Atrophy of the optic disc of both eyes. Optic atrophy: symptoms and treatment

Optic nerve atrophy is the development of a pathology in which the optic nerve is partially or completely destroyed within its own fibers, after which these fibers are replaced by connective tissue. Optic nerve atrophy, the symptoms of which are a decrease in visual function in combination with a general blanching of the nerve disc, can be congenital or acquired in the nature of its occurrence.

general description

In ophthalmology, diseases of the optic nerve of one type or another are diagnosed on average in 1-1.5% of cases, while in approximately 26% of them the optic nerve is subject to complete atrophy, which, in turn, causes blindness that cannot be treated. cure. In general, with atrophy, as is clear from the description of the consequences to which it leads, there is a gradual death of its fibers in the optic nerve, followed by their gradual replacement, ensured by connective tissue. This is also accompanied by the conversion of the light signal received by the retina into an electrical signal during its further transmission to the posterior lobes of the brain. Against this background, various types of disorders develop, with a narrowing of the visual fields and a decrease in visual acuity preceding blindness.

Optic nerve atrophy: causes

Congenital or hereditary pathologies directly related to vision that are relevant to the patient can be considered as reasons that provoke the development of the disease we are considering. Optic nerve atrophy can also develop as a result of suffering from any eye diseases or a certain type of pathological process that affects the retina and the optic nerve itself. Examples of the latter factors include eye injury, inflammation, degeneration, congestion, edema, damage caused by toxic effects, compression of the optic nerve, circulatory disorders of one scale or another. In addition, current pathologies affecting the nervous system, as well as the general type of the disease, also play an important role in the causes.

In frequent cases, the development of optic nerve atrophy is caused by the influence exerted by the pathology of the central nervous system that is relevant to the patient. Such pathologies can be considered syphilitic brain damage, abscesses and brain tumors, meningitis and encephalitis, skull trauma, multiple sclerosis, etc. Alcohol poisoning caused by the use of methyl alcohol and general intoxication of the body are also among the factors affecting the central nervous system , and, ultimately, among the factors provoking optic nerve atrophy.

The development of the pathology we are considering can also be contributed to by diseases such as atherosclerosis and hypertension, as well as conditions the development of which is provoked by vitamin deficiency, quinine poisoning, profuse bleeding and fasting.

In addition to the listed factors, optic nerve atrophy can also develop against the background of obstruction of the peripheral retinal arteries and obstruction of the central artery in it. These arteries provide nutrition to the optic nerve; accordingly, if they are obstructed, its functions and general condition are disrupted. It should be noted that obstruction of these arteries is also considered as the main symptom indicating the manifestation of glaucoma.

Optic nerve atrophy: classification

Optic nerve atrophy, as we initially noted, can manifest itself both as a hereditary pathology and as a non-hereditary pathology, that is, acquired. The hereditary form of this disease can manifest itself in such basic forms as the autosomal dominant form of optic atrophy, the autosomal recessive form of optic atrophy, and the mitochondrial form.

Congenital atrophy is considered to be atrophy resulting from genetic diseases that cause visual impairment in the patient from birth. Leber's disease is identified as the most common disease in this group.

As for the acquired form of optic nerve atrophy, it is determined by the peculiarities of the influence of etiological factors, such as damage to the fibrous structure of the optic nerve (which determines such a pathology as descending atrophy) or damage to retinal cells (this, accordingly, determines such a pathology as ascending atrophy) atrophy). The acquired form of optic nerve atrophy can, again, be provoked by inflammation, glaucoma, myopia, metabolic disorders in the body and other factors that we have already discussed above. Acquired optic atrophy can be primary, secondary or glaucomatous.

At the heart of the mechanism primary form of atrophy The optic nerve is considered to be an effect in which compression of peripheral neurons within the visual pathway occurs. The primary form (which is also defined as the simple form) of atrophy is accompanied by clear disc boundaries and pallor, narrowing of the vessels in the retina and the possible development of excavation.

Secondary atrophy, developing against the background of stagnation of the optic nerve or against the background of its inflammation, is characterized by the appearance of signs inherent in the previous, primary form of atrophy, but in this case the only difference is the vagueness of the boundaries, which is relevant for the boundaries of the optic nerve head.

At the heart of the development mechanism glaucomatous form of atrophy The optic nerve, in turn, is considered to be a collapse that has arisen in the sclera from the side of its cribriform plate, which occurs due to a state of increased intraocular pressure.

In addition, the classification of forms of optic nerve atrophy also includes such variants of this pathology as already noted in the general review partial atrophy optic nerve and complete atrophy optic nerve. Here, as the reader can roughly assume, we are talking about the specific degree of scale of damage to nerve tissue.

