Damage to the optic nerve associated with the central parts. Causes of development of optic nerve atrophy and methods of treatment

This condition is the final stage of damage to the optic nerve. This is not a disease, but rather a sign of a more serious disease. Possible causes include direct trauma, pressure on the optic nerve or toxic damage, and nutritional deficiencies.

Causes of optic nerve atrophy

The optic nerve is made up of nerve fibers that transmit impulses from the eye to the brain. It contains approximately 1.2 million axons that originate in retinal cells. These axons have a thick myelin sheath and cannot regenerate after injury.

If fibers in any part of the optic nerve degenerate, its ability to transmit signals to the brain is impaired.

Regarding the causes of ASD, scientific studies have found that:

• Approximately 2/3 of cases were bilateral.
• The most common cause of bilateral ADN is intracranial neoplasms.
• The most common cause of unilateral damage is traumatic brain injury.
• Vascular factors are a common cause of AD after the age of 40 years.

In children, causes of AUD include congenital, inflammatory, infectious, traumatic and vascular factors, including perinatal strokes, mass lesions and hypoxic encephalopathy.

Let's look at the most common causes of ASD:

1. Primary diseases affecting the optic nerve: chronic glaucoma, retrobulbar neuritis, traumatic optic neuropathy, formations compressing the optic nerve (for example, tumors, aneurysms).
2. Primary retinal diseases, such as occlusion of the central retinal artery or central vein.
3. Secondary diseases of the optic nerve: ischemic optic neuropathy, chronic neuritis or papilledema.

Less common causes of ASD:

1. Hereditary optic neuropathy (eg, Leber optic neuropathy).
2. Toxic neuropathy, which can be caused by exposure to methanol, certain drugs (disulfiram, ethambutol, isoniazid, chloramphenicol, vincristine, cyclosporine and cimetidine), alcohol and tobacco abuse, metabolic disorders (eg, severe renal failure).
3. Retinal degeneration (eg, retinitis pigmentosa).
4. Retinal storage diseases (eg, Tay-Sachs disease)
5. Radiation neuropathy.
6. Syphilis.

Classification of optic nerve atrophy

There are several classifications of ADS.

According to the pathological classification, ascending (anterograde) and descending (retrograde) optic nerve atrophy is distinguished.

The ascending ADS looks like this:

• In diseases with anterograde degeneration (for example, toxic retinopathy, chronic glaucoma), the atrophy process begins in the retina and spreads towards the brain.
• The rate of degeneration is determined by the thickness of the axons. Larger axons decay faster than smaller ones.

Descending optic atrophy is characterized by the fact that the atrophy process begins in the proximal part of the axon and spreads towards the optic nerve head.

According to ophthalmoscopic classification there are:

• Primary ADS. In diseases with primary atrophy (for example, pituitary tumor, optic nerve tumor, traumatic neuropathy, multiple sclerosis), degeneration of optic nerve fibers leads to their replacement by columns of glial cells. On ophthalmoscopy, the optic disc appears white and has clear edges, and the retinal blood vessels are normal.
• Secondary ADS. In diseases with secondary atrophy (eg, papilledema or inflammation of the optic disc), degeneration of nerve fibers is secondary to papilledema. On ophthalmoscopy, the optic disc has a gray or dirty gray color, its edges are unclear; retinal blood vessels may be altered.
• Sequential ADS. With this form of atrophy (for example, with retinitis pigmentosa, myopia, central retinal artery occlusion), the disc has a waxy pale color with clear edges.
• Glaucomatous atrophy is characterized by a cup-shaped optic disc.
• Temporary optic disc pallor can occur with traumatic neuropathy or nutritional deficiencies, and is most common in patients with multiple sclerosis. The disc is pale in color with clear edges and normal vessels.

According to the degree of damage to nerve fibers, they are distinguished:

• Partial atrophy of the optic nerve - the process of degeneration affects not all fibers, but a certain part of them. This form of optic nerve subatrophy is characterized by incomplete loss of vision.
• Complete atrophy of the optic nerve - the degeneration process affects all nerve fibers, leading to blindness.

Symptoms of optic atrophy

The main symptom of optic atrophy is blurred vision. The clinical picture depends on the cause and severity of the pathology. For example, with partial atrophy of the optic nerves of both eyes, bilateral symptoms of vision deterioration are observed without complete loss, manifested first by loss of clarity and impaired color perception. When the optic nerves are compressed by the tumor, the visual field may decrease. If partial optic atrophy is left untreated, visual impairment often progresses to complete loss.

Depending on the etiological factors, patients with AD may also exhibit other symptoms that are not directly related to this pathology. For example, with glaucoma, a person may suffer from eye pain.

Characterizing the clinical picture of ADN is important in determining the cause of neuropathy. Rapid onset is characteristic of neuritis, ischemic, inflammatory and traumatic neuropathy. Gradual progression over several months is characteristic of toxic neuropathy and atrophy due to nutritional deficiencies. The pathological process develops even more slowly (over several years) with compressive and hereditary ADN.

