Optic nerve damage treatment. Partial optic atrophy: treatment
Update: December 2018
The quality of life is primarily affected by our health. Free breathing, clear hearing, freedom of movement - all this is very important for a person. Disruption of even one organ can lead to a change in the usual way of life in a negative direction. For example, forced refusal of active physical activity (running in the morning, going to the gym), eating tasty (and fatty) foods, intimate relationships, etc. This manifests itself most clearly when the organ of vision is damaged.
Most eye diseases have a fairly favorable course for humans, since modern medicine can cure them or reduce their negative effects 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 timely detection of the cause of the disease and adequate treatment.
What is optic 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, 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.
To understand how this disease manifests itself, it is necessary to imagine the course of impulses to brain structures. They are conventionally divided into two portions – lateral and medial. The first 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 structures of the brain. This path is quite difficult, but there is one fundamental point - almost immediately after leaving the orbit, a cross occurs in internal portions. What does this lead to?
- The left tract perceives the image of the world from the left side of the eyes;
- The right one transfers 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 changes in the function of both eyes.
Causes
In the vast majority of cases, this pathology does not occur independently, but is a consequence of another eye disease. It is very important to consider the cause of optic nerve atrophy, or rather the location of its occurrence. It is this factor that will determine the nature of the patient’s symptoms and the specifics of therapy.
There may be two options:
- Ascending type - the disease occurs from that part of the nerve trunk that is closer to the eye (before the chiasm);
- Descending form - the nervous tissue begins to atrophy from top to bottom (above the chiasm, but before entering the brain).
The most common causes of these conditions are presented in the table below.
| Characteristic reasons | a brief description of |
Ascending type |
|
| Glaucoma | This word hides a number of disorders that are united by one feature - increased intraocular pressure. Normally, it is necessary to maintain the correct shape of the eye. But with glaucoma, pressure impedes the flow of nutrients to the nerve tissue and makes them atrophic. |
| Intrabulbar neuritis | An infectious process that affects neurons in the cavity of the eyeball (intrabulbar form) or behind it (retrobulbar type). |
| Retrobulbar neuritis | |
| Toxic nerve damage | Exposure to toxic substances in the body leads to the breakdown of nerve cells. The following have a damaging effect on the analyzer:
|
| Ischemic disorders | Ischemia is a lack of blood flow. May occur when:
|
| Stagnant disk | By its nature, this is swelling of the initial part of the nerve trunk. It can occur in any condition associated with increased intracranial pressure:
|
| Tumors of the nerve or surrounding tissues located before the chiasm | Pathological tissue proliferation can lead to compression of neurons. |
Descending type |
|
| Toxic lesions (less common) | In some cases, the toxic substances described above can damage neurocytes after crossing. |
| Tumors of the nerve or surrounding tissues located after the chiasm | Oncological processes are the most common and most dangerous cause of the descending form of the disease. They are not classified as benign, since the difficulties of treatment make it possible to call all brain tumors malignant. |
| Specific lesions of nervous tissue | As a result of some chronic infections that occur with the destruction of neurocytes throughout the body, the optic nerve trunk may partially/completely atrophy. These specific lesions include:
|
| Abscesses in the cranial cavity | After neuroinfections (meningitis, encephalitis and others), cavities limited by connective tissue walls - abscesses - may appear. If they are located next to the optic tract, there is a possibility of pathology. |
Treatment of optic atrophy is closely related to identifying the cause. Therefore, close attention should be paid to clarifying it. Symptoms of the disease, which allow one to distinguish the ascending form from the descending one, can help in diagnosis.
Symptoms
Regardless of the level of damage (above or below the chiasm), there are two reliable signs of optic nerve atrophy - loss of visual fields (“anopsia”) and decreased visual acuity (amblyopia). How pronounced they will be in a particular patient depends on the severity 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? Essentially, this is just an area that a person sees. To imagine it, you can close half of your 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 “lost” one (right or left) zone. This is exactly 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, since 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 certainly appear in the patient.
Which areas will be missing from the patient’s perception? This depends on the level at which the pathological process is located and on the degree of cell damage. There are several options:
| Type of atrophy | Damage level | What does the patient feel? |
| Complete – the entire diameter of the nerve trunk is damaged (the signal is interrupted and is not transmitted to the brain) | The organ of vision on the affected side completely ceases to see | |
| Loss of right or left visual fields in both eyes | ||
| Incomplete - only part of the neurocytes do not perform their function. Most of the image is perceived by the patient | Before the cross (with an ascending form) | There may be no symptoms or the field of vision in one eye may be lost. Which one depends on the location of the atrophy process. |
| After crossing (with descending type) |
This neurological symptom seems difficult to perceive, but thanks to it, an experienced specialist can identify the location of the lesion without any additional methods. Therefore, it is very important that the patient speaks openly to their 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:
- Mild – characteristic of the initial manifestations of the process. The patient does not feel a decrease in vision, the symptom appears only when carefully examining distant objects;
- Medium – occurs when a significant portion of neurons are damaged. Distant objects are practically invisible; at a short distance the patient does not experience any difficulties;
- Severe – indicates the activity of the pathology. The sharpness is reduced so much that even objects located nearby become difficult to distinguish;
- Blindness (synonymous with amorosis) 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 is aggressive or the patient does not seek help in a timely manner, there is a possibility of developing irreversible blindness.