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.

In addition, optic nerve atrophy can manifest itself in stationary form ( that is, in finished form or 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. Depending on the extent of the lesion, optic nerve atrophy manifests itself in both unilateral and bilateral forms (that is, affecting one eye or both eyes at once).

Optic nerve atrophy: symptoms

The main symptom of this disease is, as noted earlier, a decrease in visual acuity, and this pathology cannot be corrected. The manifestations of this symptom may vary depending on the specific type of atrophy. Progression of the disease can lead to a gradual decrease in vision until complete atrophy is achieved, in which vision is completely lost. The duration of this process can vary from several days to several months.

Partial atrophy is accompanied by a stop in the process at a certain stage, after which vision stops falling. According to these features, a progressive or completed form of the disease is distinguished.

With atrophy, vision can be impaired in various ways. Thus, the fields of vision may change (basically they narrow, which is accompanied by the disappearance of the so-called lateral vision), which can lead to the development of a “tunnel” type of vision, in which it seems that everything is seen as if through a tube, in other words, only visibility of objects directly in front of a person. Often scotomas become a companion to this type of vision; in particular, they mean the appearance of dark spots in any part of the visual field. Color vision disorder is also relevant.

Visual fields can change not only according to the type of “tunnel” vision, but also based on the specific location of the lesion. If scotomas, that is, the dark spots noted above, appear in the patient’s eyes, this indicates that those nerve fibers that are concentrated in maximum proximity to the central part of the retina or are located directly in it have been affected. The visual fields are narrowed due to damage to the nerve fibers; if the optic nerve is affected at a deeper level, then half of the visual field (nasal or temporal) may disappear. As already noted, the lesion can be either unilateral or bilateral.

Thus, we can summarize the symptoms under the following main points that determine the picture of the course:

• the appearance of sector-shaped and central scotomas (dark spots);
• decreased quality of central vision;
• concentric narrowing of the field of view;
• pallor of the optic nerve head.

Secondary optic nerve atrophy determines the following manifestations during ophthalmoscopy:

• varicose veins;
• vasoconstriction;
• smoothing the area of ​​the optic nerve boundaries;
• disc blanching.

Diagnosis

Self-diagnosis, as well as self-medication (including treatment of optic nerve atrophy with folk remedies) for the disease in question should be completely excluded. In the end, due to the similarity of the manifestations characteristic of this pathology with manifestations, for example, of a peripheral form of cataract (accompanied initially by impaired lateral vision with subsequent involvement of the central parts) or with amblyopia (a significant decrease in vision without the possibility of correction), it is simply impossible to establish an accurate diagnosis on your own .

What is noteworthy is that even of the listed disease options, amblyopia is not a disease as dangerous as optic nerve atrophy can be for a patient. Additionally, it should be noted that atrophy can also manifest itself not only as an independent disease or as a result of exposure to another type of pathology, but can also act as a symptom of certain diseases, including diseases that end in death. Considering the seriousness of the lesion and all possible complications, it is extremely important to promptly begin diagnosing optic nerve atrophy, to find out the reasons that provoked it, as well as to adequately treat it.

The main methods on which the diagnosis of optic nerve atrophy is based include:

• ophthalmoscopy;
• visometry;
• perimetry;
• color vision research method;
• CT scan;
• radiography of the skull and sella turcica;
• NMR scanning of the brain and orbit;
• fluorescein angiography.

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 borelliosis or syphilis.

Treatment

Before moving on to the specifics of the treatment, we note that it in itself is an extremely difficult task, because the restoration of damaged nerve fibers is in itself impossible. A certain effect, of course, can be achieved through treatment, but only under the condition of restoration of those fibers that are in the active phase of destruction, that is, with a certain degree of their vital activity against the background of such exposure. Missing this moment can cause final and irreversible loss of vision.

Among the main areas of treatment for optic nerve atrophy, the following options can be distinguished:

• treatment is conservative;
• therapeutic treatment;
• surgical treatment.

Principles conservative treatment boil down to the sale of the following drugs in it:

• vasodilators;
• anticoagulants (heparin, ticlid);
• drugs whose effect is aimed at improving the general blood supply to the affected optic nerve (papaverine, no-spa, etc.);
• drugs that affect metabolic processes and stimulate them in the area of ​​nerve tissue;
• drugs that stimulate metabolic processes and have a resolving effect on pathological processes; drugs that stop the inflammatory process (hormonal drugs); drugs that help improve the functions of the nervous system (nootropil, Cavinton, etc.).

Physiotherapeutic procedures include magnetic stimulation, electrical stimulation, acupuncture and laser stimulation of the affected nerve.