If a young patient complains of eye pain associated with eye movement and the presence of neurological symptoms (eg, paresthesia, ataxia, limb weakness), this may indicate the presence of demyelinating diseases.

In older adults with signs of ADN, the presence of temporary vision loss, double vision (diplopia), fatigue, weight loss, and muscle pain may suggest ischemic neuropathy due to giant cell arteritis.

In children, the presence of flu-like symptoms in the recent past or recent vaccination indicates parainfectious or post-vaccination optic neuritis.

Diplopia and facial pain suggest multiple neuropathy of the cranial nerves, observed with inflammatory or neoplastic lesions of the posterior orbit and the anatomical area around the sella turcica.

Short-term blurred vision, diplopia and headaches indicate the possibility of increased intracranial pressure.

Diagnosis of optic nerve atrophy

The described clinical picture can be observed not only with ADN, but also with other diseases. To establish the correct diagnosis, if vision problems occur, you need to consult an ophthalmologist. He will perform a comprehensive eye examination, including an ophthalmoscopy, which can be used to examine the optic nerve head. With atrophy, this disc has a pale color, which is associated with a change in blood flow in its vessels.

To confirm the diagnosis, you can perform optical coherence tomography, an examination of the eyeball that uses infrared light waves for visualization. The ophthalmologist also evaluates color vision, the reaction of the pupils to light, determines the acuity and impairment of visual fields, and measures intraocular pressure.

It is very important to determine the cause of ADN. For this purpose, the patient may undergo computed or magnetic resonance imaging of the orbits and brain, laboratory testing for the presence of genetic abnormalities, or a diagnosis of toxic neuropathy.

How to treat optic nerve atrophy?

How to treat optic nerve atrophy? The importance of vision for a person cannot be overestimated. Therefore, if you have any symptoms of optic nerve atrophy, you should never resort to treatment with folk remedies on your own; you should immediately contact a qualified ophthalmologist.

It is necessary to begin treatment at the stage of partial atrophy of the optic nerve, which allows many patients to retain some vision and reduce the degree of disability. Unfortunately, with complete degeneration of nerve fibers, it is almost impossible to restore vision.

The choice of treatment depends on the cause of the disorder, for example:

• Treatment of descending optic atrophy caused by an intracranial tumor or hydrocephalus is aimed at eliminating compression of the nerve fibers by the tumor.
• In the case of inflammatory diseases of the optic nerve (neuritis) or ischemic neuropathy, intravenous corticosteroids are used.
• For toxic neuropathy, antidotes are prescribed to those substances that caused damage to the optic nerves. If atrophy is caused by drugs, their use is stopped or the dose is adjusted.
• Neuropathy due to nutritional deficiencies is treated by adjusting the diet and prescribing multivitamins that contain microelements necessary for good vision.
• For glaucoma, conservative treatment aimed at reducing intraocular pressure or surgery is possible.

In addition, there are methods of physiotherapeutic, magnetic, laser and electrical stimulation of the optic nerve, which are aimed at preserving the functions of the nerve fibers as much as possible.

There are also scientific works that have shown the effectiveness of treating ADN using the introduction of stem cells. With the help of this still experimental technique, it is possible to partially restore vision.

Prognosis for ADN

The optic nerve is part of the central, not the peripheral, nervous system, which makes it impossible to regenerate after damage. Thus, ADN is irreversible. Treatment of this pathology is aimed at slowing down and limiting the progression of the degeneration process. Therefore, every patient with optic nerve atrophy should remember that the only place where this pathology can be cured or its development stopped is ophthalmology departments in medical institutions.

The prognosis for vision and life with AD depends on the cause of it and the degree of damage to the nerve fibers. For example, with neuritis, after the inflammatory process subsides, vision may improve.

Prevention

In some cases, the development and progression of ADN can be prevented by proper treatment of glaucoma, toxic, alcohol and tobacco neuropathy, and eating a nutritious and nutrient-rich diet.

Optic nerve atrophy is a consequence of degeneration of its fibers. It can be caused by many diseases, from glaucoma and blood supply disorders (ischemic neuropathy) to inflammatory processes (for example, multiple sclerosis) and formations that compress the nerve (for example, intracranial tumors). Effective treatment is possible only at the stage of partial atrophy of the optic nerve. The choice of treatment method depends on etiological factors. In this regard, it is necessary to establish the correct diagnosis in time and direct all efforts to preserve vision.

Useful video about optic atrophy

A rapid decline in visual acuity sometimes signals the development of various ophthalmological ailments. But few people think that unpleasant symptoms can be caused by such a dangerous anomaly as optic nerve atrophy. This element of the eye is the main component in the perception of light information. Violation of its functionality can lead to blindness.

This is a pathological condition in which nervous matter is deficient in nutrients. As a result, it ceases to perform its functions. Without treatment, neurons gradually begin to die. As the pathology progresses, it involves an increasing number of cells. In severe situations, the nerve trunk is completely damaged. In this case, it is almost impossible to restore visual function.

To understand how the anomaly manifests itself, it is necessary to visualize the movement of impulses to the structures of the brain. Conventionally, they can be divided into two types: lateral and medial. The first part contains an image of surrounding objects that are seen by the side of the organ of vision located closer to the nose. The second area is responsible for the perception of the outer part of the picture (closer to the crown).