Diagnostics
As a rule, problems with detecting this pathology rarely arise. The main thing is that the patient seeks medical help in a timely manner. To confirm the diagnosis, he is referred to an ophthalmologist for a fundus examination. This is a special technique with which you can examine the initial part of the nerve trunk.
How is ophthalmoscopy performed?. In the classic version, the fundus is examined by a doctor in a dark room, using a special mirror device (ophthalmoscope) and a light source. The use of modern equipment (electronic ophthalmoscope) allows this study to be carried out with greater accuracy. The patient is not required to have any preparation for the procedure or special actions during the examination.
Unfortunately, ophthalmoscopy does not always detect changes, since symptoms of damage occur earlier than tissue changes. Laboratory tests (blood, urine, cerebrospinal fluid tests) are nonspecific and have only auxiliary diagnostic value.
How to proceed in this case? In modern multidisciplinary hospitals, to detect the cause of the disease and changes in nervous tissue, the following methods exist:
| Research method | Principle of the method | Changes in atrophy |
| Fluorescein angiography (FA) | The patient is injected with a dye through a vein, which enters the blood vessels of the eyes. Using a special device that emits light of different frequencies, the fundus of the eye is “illuminated” and its condition is assessed. | Signs of insufficient blood supply and tissue damage |
| Laser eye disc tomography (HRTIII) | Non-invasive (remote) way to study the anatomy of the fundus. | Changes in the initial part of the nerve trunk according to the type of atrophy. |
| Optical coherence tomography (OCT) of the optic nerve head | Using high-precision infrared radiation, the condition of tissues is assessed. | |
| CT/MRI of the brain | Non-invasive methods for studying the tissues of our body. Allows you to obtain an image at any level, with an accuracy of cm. | Used to determine the possible cause of a disease. Typically, the purpose of this study is to look for a tumor or other mass formation (abscesses, cysts, etc.). |
Treatment of the disease begins from the moment the patient contacts, since it is irrational to wait for diagnostic results. During this time, the pathology may continue to progress, and changes in tissues will become irreversible. After clarifying the cause, the doctor adjusts his tactics to achieve the optimal effect.
Treatment
There is a widespread belief in society that “nerve cells do not recover.” 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. If the trunk is partially damaged, medications can improve visual acuity and fields. In rare cases, even virtually restore the patient's ability to see to normal levels. If the pathological process completely disrupts the transmission of impulses from the eye to the brain, only surgery can help.
To successfully treat this disease, it is necessary, first of all, to eliminate the cause of its occurrence. This will prevent/reduce cell damage and stabilize the course of pathology. Since there are a large number of factors that cause atrophy, doctors' tactics can vary significantly for different conditions. If it is not possible to cure the cause (malignant tumor, hard-to-reach abscess, etc.), you should immediately begin to restore the functionality of the eye.
Modern methods of nerve restoration
Just 10-15 years ago, the main role in the treatment of optic nerve atrophy was given to vitamins and angioprotectors. At present, they have only additional meaning. Medicines that restore metabolism in neurons (antihypoxants) and increase blood flow to them (nootropics, antiplatelet agents and others) come to the fore.
A modern scheme for restoring eye functions includes:
- Antioxidant and antihypoxant (Mexidol, Trimetazidine, Trimectal and others) - this group is aimed at tissue restoration, reducing the activity of damaging processes, and eliminating “oxygen starvation” of the nerve. In a hospital setting, they are administered intravenously; during 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. Also available in the form of solutions for intravenous infusions and tablets;
- Nootropics (Piracetam, Cerebrolysin, Glutamic acid) are stimulators of blood flow to neurocytes. 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 administered parabulbarly (a thin needle is passed along the wall of the orbit into the tissue surrounding 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 eye function using peptide bioregulators. At the moment, only two drugs are widely used in specialized centers - Cortexin and Retinalamin. Studies have shown that they improve vision almost twice.
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 - used as injections into the skin of the temples or intramuscularly. The first method is preferable, since it creates a higher concentration of the substance;
- Retinalamin - the medicine is injected into the parabulbar tissue.
The combination of classical and peptide therapy is quite effective for nerve regeneration, but even this does not always achieve the desired result. You can additionally stimulate recovery processes with the help of targeted physiotherapy.