The repetition of the course of treatment, based on the implementation of measures in the listed areas of influence, occurs after a certain time (usually within several months).

As for surgical treatment, it implies an intervention aimed at eliminating those formations that compress the optic nerve, as well as ligating the area of ​​the temporal artery and implanting biogenic materials that help improve blood circulation in the atrophied nerve and its vascularization.

Cases of significant loss of vision due to the disease in question necessitate assigning the patient the appropriate degree of impairment to a disability group. Visually impaired patients, as well as patients who have completely lost their vision, are sent to a rehabilitation course aimed at eliminating the restrictions that have arisen in life, as well as compensating for them.

Let us repeat that optic nerve atrophy, which is treated using traditional medicine, has one very significant drawback: when using it, time is lost, which is almost precious as part of the progression of the disease. It is during the period of active independent implementation of such measures by the patient that there is an opportunity to achieve positive and significant results on their own scale due to more adequate treatment measures (and previous diagnostics, by the way, too); it is in this case that the treatment of atrophy is considered as an effective measure in which the return of vision is permissible . Remember that treatment of optic nerve atrophy with folk remedies determines the minimum effectiveness of the effect thus provided!

1178 10.10.2019 6 min.

Partial optic atrophy (PANA) is one of the most common ophthalmological diseases. This disease poses a serious danger, since from partial, in the case of improper treatment or lack thereof, it can turn into complete - when a person becomes completely blind.

Description of partial optic nerve atrophy (PANA) and ICD-10 code

Atrophy in ophthalmology is the death of tissues and fibers of the optic nerve. Atrophied tissue is replaced by simple connective tissue, which is unable to transmit signals from nerve cells to the organs of vision. As a result of the disease, the ability to see is sharply reduced, and if treatment is not started in time, partial atrophy can give way to complete atrophy, which will lead to complete loss of vision. The disease code according to ICD is H47.2.

In the case of partial atrophy of the optic nerve head (OND), a person can see, however, colors are not transmitted correctly, the contours of objects are distorted, cloudiness appears before the eyes, blurriness, and other vision defects occur.

diagram of the structure of the eyeball

In this case, vision can decrease either extremely sharply (over several days) or quite gradually (over several months). Usually, having decreased, vision in this case stabilizes - it is this fact that gives grounds to talk about partial atrophy. If vision, having decreased, does not fall any further, complete partial atrophy of the optic nerve is diagnosed. However, the disease can also be progressive - in this case it leads to complete blindness (if left untreated).

Previously, partial atrophy of the optic nerve, not to mention complete, was the basis for the assignment of disability. Modern medicine, fortunately, makes it possible to cure pathology, especially if it is detected in the earliest stages.

Reasons for the death of the optic disc

The main causes of partial atrophy of the optic nerve are the most common eye pathologies:

• myopia (including age-related);
• glaucoma;
• retinal lesions;
• visual fiber defects;
• tumor-like formations of any etiology in the organs of vision;
• inflammatory processes.

stages of optic nerve atrophy

In addition to the above, sometimes (less often) the following pathologies become causes of the disease:

• syphilis;
• encephalitis;
• meningitis;
• purulent brain abscess.

diagram of the location of the optic nerve

The appearance of scotomas (blind spots) is also a common symptom of this disease. In this case, a person sees the picture partially, some areas fall out of the general view, and in their place are whitish, cloudy spots.

Why bestoxol drops are prescribed can be read.

Diagnostics

As a rule, this disease is diagnosed without any difficulties. It is impossible not to notice a sharp decrease in vision, so the vast majority of patients themselves turn to an ophthalmologist, who then makes a diagnosis. An examination of the visual organs of a sick person will certainly in this case show a deformation of the optic nerve, its color paler than necessary.

In children

Partial optic atrophy is a disease typical of adults; it is rare in children. However, in recent years, ophthalmologists have noticed a rejuvenation of the disease, so cases of pathology in adolescents and children are no longer surprising. Sometimes the disease occurs even in newborns.

The causes of illness in children are as follows:

• severe heredity (leads to congenital CHAZN);
• pathologies of the retina, nerve - dystrophy, trauma, swelling, congestion, inflammatory processes;
• pathologies of a neurological nature - meningitis, encephalitis, head injuries, purulent abscesses of the meninges, tumor formations;

Fundus image with partial atrophy

In addition to the above, this disease in children can develop as a result of prolonged vitamin deficiency, high blood pressure, excessive mental and physical stress and malnutrition.

You can familiarize yourself with the causes of optic neuritis.