As a result, the left tract sees an image from the identical half of the organ of vision, the right one sends to the brain the image received from the second part of the eye. For this reason, damage to one of the optic nerves, after leaving the orbit, leads to impaired functionality of both eyes.

Reasons

Optic nerve atrophy is not considered an independent pathology. Most often it is a manifestation of other destructive processes occurring in the eyes. The main reasons that provoke the development of the disease include:

• Ophthalmological abnormalities (damage to the retina, violation of the integrity of the structures of the organ of vision);
• Destructive processes in the central nervous system (neoplasms, meningitis, encephalitis, skull trauma, inflammation of the brain);
• Long-term abuse of alcoholic beverages, illicit drugs and tobacco products;
• Genetic predisposition;
• Diseases of the cardiovascular system (spasm, atherosclerosis, arterial hypertension).

Damage to the optic nerve can be congenital or acquired. The first occurs as a result of various genetic pathologies (most often due to Leber's disease). In such situations, a person has poor vision from the first days of birth. An acquired anomaly develops as a result of illnesses suffered in adulthood.

Classification

Depending on the cause that triggered the development of atrophy, there are two forms of the disease:

• Primary. The appearance of pathology occurs as a result of damage to the X chromosome. Therefore, only young men between the ages of fifteen and twenty-five suffer from it. The disease progresses in a relapsing manner and is transmitted at the genetic level;
• Secondary. It manifests itself as a result of a previous ophthalmological or systemic anomaly associated with a failure in the blood supply to the optic nerve. This form can manifest itself regardless of age and gender.

Depending on the location of the source of damage, the disease is also classified into two types:

• Ascending type. Damage to nerve cells located on the retina. The anomaly progresses towards the brain. This form of the disease is often diagnosed in ophthalmological diseases (for example, glaucoma or myopia);
• Descending type. The movement proceeds in the reverse order, i.e. from the optical center to the retina. This form is characteristic of retrobulbar neuritis and brain damage affecting the area with the optic nerve.

Symptoms

The disease has two main manifestations: loss of visual fields and deterioration of eye acuity. In each patient they are expressed to varying degrees. It all depends on the cause that provoked the illness and the severity of the disease.

Loss of visual fields (anopsia)

Optical review is the area that a person sees. To determine it, simply cover one eye with your palm. You will only look at part of the image, since the visual analyzer does not perceive the second area. In other words, the patient loses the right or left zone. This is anopsia.

Neurologists divide it into two types:

• Temporal. The part of the picture located closer to the temples is visible;
• Nasal. In the viewing area is the other half of the image, located on the side of the nose;
• Right or left. Depending on which side the field fell on.

With partial atrophy, there may be no symptoms at all, since the “surviving” neurons transmit enough information to the brain. However, if the damage affected the entire trunk, then anopsia will certainly manifest itself.

Decreased visual acuity (amblyopia)

This symptom manifests itself in all patients suffering from atrophy. Only each person has an individual degree of expression:

• Easy. It appears at the initial stage of development of the disease. Deviations in visual acuity are practically not noticeable. The symptom can only make itself felt when viewing distant objects;
• Average. Occurs when a significant portion of neurons is damaged. Objects located far away are practically invisible, but at short distances there are no problems;
• Heavy. A clear sign of progression of the disease. Optical performance is reduced to such an extent that a person cannot see objects at arm's length;
• Complete loss of vision. Blindness occurs as a result of the death of all neurons.

Amblyopia usually appears suddenly and progresses rapidly without treatment. If you ignore the symptoms, the risk of irreversible blindness increases many times over.

Complications

It is important to realize that optic nerve atrophy is a serious disease and trying to cure it on your own can have dire consequences. The most dangerous complication that can occur as a result of an irresponsible approach to health is complete loss of vision.

If you ignore the pathology, then sooner or later all neurons will die. A person will not be able to lead a normal lifestyle, as vision problems will appear. Often, when optic nerve atrophy is detected at a late stage, the patient is assigned a disability.

Diagnostics

In most cases, there are no difficulties in detecting an anomaly. A person notices an unexpected drop in visual acuity and goes to see an ophthalmologist. To select competent therapy, it is important to correctly determine the root cause of the activation of the disease.

To make an accurate diagnosis, the patient is sent for a detailed examination, which includes a number of procedures:

• Visometry. Checking visual acuity using special test tables;
• Spheroperimetry. Allows you to evaluate optical fields;
• Ophthalmoscopy. It is carried out using a modern apparatus and makes it possible to analyze the condition of the fundus of the eye, the initial section of the nerve trunk;
• Computed tomography. The procedure involves examining the brain. CT helps to identify possible causes that provoked the development of the disease;
• Videoophthalmography. Study of the relief of the optic nerve;
• Tonometry. Measurement of intraocular pressure indicators;
• Computer perimetry. It is prescribed to analyze areas of damaged nerve.