Physiotherapy for optic atrophy
There are two physiotherapeutic techniques, whose positive effects are confirmed by scientific research:
- Pulsed magnetic therapy (MPT) - this method is not aimed at restoring cells, but at improving their functioning. Thanks to the directed influence of magnetic fields, the contents of neurons are “condensed”, which is why the generation and transmission of impulses to the brain is faster;
- Bioresonance therapy (BT) - its mechanism of action is associated with improving metabolic processes in damaged tissues and normalizing blood flow through microscopic vessels (capillaries).
They are very specific and are used only in large regional or private ophthalmology 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:
- 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, some of the vessels on the face are ligated, which is why most of the blood is forced to flow through the ophthalmic artery. This type of intervention is performed quite rarely, as it can lead to complications in the postoperative period;
- Transplantation of revascularizing tissues - the principle of this operation is to transplant tissues with an abundant blood supply (parts of muscle, conjunctiva) into an atrophic area. New vessels will grow through the graft, ensuring adequate blood flow to the neurons. Such an intervention is much more widespread, since it practically does not affect other tissues of the body.
Several years ago, stem cell treatment methods were actively developed in the Russian Federation. However, an amendment to the country's legislation made these studies and the use of their results on people 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 damage to the nerve trunk and the time of initiation of treatment. If the pathological process has affected only a part of the neurocytes, in some cases it is possible to almost completely restore the functions of the eye, with adequate therapy.
Unfortunately, with the atrophy of all nerve cells and the cessation of impulse transmission, there is a high probability of the patient developing blindness. The solution in this case may be surgical restoration of tissue nutrition, but such treatment does not guarantee the 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 detected before the age of one year (6-8 months). It is important to consult an ophthalmologist in a timely manner, since the greatest effect of 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 pathology develop in children?
No, these are quite rare cases. If a child is diagnosed and confirmed, it is necessary to clarify whether it is congenital.
Question:
What treatment with folk remedies is most effective?
Atrophy is difficult to treat even with highly active drugs and specialized physiotherapy. Traditional methods will not have a significant impact on this process.
Question:
Do they provide disability groups for atrophy?
This depends on the degree of vision loss. Blindness is the indication for the first group, acuity from 0.3 to 0.1 for the second.
All therapy is accepted by the patient for life. Short-term treatment is not enough to control this disease.
Optic nerve atrophy is a serious ophthalmological disease with a significant decrease in the patient’s visual function. 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.
Causes of optic nerve atrophy of neurological, infectious, phlebological etiology include brain tumors, meningitis, hypertension, profuse bleeding, atherosclerosis and other diseases. Destruction of the nerve fibers of the optic nerve can also be caused by genetic factors or intoxication of the body.
During the development of optic nerve atrophy, the destruction of nerve fibers gradually occurs, their replacement by connective and glial tissue, and then blockage of the vessels responsible for the blood supply to the optic nerve. As a result, the patient's visual acuity decreases and the optic disc becomes pale.
Symptoms of optic atrophy
Symptoms of optic atrophy depend on the form of the disease. A sign of primary optic nerve atrophy, as an independent disease, is the clear boundaries of the pale disc. In this case, the normal excavation (deepening) of the disc is disrupted. With primary atrophy of the optic nerve, it takes on the shape of a saucer with narrowed retinal arterial vessels.
Symptoms of secondary optic nerve atrophy include blurred disc boundaries, vasodilation, and prominence (bulging) of its central part. However, it must be taken into account that at the late stage of secondary optic nerve atrophy there are no symptoms: the vessels narrow, the boundaries of the disc are smoothed, and the disc is flattened.
Hereditary atrophy of the optic nerve, for example, in Leber's disease, is manifested by retrobulbar neuritis. This is the name for inflammation of the portion of the optic nerve located behind the eyeball. Visual acuity decreases gradually, but painful sensations are noted during eye movements.
A symptom of optic nerve atrophy against the background of profuse bleeding (uterine or gastrointestinal) is a sharp narrowing of the retinal vessels and loss of its lower half from the field of view.
Symptoms of optic nerve atrophy due to compression by a tumor or injury depend on the location of damage to the optic disc. Often, even with the most serious injuries, the quality of vision decreases gradually.
Partial atrophy of the optic nerve is characterized by the least functional and organic changes. The term “partial optic nerve atrophy” means that the destructive process began, affected only part of the optic nerve and stopped. Symptoms of partial optic nerve atrophy can be very different and have different severity. For example, narrowing of the field of vision up to tunnel syndrome, the presence of scotomas (blind spots), decreased visual acuity.
With significant pallor of the optic nerve, diagnosing the disease is simple. Otherwise, a more detailed study of the patient’s visual functions is required using tests to determine the visual field, X-ray and fluorescein angiographic studies.
Atrophy of the optic nerve is also indicated by a change in the electrical physiological sensitivity of the optic nerve and an increase in intraocular pressure in the glaucomatous form of the disease.
Treatment of optic atrophy
The most favorable prognosis in the treatment of partial optic nerve atrophy. The main standard in treating the disease is the use of drugs to improve blood supply to the optic nerve, vitamins and physiotherapy.