Treatment and prognosis

Usually, if you consult a doctor in a timely manner, the prognosis for this disease is favorable. The goal of therapy is to stop the deformation of the optic nerve tissue and maintain the level of vision that is still available. In this case, it is impossible to restore full vision, since the already deformed tissue of the optic nerve cannot be restored.

The treatment method is selected depending on the underlying cause that gave rise to the disease. Typically, the following types of medications are used in the treatment of partial optic atrophy:

• improving cerebral blood supply;
• activating metabolic processes, metabolism;
• dilating vessels;
• multivitamins;
• stimulators of biological processes.

Also, during treatment, agents are necessarily used that activate regeneration processes in the tissues of the organs of vision and improve metabolic processes. This:

• stimulants- aloe extracts, peat;
• glutamic acid as an amino acid;
• extracts of ginseng, eleutherococcus as vitamin supplements and immunostimulants.

Drugs are also prescribed that help pathological processes resolve faster and stimulate metabolism:

• Pyrogenal;
• Phosphaden;
• Preducted.

It is unacceptable to use any self-prescribed medications - all medications must be taken strictly according to the medical prescription and the regimen suggested by the specialist.

No folk remedies or alternative medicine can help your health in this case. Therefore, you should not waste precious time, but should immediately consult a doctor for qualified help.

How to treat through surgery and physiotherapy

If the disease requires surgical intervention, then surgery will be the main method in this case. And if vision has fallen sufficiently, there are grounds for assigning a disability group.

optic nerve pathways

The emphasis in therapy is on eliminating the underlying disease, which was the direct cause of atrophy. To achieve treatment results faster and more effectively, additional procedures are prescribed:

• ultrasound;
• magnetic resonance procedure;
• electrophoresis;
• laser;
• therapy using oxygen.

In this case, it is important to start treatment as early as possible. The sooner therapy begins, the more of the optic nerve can be saved. In addition, atrophied fibers cannot be restored, so the part of the nerve that is damaged will not recover.

You can read how to treat lazy eye in adults.

Prevention

In order to cope with this disease as quickly as possible, it is important to seek medical help in a timely manner. In addition, abstaining from alcohol and drugs will help prevent the occurrence of pathology. The fact is that alcohol and drug intoxication is one of the factors that provokes atrophy.

Video

We will learn what atrophy is and signs of the disease from the video.

Conclusion

Partial atrophy of the optic nerve is a serious pathology, and if you do not pay attention to it in time, it can lead to complete blindness. Therefore, be sure to visit an ophthalmologist if your vision begins to sharply and unreasonably decrease - the sooner you start treatment, the larger part of the optic nerve will be preserved.

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

Descending 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 atrophy of the optic nerve with certain typical ophthalmoscopic features, for example, glaucoma, circulatory disorders in the vessels supplying the optic nerve. However, there are characteristics common to optic atrophy of any nature: blanching of the optic disc and impaired visual function.

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.

Based on the ophthalmoscopic picture, primary (simple) atrophy is distinguished, which is characterized by pallor of the optic nerve head with clear boundaries. The number of small vessels on the disc is reduced (Kestenbaum's symptom). The retinal arteries are narrowed, the veins may be of normal caliber or also slightly narrowed.

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.

The time during which pallor of the optic nerve head develops and its severity depend not only on the nature of the disease that led to optic nerve atrophy, but also on the distance of the source of damage from the eyeball. For example, with inflammatory or traumatic damage to the optic nerve, the first ophthalmoscopic signs of optic nerve atrophy appear several days to several weeks after the onset of the disease or the moment of injury. At the same time, when a space-occupying lesion affects the optic fibers in the cranial cavity, at first only visual disorders are clinically manifested, and changes in the fundus in the form of optic nerve atrophy develop after many weeks and even months.

Congenital optic 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.

If ophthalmoscopic signs of optic nerve atrophy are detected, it is necessary to conduct a thorough clinical examination of the patient, including determination of visual acuity and the boundaries of the visual field for white, red and green colors, and a study of intraocular pressure.

If atrophy develops against the background of papilledema, even after the edema disappears, the boundaries and pattern of the disc remain unclear. This ophthalmoscopic picture is called secondary (post-edema) optic nerve atrophy. The retinal arteries are narrowed in caliber, while the veins are dilated and tortuous.

When clinical signs of optic nerve atrophy are detected, it is necessary first of all to establish the cause of the development of this process and the level of damage to the optic fibers. For this purpose, not only a clinical examination is carried out, but also CT and/or MRI of the brain and orbits.

In addition to etiologically determined treatment, symptomatic complex therapy is used, including vasodilator therapy, vitamins C and B, drugs that improve tissue metabolism, various options for stimulating therapy, including electrical, magnetic and laser stimulation of the optic nerve.