Treatment

There is an opinion that nerve cells do not recover. This is not entirely true. Neurocytes tend to grow, constantly increasing the number of connections with adjacent tissues. Thus, they take on the functions of comrades who “fell in an unequal battle.” However, for full regeneration they lack one important quality - the ability to reproduce.

Therefore, to the question whether atrophy can be completely cured, there is a clear answer - no! If the trunk is partially damaged, then with the help of medications there is still a chance to increase visual acuity and improve visual fields. If destructive processes have completely blocked the transmission of impulses from the visual apparatus to the brain, then there is only one way out - surgical intervention.

For therapy to bring results, it is first necessary to identify the cause that provoked its development. This will help reduce damage to the cell layer and stabilize the course of the disease. If the root cause cannot be eliminated (for example, in the case of a cancerous tumor), doctors immediately begin to rehabilitate the functionality of the visual apparatus.

Modern methods of nerve restoration

About ten years ago, vitamins were mainly used to combat the disease; today they are of secondary importance and are prescribed as additional means. Medicines aimed at restoring metabolism in neurons and increasing blood flow to them have taken first place.
The drug therapy regimen is as follows:

• Antioxidants (Mexidol, Trimectal, etc.). Medicines regenerate tissues, block the activity of pathological processes, and eliminate oxygen deficiency of the optic nerve. In the hospital they are administered intravenously, on an outpatient basis they are used in the form of tablets;
• Microcirculation correctors (“Actovegin”, “Trental”). The drugs normalize metabolism in nerve cells and blood supply. One of the most important elements of conservative therapy. Sold in tablet and injection form;
• Nootropics (“Piracetam”, “Glutamic acid”). Stimulate blood flow and accelerate the process of regeneration of neurocytes;
• Medicines to reduce the degree of permeability of vascular walls (“Emoxipin”). Creates a protective barrier around the optic nerve that prevents further destruction. The injection is carried out using the parabulbar method (a thin needle is inserted along the wall of the orbit into the tissue located around the eye);
• Vitamin and mineral complexes. An auxiliary element of treatment.
  It is important to understand that medications are unable to eliminate the disease, but they significantly improve the condition of nerve cells.

Physiotherapy for optic atrophy

There are two methods whose effectiveness has been proven in practice:

• Pulse magnetic therapy. The method does not regenerate nerve fibers, but improves their functionality. Directional magnetic fields impart “thickness” to the contents of neurons, as a result of which the formation of impulses and their sending to the brain occurs several times faster;
• Bioresonance therapy. The procedure is aimed at normalizing metabolism in the affected tissues and improving blood flow through the capillaries.

The methods are quite specific and are used only in large medical institutions, since they require expensive equipment. Most often, the procedures are paid, so they are extremely rarely used in practice.

Surgical treatment

There are several operations aimed solely at improving visual acuity during atrophy. Conventionally, they can be divided into two categories:

• Redistributing blood flow in the area of ​​the organ of vision. This allows you to activate the supply of useful substances to the damaged element by reducing it in other matters. To do this, some of the vessels on the face are ligated; as a result of the “dead end” that has arisen, the main blood flow is forced to go along the paths leading to the visual apparatus. The operation is used in exceptional cases, since the risk of complications during the recovery period is high;
• Transplantation of revascularizing tissue. The essence of the procedure is the transplantation of tissues with increased blood supply (for example, the mucous membrane) to the atrophied area. A new vascular network grows through the implant, which will provide the neurons with the necessary blood flow. This type of operation is used much more often than the first type. Because it practically does not affect or damage other matters.

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.

Reasons

One of the factors that can provoke diseases of the optic nerve is multiple sclerosis. This damages the myelin covering the nerve cells of the spinal cord and brain. Damage to the brain's immune system develops. People with brain disorders are at risk. Damage to the optic nerve is caused by autoimmune diseases such as sarcoidosis and lupus erythematosus.

Neuromyelitis optica leads to the development of neuritis. This occurs because the disease is accompanied by inflammation of the spinal cord and optic nerve, but no damage to brain cells. The appearance of neuritis is also provoked by other factors:

• The presence of cranial arteritis, characterized by inflammation of the intracranial arteries. Disturbances occur in the blood circulation, blocking the supply of the required amount of oxygen to the cells of the brain and eyes. Such phenomena provoke a stroke and loss of vision in the future.
• Viral, infectious, bacterial diseases, measles, syphilis, cat scratch disease, herpes, rubella, Lyme disease, neuroretinitis lead to inflammation of the nerve, the development of chronic or purulent conjunctivitis.
• Long-term use of certain medications that can provoke the development of nerve inflammation (Ethambuton, prescribed for the treatment of tuberculosis).
• Radiation therapy. Prescribed for certain diseases that are severe.
• Various mechanical effects - severe intoxication of the body, tumors, insufficient supply of nutrients to the cornea and retina.

What can trigger the development of eye pathology? By and large, these are both congenital/inherited pathologies and common childhood trauma. There are cases when people suffered a certain inflammatory disease, after which atrophy began to develop.

We should not exclude such factors as inflammation of the eyeball and its dystrophy, swelling and stagnation, damage and subsequent compression of a certain area of ​​the nerve, unexpected hemorrhage.