If the decrease in visual acuity is caused by compression, treatment of optic nerve atrophy is primarily neurosurgical, and only then magnetic and laser stimulation methods, electrotherapy and physiotherapy are used.
The main goal of treatment for optic nerve atrophy is to stop the destruction of optic nerve tissue and maintain existing visual acuity. It is usually impossible to completely restore visual function. But without treatment, optic nerve atrophy can lead to complete blindness of the patient.
Optic nerve atrophy in children
Many congenital eye diseases are diagnosed in a child during the first examination in the maternity hospital: glaucoma, cataracts, ptosis of the upper eyelid, etc. Optic nerve atrophy in children, unfortunately, is not one of them, since its course is often hidden, without external visible symptoms of the disease. Therefore, the diagnosis of complete damage to the optic nerve or partial atrophy of the optic nerve in children is established, as a rule, in the second month of the child’s life during a routine examination by an ophthalmologist.
The doctor checks the visual acuity of the newborn, based on the quality of gaze fixation and the child’s ability to follow a moving toy. The infant's field of vision is determined in the same way. If it is not possible to determine visual acuity in this way, then a study of the brain’s reaction to visual stimuli is used.
Using ophthalmological equipment and drugs that dilate the pupil, the baby's fundus is studied. If a clouded optic disc is detected, a diagnosis of optic nerve atrophy is made. In children, treatment of the disease follows the same scheme as in adults, with the prescription of vasodilator therapy, nootropics to improve metabolic processes in the brain and courses of light, laser, electrical and magnetic influences that stimulate vision.
Video from YouTube on the topic of the article:
Optic atrophy- complete or partial destruction of the fibers of the nervus opticus with their replacement by connective tissue. Obliteration of the capillaries supplying the optic nerve also occurs. The disease belongs to the class of serious ophthalmological diseases, accompanied by a decrease in the patient’s visual function.
Classification of optic nerve atrophy
The types of optic nerve atrophy can be classified as follows:
- For reasons of occurrence: hereditary and acquired atrophy. Hereditary atrophy is divided into autosomal dominant, autosomal recessive (found in Jensen's syndrome, Vera, Bourneville, etc.) and mitochondrial (Leber's disease) forms. Acquired atrophy is divided into primary, secondary and glaucomatous atrophy.
- According to the degree of color change of the optic nerve head: initial (slight blanching of the optic nerve head), partial (blanching of the optic nerve head in one of the segments) and complete (uniform blanching of the entire optic nerve head, as well as narrowing of the fundus vessels).
- According to the nature of the damage: ascending (damaged retinal cells) and descending (damaged optic nerve fibers) atrophy.
- By localization: one-sided and two-sided.
- According to the degree of progression: stationary and progressive.
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, edema, 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 that supply the optic nerve, and is also the main symptom of glaucoma.
Symptoms of optic atrophy
Regardless of the level of damage (above or below the chiasm), there are two reliable signs of optic nerve atrophy - loss of visual fields (“anopsia”) and decreased visual acuity (amblyopia). How pronounced they will be in a particular patient depends on the severity 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). Essentially, this is just an area that a person sees. To imagine it, you can close half of your 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 “lost” one (right or left) zone. This is exactly 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 symptom, since 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 certainly appear in the patient.
This neurological symptom seems difficult to perceive, but thanks to it, an experienced specialist can identify the location of the lesion without any additional methods. Therefore, it is very important that the patient speaks openly to their 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:
- Mild – characteristic of the initial manifestations of the process. The patient does not feel a decrease in vision, the symptom appears only when carefully examining distant objects;
- Medium – occurs when a significant portion of neurons are damaged. Distant objects are practically invisible; at a short distance the patient does not experience any difficulties;
- Severe – indicates the activity of the pathology. The sharpness is reduced so much that even objects located nearby become difficult to distinguish;
- Blindness (synonymous with amaurosis) 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 is aggressive or the patient does not seek help in a timely manner, there is a possibility of developing irreversible blindness.
If you discover signs of optic nerve atrophy, you should immediately seek help from a specialist in order to prevent irreversible consequences of the disease.
Diagnosis of optic nerve atrophy
In severe cases, diagnosis is not difficult. If the pallor of the optic disc is insignificant (especially temporal, since the temporal half of the disc is normally somewhat paler than the nasal half), then a long-term study of visual functions over time helps establish the diagnosis. In this case, it is necessary to pay special attention to the study of the visual field for white and colored objects. Electrophysiological, radiological and fluorescein angiographic studies facilitate diagnosis. Characteristic changes in the visual field and an increase in the threshold of electrical sensitivity (up to 400 μA when the norm is 40 μA) indicate optic nerve atrophy. The presence of marginal excavation of the optic nerve head and increased intraocular pressure indicate glaucomatous atrophy.
