder.

Changes in visual fields can be not only “tunnel”, it depends on the localization of the pathological process. Thus, the appearance of scotomas (dark spots) right before the eyes indicates damage to nerve fibers closer to the central or directly in the central part of the retina; narrowing of the visual fields occurs due to damage to peripheral nerve fibers; with deeper lesions of the optic nerve, half of the visual field (or temporal , or nasal). These changes can occur in one or both eyes.

Examination for suspected optic nerve atrophy

It is unacceptable to engage in self-diagnosis and self-medication for this pathology, because something similar happens with peripheral cataracts, when lateral vision is first impaired, and then the central parts are involved. Also, optic atrophy can be confused with amblyopia, in which vision can also be significantly reduced and cannot be corrected. It is worth noting that the above pathology is not as dangerous as optic nerve atrophy. Aatrophy can be not only an independent disease or a consequence of some local pathology in the eye, but also a symptom of a serious and sometimes fatal disease of the nervous system, so it is very important to establish the cause of optic nerve atrophy as early as possible.

If similar symptoms occur, you should immediately contact an ophthalmologist and neurologist. These two specialists are primarily involved in the treatment of this disease. There is also a separate branch of medicine - neuro-ophthalmology, doctors - neuro-ophthalmologists, who are engaged in the diagnosis and treatment of such pathologies. If necessary, neurosurgeons, therapists, otorhinolaryngologists, infectious disease specialists, oncologists, toxicologists, etc. can also take part in diagnosis and treatment.

Diagnosis of optic atrophy is usually not difficult. It is based on the determination of visual acuity and fields (perimetry), on the study of color perception. An ophthalmologist must perform an ophthalmoscopy, during which he detects blanching of the optic nerve head, narrowing of the vessels of the fundus and measures intraocular pressure. A change in the contours of the optic nerve head indicates the primary or secondary nature of the disease, i.e. if its contours are clear, then most likely the disease has developed for no apparent reason, but if the contours are blurred, then perhaps it is post-inflammatory or post-stagnant atrophy.

If necessary, an X-ray examination is carried out (craniography with a mandatory image of the sella region), computed tomography or magnetic resonance imaging of the brain, electrophysiological research methods and fluorescein angiographic methods, in which the patency of the retinal vessels is checked using a special substance administered intravenously.

Laboratory research methods can also be informative: a general blood test, a biochemical blood test, a test for syphilis or borelliosis.

Treatment of optic atrophy

When treating atrophy, it is necessary to keep in mind that this is often not an independent disease, but a consequence of other pathological processes affecting various parts of the visual pathway. Therefore, treatment of optic nerve atrophy must be combined with elimination of the cause that caused it. If the cause is eliminated in a timely manner and if atrophy has not yet developed, normalization of the fundus picture and restoration of visual functions occurs within 2-3 weeks to 1-2 months.

Treatment is aimed at eliminating edema and inflammation in the optic nerve, improving its blood circulation and trophism (nutrition), restoring the conductivity of not completely destroyed nerve fibers.

But it should be noted that the treatment of optic nerve atrophy is long-term, its effect is weak, and sometimes completely absent, especially in advanced cases. Therefore it should be started as early as possible.

As mentioned above, the main thing is the treatment of the underlying disease, against the background of which complex treatment of optic nerve atrophy is carried out. For this, various forms of drugs are prescribed: eye drops, injections, both general and local; tablets, electrophoresis. Treatment is aimed at

improvement of blood circulation in the vessels supplying the nerve - vasodilators (complamin, nicotinic acid, no-spa, papaverine, dibazol, aminophylline, trental, halidor, sermion), anticoagulants (heparin, ticlid);
to improve metabolic processes in nerve tissue and stimulate the restoration of altered tissue - biogenic stimulants (aloe extract, peat, vitreous, etc.), vitamins (ascorutin, B1, B2, B6), enzymes (fibrinolysin, lidase), amino acids (glutamic acid ), immunostimulants (ginseng, eleuthorococcus);
to resolve pathological processes and stimulate metabolism (phosphaden, preductal, pyrogenal); to relieve the inflammatory process - hormonal drugs (prednisolone, dexamethasone); to improve the functioning of the central nervous system (emoxipin, Cerebrolysin, Fezam, nootropil, Cavinton).

Medicines must be taken as prescribed by a doctor after diagnosis. The doctor will select the optimal treatment, taking into account concomitant diseases. In the absence of concomitant somatic pathology, you can independently take no-shpu, papaverine, vitamin preparations, amino acids, emoxypine, nootropil, fesam.

But you should not self-medicate for this serious pathology. Physiotherapeutic treatment and acupuncture are also used; methods of magnetic, laser and electrical stimulation of the optic nerve have been developed.

The course of treatment is repeated after several months.

Nutrition for optic nerve atrophy should be complete, varied and rich in vitamins. You need to eat as much fresh vegetables and fruits as possible, meat, liver, dairy products, cereals, etc.

If vision is significantly reduced, the issue of assigning a disability group is decided.

The visually impaired and the blind are prescribed a course of rehabilitation aimed at eliminating or compensating for the limitations in life that have arisen as a result of vision loss.

Treatment with folk remedies is dangerous because precious time is lost when it is still possible to cure atrophy and restore vision. It should be noted that for this disease, folk remedies are ineffective.

Complications of optic atrophy

The diagnosis of optic atrophy is very serious. At the slightest decrease in vision, you should immediately consult a doctor so as not to miss your chance of recovery. Without treatment and as the disease progresses, vision may disappear completely, and it will be impossible to restore it. In addition, it is very important to identify the cause of optic nerve atrophy and eliminate it as early as possible, because this can not only lead to loss of vision, but can also be fatal.

Prevention of optic atrophy

In order to reduce the risk of optic nerve atrophy, it is necessary to promptly treat diseases that lead to atrophy, prevent intoxication, conduct blood transfusions in case of profuse bleeding and, of course, promptly consult a doctor at the slightest sign of vision deterioration.

Ophthalmologist E.A. Odnoochko