Symptoms

Damage to the optic nerve is a pathology that is characterized by inflammation of the nerve sheaths or fibers. Its symptoms may be: pain when moving the eyeballs, blurred vision, changes in color perception, photopsia, the eye may swell.

Patients may complain of a decrease in the peripheral field of vision, vomiting, nausea, darkening of the eyes, and fever. Each form of optic nerve damage has its own symptoms.

Symptoms characteristic of optic nerve atrophy of any etiology:

• decrease in distance visual acuity, and patients note that vision has decreased sharply, more often in the morning, can be reduced to hundredths of a unit, but sometimes remains high;
• loss of the visual field, which depends on the localization of the pathological process; Central scotomas (“spots”) and concentric narrowing of the visual field may be observed;
• impaired color perception;
• complaints characteristic of the underlying disease.

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

The main symptom of optic nerve atrophy is a decrease in visual acuity that cannot be corrected. Depending on the type of atrophy, this symptom manifests itself differently.

Thus, as atrophy progresses, vision gradually decreases, which can lead to complete atrophy of the optic nerve and, accordingly, to complete loss of vision. This process can take place from several days to several months.

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

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

Since the optic nerve carries visual images, the most common signs of its inflammation are the following:

• sudden deterioration of vision in one or both eyes;

• the appearance of black and white vision. Color vision, being more perfect, suffers first;

• Pain appears when moving the eyes. An optional symptom that may be absent if there are no signs of classic inflammation and swelling of the retrobulbar tissue;

As noted above, the defining symptom here is a sharp decrease in human visual acuity. It can manifest itself in different ways, depending on the type of atrophy. If the form is partial, the deterioration of vision simply stops at some stage, after which it stops falling. Accordingly, the progressive form is characterized by the fact that a person begins to see worse and worse and, in the end, completely loses vision.

Vision with ocular atrophy is impaired in a variety of ways. For example, the field of vision changes (as a rule, they begin to narrow), and lateral vision completely deteriorates. A person experiences symptoms of “tunnel” vision, when all objects are visible as if through a narrow tube.

The pathogenetic course and symptoms of optic neuropathy directly depend on the etiological factors that caused this or that disorder, and are characterized by some differences in the impairment of visual functionality.

Thus, anterior ischemic optic neuropathy is characterized by:

• gradual painless loss of vision, usually worsening during morning awakening;
• loss of the lower fields of vision in the early stages of the disease, then the process includes the loss of the upper areas.

Posterior optic neuropathy is caused by spontaneous and sudden complete loss of vision at a certain point in the development of the pathological process.

Characteristic symptoms of optic neuritis are:

• sudden decrease in visual acuity;
• loss of color characteristics;
• pain in the eye sockets;
• photopsia;
• phenomena of visual hallucinations.

Optic neuritis is a treatable disease, with good remission and prognosis rates. However, in complicated cases, it is capable of leaving irreversible marks in the visual neurostructure, which can provoke neuropathic progress.

The toxic etiology of neuropathies usually causes acute loss of vision, but with a favorable prognosis if you immediately consult a doctor. Irreversible processes of destructive changes in the neurons of the optic nerve begin 15-18 hours after taking methanol, during which time it is necessary to use an antidote, as a rule, ethyl alcohol.

Other types of neuropathic conditions of the optic nerve have identical symptoms of gradual loss of visual acuity and color qualities. It is worth noting that the perception of red shades always decreases first, followed by all other colors.

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.

Diagnostics

Methods for detecting inflammation of the optic nerve are based on clinical manifestations, since in most cases the pathology is not detected during examination of the fundus. To exclude the presence of multiple sclerosis, a study of cerebrospinal fluid and MRI (magnetic resonance imaging) is performed. With the help of timely diagnosis, you can prevent and cure this disease, otherwise blindness and nerve atrophy will develop.

Fluorescein angiography of the fundus

This diagnostic method refers to objective methods of examination by contrasting the vessels inside the eye with fluorescein, which is administered intravenously. In pathological conditions, the eye barriers, which work normally, are destroyed, and the bottom of the eye takes on the appearance that is characteristic of a particular process.

Interpretation of fluorescein angiograms is based on a comparison of the characteristics of the passage of fluorescein through the wall of the retina and choroidal vessels with the clinical picture of the disease. The price of the study is 2500-3000 rubles.

Electrophysiological study

This diagnostic procedure is a series of highly informative techniques for studying the functions of the retina, optic nerve, and areas of the cerebral cortex. Electrophysiological examination of the eye is based on recording its reaction to specific stimuli.

The ophthalmologist and the doctor who conducts the examination work closely with each other to set the right task and decide on the diagnostic method. This study is considered the most informative and effective.

The cost of diagnostics is 2500-4000 rubles.

Diagnosis of this disease is carried out by an ophthalmologist together with other specialists. It is performed in several stages, the first of which is an examination by an ophthalmologist, who will refer the patient for additional examinations.