Sometimes it is difficult to determine the type of damage to the optic nerve or the nature of the underlying disease just by the presence of disc atrophy in the fundus. Blurring of the disc boundaries during atrophy indicates that it was the result of edema or inflammation of the disc. It is necessary to study the anamnesis in more detail: the presence of symptoms of intracranial hypertension indicates the post-congestive nature of atrophy. The presence of simple atrophy with clear boundaries does not exclude its inflammatory origin. Thus, descending atrophy due to retrobulbar neuritis and inflammatory processes of the brain and its membranes causes changes in the disc in the fundus similar to simple atrophy.
The nature of atrophy (simple or secondary) is of great importance in diagnosis, since certain diseases lead to certain, “favorite” types of damage to the optic nerves. For example, compression of the optic nerve or chiasm by a tumor leads to the development of simple atrophy of the optic nerves, tumors of the ventricles of the brain - to the development of congestive nipples and further to secondary atrophy. However, diagnosis is complicated by the fact that some diseases, for example meningitis, arachnoiditis, neurosyphilis, can be accompanied by both simple and secondary atrophy of the optic discs. In this case, the accompanying ocular symptoms are important: changes in the vessels of the retina, the retina itself, the choroid, as well as the combination of optic nerve atrophy with a disorder of pupillary reactions.
When assessing the degree of color loss and pallor of the optic nerve head, it is necessary to take into account the general background of the fundus. Against the parquet background of the fundus of brunettes, even a normal or slightly atrophied disc appears paler and whiter. Against a light background of the fundus, the atrophic nipple may not look so pale and white. In severe anemia, the optic discs are completely white, but more often a faint pink tint remains. In hypermetropics, the optic discs are normally more hyperemic, and with a high degree of hypermetropia there may be a picture of false neuritis (severe hyperemia of the nipples). With myopia, the optic discs are paler than those of emmetropes. The temporal half of the optic nerve head is normally somewhat paler than the nasal half.
Treatment of optic atrophy
Since optic nerve atrophy in most cases is not an independent disease, but is a consequence of other pathological processes, its treatment must begin with eliminating the cause. Neurosurgical surgery is indicated for patients with intracranial tumors, intracranial hypertension, cerebral aneurysms, etc.
Nonspecific conservative treatment of optic nerve atrophy is aimed at preserving visual function as much as possible. In order to reduce inflammatory infiltration and swelling of the optic nerve, para- and retrobulbar injections of dexamethasone solution, intravenous infusions of glucose and calcium chloride solutions, and intramuscular administration of diuretics (furosemide) are performed.
To improve blood circulation and trophism of the optic nerve, injections of pentoxifylline, xanthinol nicotinate, atropine (parabulbar and retrobulbar) are indicated; intravenous administration of nicotinic acid, aminophylline; vitamin therapy (B2, B6, B12), injections of aloe or vitreous extract; taking cinnarizine, piracetam, riboxin, ATP, etc. In order to maintain a low level of intraocular pressure, pilocarpine is instilled and diuretics are prescribed.
In the absence of contraindications for optic nerve atrophy, acupuncture and physiotherapy (electrophoresis, ultrasound, laser or electrical stimulation of the optic nerve, magnetic therapy, endonasal electrophoresis, etc.) are prescribed. If visual acuity decreases below 0.01, any treatment provided is not effective.
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.
If treatment is started early, lost vision can be restored. However, the later treatment is started, the more difficult it is to avoid negative consequences.
Treatment of optic nerve atrophy with folk remedies
To treat such a serious illness, medicinal herbs are used, which are offered by traditional medicine, but they can help only to a certain extent and at the initial stage of the disease.
It is not advisable to self-medicate, and using various decoctions and infusions corresponding to folk recipes as additional medications is possible only after consultation with an ophthalmologist.
Wild mallow tincture for the treatment of optic nerve atrophy
The most effective recipe for treating such a serious illness is a tincture of wild mallow or wild mallow. Dry crushed roots of these plants in the amount of 3 tablespoons must be mixed with the same amount of burdock, and then boiled for about half an hour in 1.5 liters of water.
Already in the finished decoction you need to add primrose (2 parts), lemon balm (3 parts) and dolnik herb (4 parts). Let the broth cool and strain. The finished product should be taken for a month, 1 tablespoon three times a day.
Treatment of night blindness with blue cornflower
People believe that blue cornflower helps cure night blindness. In order to prepare such an infusion, you need 1 teaspoon of dried or fresh flowers, pour boiling water (250 ml) and leave to stand for 1 hour.
Take the prepared infusion three times a day, half an hour before meals, 0.50 ml. In case of blepharitis, it is recommended to wash the eyes with this infusion twice a day.
Decoction of lemon, pine cones and rue herb
The full course of treatment according to the folk recipe is about 25-30 days. This decoction is prepared from rue grass (25 g), cut when it is in flower, unripe pine cones (100 pieces), as well as one small lemon, divided into 4 pieces.