Hereditary atrophies come in six forms:

1. with a recessive type of inheritance (infantile) - from birth to three years of age there is a complete decrease in vision;
2. with the dominant type (juvenile blindness) - from 2-3 to 6-7 years. The course is more benign. Vision decreases to 0.1-0.2. In the fundus there is segmental blanching of the optic disc; there may be nystagmus and neurological symptoms;
3. opto-oto-diabetic syndrome - from 2 to 20 years. Atrophy is combined with retinal pigmentary dystrophy, cataracts, diabetes mellitus and diabetes insipidus, deafness, and urinary tract damage;
4. Beer's syndrome is a complicated atrophy. Bilateral simple atrophy already in the first year of life, reggae drops to 0.1-0.05, nystagmus, strabismus, neurological symptoms, damage to the pelvic organs, the pyramidal tract suffers, mental retardation is added;
5. gender-related (more often observed in boys, develops in early childhood and grows slowly);
6. Leicester's disease (Lester's hereditary atrophy) - in 90% of cases occurs between the ages of 13 and 30 years.

Symptoms Acute onset, a sharp drop in vision over several hours, less often - several days. The lesion is a type of retrobulbar neuritis. The optic disc is initially unchanged, then blurring of the boundaries and changes in small vessels appear - microangiopathy. After 3-4 weeks, the optic disc becomes paler on the temporal side. In 16% of patients, vision improves. Most often, reduced vision remains for life. Patients are always irritable, nervous, they are bothered by headaches and fatigue. The cause is optochiasmatic arachnoiditis.

Optic nerve atrophy in some diseases

1. Optic nerve atrophy is one of the main signs of glaucoma. Glaucomatous atrophy is manifested by paleness of the disc and the formation of a depression - an excavation, which first occupies the central and temporal sections, and then covers the entire disc. Unlike the above diseases leading to disc atrophy, with glaucomatous atrophy the disc has a gray color, which is associated with the characteristics of damage to its glial tissue.
2. Syphilitic atrophy.

Symptoms The optic disc is pale, gray, the vessels are of normal caliber and sharply narrowed. Peripheral vision narrows concentrically, scotoma does not occur, and color perception suffers early. There may be progressive blindness that occurs quickly, within a year.

It occurs in waves: a rapid decrease in vision, then during the period of remission - improvement, during the period of exacerbation - repeated deterioration. Miosis develops, divergent strabismus, changes in pupils, lack of reaction to light while maintaining convergence and accommodation. The prognosis is poor, with blindness occurring within the first three years.

1. Features of optic nerve atrophy from compression (tumor, abscess, cyst, aneurysm, sclerotic vessels), which can be in the orbit, anterior and posterior cranial fossa. Peripheral vision suffers depending on the location of the process.
2. Foster-Kennedy syndrome - atherosclerotic atrophy. Compression can cause sclerosis of the carotid artery and sclerosis of the ophthalmic artery; Ischemic necrosis occurs from softening during arterial sclerosis. Objectively - excavation caused by retraction of the cribriform plate; benign diffuse atrophy (with sclerosis of small vessels of the pia mater) increases slowly and is accompanied by atherosclerotic changes in the vessels of the retina.

Optic nerve atrophy in hypertension is the outcome of neuroretinopathy and diseases of the optic nerve, chiasm and optic tract.

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:

1. Ascending type - the disease occurs from that part of the nerve trunk that is closer to the eye (before the chiasm);
2. 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: Methanol (a few grams is enough); Combined use of alcohol and tobacco in significant quantities; Industrial waste (lead, carbon disulfide); Medicinal substances in case of increased susceptibility in the patient (Digoxin, Sulfalene, Co-trimoxazole, Sulfadiazine, Sulfanilamide and others).
Ischemic disorders	Ischemia is a lack of blood flow. May occur when: Hypertension of 2-3 degrees (when blood pressure is constantly higher than 160/100 mmHg); Diabetes mellitus (type does not matter); Atherosclerosis – deposition of plaques on the walls of blood vessels.
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: Injuries to the skull area; Meningitis; Hydrocephalus (synonym – “dropsy of the brain”); Any oncological processes of the spinal cord.
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: Neurosyphilis; Tuberculosis damage to the nervous system; Leprosy; Herpetic infection.
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:

1. 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;
2. 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;
3. Severe – indicates the activity of the pathology. The sharpness is reduced so much that even objects located nearby become difficult to distinguish;
4. 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:

1. Redistributing blood flow in the eye area - in order to increase the flow of nutrients to one place, it is necessary to reduce it in other tissues. For this purpose, 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;
2. 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.