Stages of diagnostics in an ophthalmologist’s office:

1. Determination of visual acuity - the study is carried out using special tables or a sign projector. In rare cases, visual acuity remains within 0.8-0.9; more often, a decrease to hundredths of a unit is observed.
2. Kinetic perimetry: in case of optic nerve disease there will be a narrowing of the field of vision into green and red.
3. Computer perimetry: carried out to more accurately determine the presence of scotomas (“blind spots”), their quantity and properties. Photosensitivity and threshold sensitivity of the retina are studied.
4. Study of the reaction of the pupils to light: if there is a disease on the affected side, the reaction to light decreases.
5. Tonometry (determination of intraocular pressure) is performed to exclude the glaucomatous process.
6. EPS (electrophysiological ocular examination): during this examination, visual evoked potentials are examined; these are signals generated in the nervous tissue in response to stimulation, and with atrophy of the optic nerves their intensity decreases.
7. Ophthalmoscopy: examination of the fundus and optic nerve head. When performing this procedure, the ophthalmologist sees:

• with primary atrophy, the disc is white or grayish-white, the boundaries are clear, the number of small vessels on the disc is reduced, the peridiscal vessels are narrowed, and the layer of retinal nerve fibers is thinned;
• with secondary atrophy, the disc is gray, the boundaries are unclear, the number of small vessels on the disc decreases;
• with glaucomatous atrophy, the disc is white or gray, the boundaries are clear, pronounced excavation (deepening of the central part of the disc), shift of the vascular bundle.

Consultations of related specialists:

1. A consultation with a therapist is carried out to identify diseases that can cause disturbances in the optic nerve and lead to its atrophy.
2. Consultation with a neurologist to rule out multiple sclerosis.
3. A consultation with a neurosurgeon is prescribed if increased intracranial pressure is suspected.
4. Consultation with a rheumatologist is indicated in the presence of complaints characteristic of vasculitis.

The diagnosis of toxic damage to the optic nerve is established on the basis of anamnestic data, studying the reaction of the pupils to light, ophthalmoscopy, visometry, perimetry, and computed tomography (CT). In most patients, it is possible to confirm the relationship between the development of symptoms and contact with toxins.

The stage of the disease can be determined using ophthalmoscopy. At stage I, slight hyperemia of the optic nerve head (ONH) and vascular injection are visualized.

At stage II, swelling of the optic fibers occurs. Stage III is characterized by severe ischemia.

Stage IV is considered terminal and is manifested by degenerative and atrophic changes in nerve fibers.

In the acute course of the disease, the reaction of the pupils to light is sluggish. Visiometry indicates a decrease in visual acuity.

The ophthalmoscopy method allows you to visualize swelling of the optic disc. With complete loss of vision, the white color of the optic disc and vasospasm are determined.

Using the perimetry method, it is possible to establish concentrically narrowed visual fields and dislocate central scotomas. In the chronic form of the disease, a moderate decrease in visual acuity is observed (0.2-0.3).

Ophthalmoscopically, a waxy hue of the optic disc and pronounced spasm of the arterioles are confirmed. Perimetry indicates a concentric narrowing of the visual field.

CT scan visualizes small focal atrophic changes in the optic nerve head.

Diagnosis of optic neuropathy includes a sufficient set of methods and means to determine the nature of the pathology and the prognosis for its cure. As you know, neuropathy is often a secondary disease caused by individual diseases, therefore anamnesis plays a leading role in diagnosing types of neuropathy.

An outpatient ophthalmological examination involves a variety of procedures.

• Fundus examination.
• Classic visual acuity test.
• Spheroperimetric diagnostics, which allows you to determine the boundaries of the visual fields.
• Assessment of color perception.
• X-ray examination of the skull with mandatory inclusion of the hypothalamic region in the image.
• Computed tomography and cerebral magnetic resonance methods are crucial in clarifying the local causes that caused the development of optic neuropathy.

Treatment

Treatment of optic nerve atrophy with medication and physiotherapy:

• Drug treatment is effective only in case of compensation of the underlying disease and with visual acuity of at least 0.01. If the cause of atrophy is not eliminated, a decrease in visual function will also be observed during neuroprotective therapy.
• Physiotherapy is carried out if there are no contraindications to this type of treatment. Main contraindications: stage 3 hypertension, severe atherosclerosis, fever, neoplasms (tumors), acute purulent-inflammatory processes, condition after a heart attack or stroke for 1-3 months.

Stages of treatment:

1. Treatment of the underlying disease, if identified, is carried out by an appropriate specialist, often in a hospital setting. The prognosis of the course of optic nerve atrophy depends on timely detection of the disease.
2. Giving up bad habits allows you to stop the progression of the disease and preserve the patient’s visual functions.
3. Direct acting neuroprotective agents protect the axons (fibers) of the optic nerve. The choice of a specific drug is carried out taking into account the leading role of one or another pathological factor (hemodynamic impairment or regional ischemia).
4. Indirectly acting neuroprotective agents affect risk factors that contribute to optic nerve cell death. The choice of drug is carried out individually.
5. Magnetotherapy.
6. Electro-laser stimulation of the optic nerve.
7. Acupuncture.