This mixture must be filled with water (2.5 liters), and then added 0.5 cups of sugar and boiled for half an hour. You need to take the drug 1 tablespoon before meals three times a day.
Prevention of optic atrophy
Optic atrophy is a serious disease. If there is the slightest decrease in vision, the patient should consult a doctor so as not to miss the time needed to treat the disease. Without treatment and progressive atrophy, vision may disappear completely and cannot be restored. It is necessary to identify the cause that led to the development of optic nerve atrophy and eliminate it in a timely manner. Lack of treatment is not only dangerous for vision loss. It can lead to death.
To prevent atrophy, 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.
Toxic damage to the organ of vision is a disease that can lead to atrophy of the optic nerve (occurring as retrobulbar neuritis with characteristic changes in color perception and central scotomas) and, as a consequence, to loss of vision (blindness).
Damage to the optic nerve is observed during general intoxication with arsenic compounds. An early symptom is a concentric narrowing of the visual field. Then visual acuity decreases. Lesions of the optic nerve may sometimes represent the only signs of poisoning and, as a rule, are bilateral, leading to rapid and significant loss of vision due to developing atrophy of the optic nerves. In the fundus there are signs of neuritis or blanching of the optic nerve head. Retinal edema, vitreous opacities, and uveitis may also occur.
In cases of lead poisoning, retinopathy develops with arteriosclerosis and periarteritis, hemorrhages and exudate appear in the fundus, more often with kidney damage and arterial hypertension. A typical eye lesion is retrobulbar neuritis (sometimes with mild hyperemia of the optic disc or hemorrhages). There is a central scotoma, often bilateral; the boundaries of the field of view are narrowed only slightly. As the process progresses, optic nerve atrophy develops, sometimes leading to blindness.
Carbon disulfide has a specific effect on the optic nerve. With chronic intoxication, neuritis of the retrobulbar type with a central scotoma and, less commonly, with simultaneous narrowing of the peripheral boundaries of the visual field can develop. The central scotoma appears earlier than other symptoms, color perception is impaired (especially significant for red). The defeat is always two-sided. Other ocular manifestations of chronic carbon disulfide intoxication may include pinpoint superficial keratitis, paralysis of the external muscles of the eye, paralysis of accommodation, nystagmus, and impaired adaptation to darkness.
With phosphorus poisoning, retrobulbar neuritis can develop, and sometimes trigeminal neuralgia occurs, which forces the patient to consult an ophthalmologist for pain in the eye area.
With retrobulbar neuritis in the background alcoholism Both eyes are always affected. At first, the decrease in visual acuity is slight, then there is a progressive drop in visual acuity to 0.1 or less. During the examination, a decrease in visual acuity is revealed, a change in refraction is often observed, and the development of myopia is more often noted. The field of vision narrows concentrically, paracentral absolute and relative scotomas appear, and the blind spot expands significantly. Characterized by a pronounced impairment of color vision, narrowing of the boundaries of color vision, and impaired dark adaptation. Intraocular pressure in patients with chronic alcoholism tends to decrease. Eye motor disorders are detected: convergence disorder, nystagmus, ptosis. Possible reflex immobility of the pupil and anisocoria. On examination, pronounced disturbances of microcirculation in the conjunctiva of the eyeball, narrowing of the arteries and dilatation of the veins of the retina, degenerative lesions on the periphery of the retina, swelling of the retina around the optic nerve head, pallor or hyperemia of the optic nerve are detected.
Chingamine (delagil, resoquine, chloraquine) and hydroxychloroquine (plaquenil) often lead to corneal edema, accompanied by the deposition of white granules in the stroma. In this regard, patients complain of fogging and rainbow circles around the light source. The sensitivity of the cornea is usually reduced. Sometimes retinal damage is observed, which is associated with the toxic effect of drugs on its pigment epithelium. Pigment accumulations are found as mottling in the macula area. Peripheral retinal pigmentation and narrowing of the visual field may occur. Changes are reversible only in the early stage of toxic damage.
Ethambutol also has a toxic effect on the optic nerve. The process occurs as a retrobulbar neuritis with a decrease in central vision, a concentric narrowing of the visual field, and central scotomas.
Toxic injuries with methyl alcohol occur when inhaling vapors, absorption from the surface of the skin, or ingestion instead of ethyl alcohol. The lethal dose is from 40 to 250 ml, but taking even 5 to 10 ml can lead to blindness. Individual tolerance varies, older people are less resilient, alcoholics are less susceptible to its effects. Decreased vision usually occurs 1 to 2 days after poisoning and progresses rapidly, up to complete blindness. In the field of view there are absolute central scotomas, possibly combined with a concentric narrowing of the field of view.
Taking into account the course of toxic lesions of the optic nerve, four stages are distinguished: Stage I - the phenomena of moderate hyperemia of the optic nerve head and vasodilatation predominate; Stage II - stage of papilledema; Stage III - ischemia, vascular disorders; Stage IV - the stage of atrophy, degeneration of the optic nerves.
Patients with acute toxic damage to the optic nerves (poisoning) are subject to immediate hospitalization; Delay in providing urgent assistance is fraught with serious consequences, including complete blindness or death. In case of chronic toxic damage to the optic nerves, hospitalization is indicated for the first course of emergency treatment to develop the most effective comprehensive individual treatment cycle. Subsequently, courses of treatment using methods that have proven to be the most effective can be carried out on an outpatient basis.
Treatment is focused on the stage of the disease (the effectiveness of treatment for patients with neuritis depends on the initial functional data): in the first stage - detoxification therapy; at the second stage - intensive dehydration (furosemide, acetazolamide, magnesium sulfate), anti-inflammatory therapy (glucocorticoids); in the third stage, vasodilators are preferred (drotaverine, pentoxifylline, vinpocetine); in the fourth stage - vasodilators, stimulating therapy, physiotherapy. For partial atrophy of the optic nerves of toxic origin, some surgical methods are used: electrical stimulation, with the introduction of an active electrode to the optic nerve, catheterization of the superficial temporal artery (with infusion of sodium heparin (500 units), dexamethasone 0.1% 2 ml, Actovegin 2 times a day day for 5 - 7 days). An effective method of treating diseases of the optic nerve of toxic origin is long-term repeated administration of pharmacological agents to the optic nerve through a catheter implanted into the retrobulbar space.
A rapid decrease in vision may indicate various eye diseases. But rarely does anyone think that it can be caused by such a dangerous disease as optic nerve atrophy. The optic nerve is an important component in the perception of light information. Therefore, it is worth taking a closer look at this disease so that it is possible to identify the symptoms in the early stages.
What it is?
The optic nerve is a nerve fiber responsible for processing and transmitting light information. The main function of the optic nerve is to deliver nerve impulses to the brain area.
The optic nerve is attached to retinal ganglion neurocytes, which make up the optic disc. Light rays, converted into a nerve impulse, are transmitted along the optic nerve from the retinal cells to the chiasma (the segment where the optic nerves of both eyes intersect).
Where is the optic nerve located?
Its integrity ensures high. However, even the smallest injuries to the optic nerve can lead to serious consequences. The most common disease of the optic nerve is its atrophy.
Optic atrophy is an eye disease in which the optic nerve deteriorates, resulting in decreased vision. With this disease, the fibers of the optic nerve completely or partially die and are replaced by connective tissue. As a result, light rays falling on the retina of the eye are converted into an electrical signal with distortions, which narrows the field of view and reduces its quality.
Depending on the degree of damage, optic nerve atrophy can be partial or complete. Partial atrophy of the optic nerve differs from complete atrophy by a less pronounced manifestation of the disease and preservation of vision at a certain level.
Vision correction using traditional methods (contact lenses) for this disease is absolutely ineffective, since they are aimed at correcting the refraction of the eye and have nothing to do with the optic nerve.
Causes
Optic nerve atrophy is not an independent disease, but is a consequence of some pathological process in the patient’s body.
Optic atrophy
The main causes of the disease include:
- Eye diseases (diseases of the retina, eyeball, eye structures).
- Pathologies of the central nervous system (brain damage due to syphilis, brain abscess, skull injury, brain tumors, multiple sclerosis, encephalitis, meningitis, arachnoiditis).
- Diseases of the cardiovascular system (cerebral atherosclerosis, arterial hypertension, vascular spasm).
- Long-term toxic effects of alcohol, nicotine and drugs. Alcohol poisoning with methyl alcohol.
- Hereditary factor.
Optic nerve atrophy can be congenital or acquired.
Congenital optic atrophy occurs as a result of genetic diseases (in most cases Leber disease). In this case, the patient has low quality of vision from birth.
Acquired optic atrophy appears as a result of certain diseases in older age.
Symptoms
The main symptoms of partial visual atrophy may be:
- Deterioration in the quality of vision and the inability to correct it with traditional correction methods.
- Pain when moving the eyeballs.
- Change in color perception.
- Narrowing of visual fields (up to the manifestation of tunnel syndrome, in which the ability to peripherally view is completely lost).
- The appearance of blind spots in the field of vision (scotomas).
Laser vision correction methods can be seen in.
Stages of optic nerve atrophy
Diagnostics
Typically, diagnosing this disease does not cause any particular difficulties. As a rule, the patient notices a significant decrease in vision and consults an ophthalmologist, who makes the correct diagnosis. Identifying the cause of the disease is of great importance.
To identify optic nerve atrophy in a patient, a set of diagnostic methods is performed:
- (visual acuity test).
- Spheroperimetry (determination of visual fields).
- Ophthalmoscopy (detection of pallor of the optic nerve head and narrowing of the fundus vessels).
- Tonometry (measurement of intraocular pressure).