The last three points are physiotherapeutic procedures. They are prescribed to improve blood circulation, stimulate reduced metabolic processes, increase tissue permeability, improve the functional state of the optic nerve, which ultimately corrects the state of visual functions. All treatment is carried out in a hospital setting.

Direct acting neuroprotective agents:

• methylethylpyridinol (Emoxipine) 1% solution for injection;
• pentahydroxyethylnaphthoquinone (Histochrome) 0.02% solution for injection.

Neuroprotective agents of indirect action:

• Theophylline tablets 100 mg;
• Vinpocetine (Cavinton) tablets 5 mg, solution for injection;
• Pentoxifylline (Trental) injection solution 2%, tablets 0.1 g;
• Picamilon tablets 20 mg and 50 mg.

Treatment of optic atrophy is a very difficult task for doctors. You need to know that destroyed nerve fibers cannot be restored.

One can hope for some effect from treatment only by restoring the functioning of nerve fibers that are in the process of destruction, which still retain their vital functions. If this moment is missed, then vision in the affected eye can be lost forever.

When treating atrophy, it is necessary to keep in mind that this is often not an independent disease, but a consequence of other pathological processes affecting various parts of the visual pathway. Therefore, treatment of optic nerve atrophy must be combined with elimination of the cause that caused it.

If the cause is eliminated in a timely manner and if atrophy has not yet developed, normalization of the fundus picture and restoration of visual functions occurs within 2-3 weeks to 1-2 months.

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

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

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

Treatment tactics for toxic damage to the optic nerve depend on the stage and characteristics of the disease. At stage I, patients are indicated for detoxification therapy.

Intensive dehydration and the administration of anti-inflammatory drugs are recommended at stage II. At stage III, it is advisable to administer antispasmodics.

With the development of stage IV, in addition to vasodilators, the complex of treatment measures should include immunomodulators, multivitamin complexes and physiotherapeutic methods of treatment (magnetic therapy, physioelectric therapy in combination with electrolaser therapy).

The most difficult task for the attending physician is to correctly prescribe treatment. This is explained by the fact that it is no longer possible to restore dead nerve fibers, although a certain effect in this area can be achieved. We are talking about fibers that are in the active stage of destruction.

All treatment methods can be divided into three types:

• Conservative. The doctor prescribes a whole series of drugs with different spectrum of effects. For example, papaverine and no-spa improve blood circulation in the affected nerve, nootropil improves the functions of the nervous system, and hormonal drugs stop the process of inflammation.
• Therapeutic. Patients are prescribed a fairly wide range of procedures, including magnetic stimulation, acupuncture, laser or electric current stimulation. As a rule, patients undergo such treatment every few months in separate courses.
• Surgical. It involves the elimination of pathological formations compressing the patient’s nerve, implantation of biogenic materials and subsequent ligation of the temporal artery. This improves the overall blood circulation of the nerve and its further vascularization.

The main direction of therapeutic regimens for the treatment of optic neuropathy is to inhibit the pathological processes developing in the parenchyma of the optic trunk, and, if possible, completely eliminate them, as well as to restore lost visual qualities.

As already mentioned, optical neuropathy is a secondary pathology initiated by other diseases. Based on this, first of all, treatment of primary diseases is carried out under regular monitoring of the condition of the optic nerve and attempts to restore its organic characteristics.

Several methods are available for this purpose.

• Magnetic stimulation of optic nerve neurons using an alternating electromagnetic field.
• Electrical stimulation of the nerve trunk by conducting currents of a special frequency and strength through the parenchyma of the optic nerve. This method is invasive and requires a highly qualified specialist.

The essence of both methods is to stimulate the metabolic processes of optic nerve fibers, which partially contributes to their regeneration due to the body’s own forces.

One of the most effective treatments for optic neuropathy is therapy through autologous stem cell transplantation.

The general background of each therapeutic regimen is traditional conservative support.

• Vasodilators.
• Tonics.
• B vitamins.
• In some cases, especially toxic neuropathy, blood transfusions are used.

Surgical treatment is the main method of therapy for compression of the optic nerve, its trauma or infiltration.

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.

Complications of optic atrophy

Timely diagnosis of optic neuropathy allows treatment to begin at an early stage. This allows you to prevent destructive processes in the optic nerve, maintain and even improve visual acuity. However, it is impossible to completely restore visual function due to damage and death of nerve cells.

Late treatment can lead to threatening consequences: not only loss of visual acuity and color sensitivity, but also the development of complete blindness.

For prevention purposes

Prevention of this disease consists of maintaining a healthy lifestyle, timely treatment of concomitant diseases, and avoiding hypothermia.

To prevent optic nerve death, you must:

• prevent the development of inflammatory processes in the body, infectious diseases, stop them;
• avoid eye damage and brain injury;
• regularly visit an oncologist and conduct appropriate research for timely diagnosis of the disease and treatment;
• do not drink alcohol, stop smoking;
• monitor blood pressure readings daily;
• monitor proper nutrition;
• lead a healthy lifestyle with sufficient physical activity.

Forecast and consequences

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.