- Video-ophthalmography (study of the optic nerve relief).
- (examination of areas of the affected nerve).
- Computed tomography and magnetic resonance imaging (a study of the brain to identify possible causes of optic atrophy).
Read what computer perimetry determines in ophthalmology.
In addition to an ophthalmological examination, the patient may be prescribed an examination by a neurologist or neurosurgeon. This is necessary because the symptoms of optic nerve atrophy may be symptoms of an incipient intracranial pathological process.
Treatment
Treatment of optic nerve atrophy is quite complex. Destroyed nerve fibers cannot be restored, so first of all it is necessary to stop the process of changes in the tissues of the optic nerve. Since the nerve tissue of the optic nerve cannot be restored, visual acuity cannot be raised to the previous level. However, the disease must be treated to avoid its progression and blindness. The prognosis of the disease depends on the timing of the start of treatment, so it is advisable to immediately consult an ophthalmologist when the first symptoms of the disease are detected.
The difference between partial optic nerve atrophy and complete one is that this form of the disease is treatable and it is still possible to restore vision. The main goal in the treatment of partial optic nerve atrophy is to stop the destruction of optic nerve tissue.
The main efforts should be aimed at eliminating. Treatment of the underlying disease will stop the destruction of optic nerve tissue and restore visual function.
During the treatment of the underlying disease that caused optic nerve atrophy, complex therapy is carried out. Additionally, during treatment, medications can be used to improve blood supply and nutrition to the optic nerve, improve metabolism, eliminate swelling and inflammation. It would be a good idea to take multivitamins and biostimulants.
The main drugs used are:
- Vasodilators. These drugs improve blood circulation and trophism in the tissues of the optic nerve. Among the drugs in this group one can highlight complamin, papaverine, dibazol, no-shpu, halidor, aminophylline, trental, sermion.
- Drugs that stimulate the restoration of altered tissues of the optic nerve and improve metabolic processes in it. These include biogenic stimulants (peat, aloe extract), amino acids (glutamic acid), vitamins and immunostimulants (eleuthorococcus, ginseng).
- Drugs that resolve pathological processes and metabolic stimulants (phosphaden, pyrogenal, preductal).
It is necessary to understand that drug therapy does not treat optic nerve atrophy, but only helps to improve the condition of the nerve fibers. To cure optic nerve atrophy, it is necessary to first cure the underlying disease.
Physiotherapeutic procedures, which are used in combination with other treatment methods, are also important. Also, methods of magnetic, laser and electrical stimulation of the optic nerve are effective. They help improve the functional state of the optic nerve and visual functions.
The following procedures are used as additional treatment:
- Magnetic stimulation. During this procedure, the optic nerve is exposed to a special device that creates an alternating magnetic field. Magnetic stimulation helps improve blood supply, saturate the tissues of the optic nerve with oxygen, and activate metabolic processes.
- Electrical stimulation. This procedure is carried out using a special electrode, which is inserted behind the eyeball to the optic nerve and electrical impulses are applied to it.
- Laser stimulation. The essence of this method is non-invasive stimulation of the optic nerve through the cornea or pupil using a special emitter.
- Ultrasound therapy. This method effectively stimulates blood circulation and metabolic processes in the tissues of the optic nerve, improves the permeability of the blood-ophthalmic barrier and the sorption properties of eye tissues. If the cause of optic nerve atrophy is encephalitis or tuberculous meningitis, then the disease will be quite difficult to treat with ultrasound.
- Electrophoresis. This procedure is characterized by the effect of low-power direct current and drugs on the eye tissue. Electrophoresis helps to dilate blood vessels, improve cell metabolism and normalize metabolism.
- Oxygen therapy. This method consists of saturating the tissues of the optic nerve with oxygen, which helps improve metabolic processes in them.
During treatment of optic nerve atrophy, it is imperative to maintain a high-quality diet rich in various vitamins and minerals. It is necessary to consume fresh vegetables and fruits, cereals, meat, and dairy products more often.
See what foods improve vision.
It is not recommended to treat the disease with folk remedies, since in this case they are ineffective. If you rely only on folk remedies, you can lose precious time when you could still preserve the quality of your vision.
Complications
It must be remembered that optic nerve atrophy is a serious disease and should not be treated on its own. Incorrect self-treatment can lead to dire consequences - complications of the disease.
The most serious complication may be complete loss of vision. Ignoring treatment leads to further development of the disease and a steady decrease in visual acuity, as a result of which the patient will no longer be able to lead his previous lifestyle. Very often, with optic nerve atrophy, the patient becomes disabled.
Also read about heterochromia.
Prevention
To avoid the occurrence of optic nerve atrophy, it is necessary to treat diseases in a timely manner, consult an ophthalmologist in a timely manner if visual acuity decreases, and not expose the body to alcohol and drug intoxication. Only if you pay due attention to your health can you reduce the risk of disease.
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