Atrophy of any organ is characterized by a decrease in its size and loss of function due to lack of nutrition. Atrophic processes are irreversible and indicate a severe form of any disease. Optic atrophy is a complex pathological condition that is almost untreatable and often results in vision loss.

In this article

Functions of the optic nerve

The optic nerve is the white matter of the large brain, as if brought to the periphery and connected to the brain. This substance conducts visual images from the retina, on which light rays fall, to the cerebral cortex, where the final image is formed, which a person sees. In other words, the optic nerve acts as a supplier of messages to the brain and is the most important component of the entire process of transforming the light information received by the eyes.

Optic atrophy: general description

With atrophy of the optic nerve, its fibers are completely or partially destroyed. They are subsequently replaced by connective tissue. The death of the fibers causes the light signals received by the retina to be converted into electrical signals that are transmitted to the brain. For the brain and eyes, this process is pathological and very dangerous. Against this background, various disorders develop, including decreased visual acuity and narrowing of its fields. Optic nerve atrophy is quite rare in practice, although even the most minor eye injuries can provoke its onset. However, approximately 26% of cases of the disease end with the patient completely losing vision in one eye.

Causes of optic nerve atrophy

Optic nerve atrophy is one of the symptoms of various eye diseases or a stage in the development of any disease. There are many reasons that can lead to this pathology. Among the ophthalmological diseases that can provoke atrophic changes in the optic nerve are the following ailments:

• glaucoma;
• retinal pigmentary dystrophy;
• myopia;
• uveitis;
• retinitis;
• optic neuritis,
• damage to the central artery of the retina.

Atrophy can also be associated with tumors and diseases of the orbit: optic nerve glioma, neuroma, orbital cancer, meningioma, osteosarcoma and others.
All kinds of diseases of the brain and central nervous system in some cases lead to atrophic processes in the eyes, affecting primarily the optic nerves. Such diseases include:

• multiple sclerosis;
• pituitary tumors;
• meningitis;
• brain abscess;
• encephalitis;
• traumatic brain injuries;
• damage to the facial skeleton with injury to the optic nerve.

Types and forms of optic nerve atrophy

This pathological condition can be congenital or acquired. Acquired atrophy is divided into descending and ascending. In the first case, the fibers of the optic nerve are directly affected. In the second, the cells of the retina come under attack.
According to another classification, acquired atrophy can be:

1. Primary. It is also called a simple form of atrophy, in which the optic disc becomes pale, but has clear boundaries. The vessels in the retina with this type of pathology narrow.
2. Secondary, which develops due to inflammation of the optic nerve or its stagnation. The boundaries of the disc become unclear.
3. Glaucomatous, accompanied by increased intraocular pressure.

Based on the extent of damage to the optic nerve fibers, atrophy is divided into partial and complete. The partial (initial) form manifests itself in severe deterioration of vision, which cannot be corrected with contact lenses and glasses. At this stage, the remaining visual functions can be preserved, but color perception will be severely impaired. Complete atrophy is damage to the entire optic nerve, in which a person can no longer see anything with the affected eye. Optic nerve atrophy manifests itself in a stationary form (does not develop, but remains at the same level) and progressive. With stationary atrophy, visual functions remain in a stable state. The progressive form is accompanied by a rapid decrease in visual acuity. Another classification divides atrophy into unilateral and bilateral, that is, with damage to one or both organs of vision.

Symptoms of optic atrophy

The first and main symptom that manifests itself in any form of optic nerve atrophy is blurred vision. However, it cannot be corrected. This is a sign by which the atrophic process can be distinguished from ametropia - a change in the ability of the human eye to correctly refract light rays. Vision can deteriorate gradually and rapidly. It depends on the form in which atrophic changes occur. In some cases, visual functions decrease within 3-4 months, sometimes a person becomes completely blind in one or both eyes within a few days. In addition to a general decrease in visual acuity, its fields are narrowed.


The patient almost completely loses lateral vision, which leads to the development of the so-called “tunnel” type of perception of the surrounding reality, when a person sees everything as if through a pipe. In other words, only what is directly in front of the person is visible, and not to the side of him.

Another common sign of optic nerve atrophy is the appearance of scotomas - dark or blind areas that appear in the field of vision. By the location of the scotomas, you can determine which fibers of the nerve or retina are damaged the most. If spots appear right in front of the eyes, then the nerve fibers located closer to the central part of the retina or directly in it are affected. Color vision disorder becomes another problem that a person faces with atrophy. Most often, the perception of green and red hues is impaired, rarely - the blue-yellow spectrum.

All these symptoms are signs of the primary form, that is, its initial stage. The patient himself can notice them. Symptoms of secondary atrophy are visible only during examination.

Symptoms of secondary optic atrophy

As soon as a person consults a doctor with symptoms such as decreased visual acuity and narrowing of its fields, the doctor conducts an examination. One of the main methods is ophthalmoscopy - examination of the fundus of the eye using special instruments and devices. During ophthalmoscopy, the following signs of optic nerve atrophy are revealed:

• vasoconstriction;
• varicose veins;
• disc blanching;
• decreased pupil reaction to light.

Diagnostics

As already described above, the first method used to detect pathology is ophthalmoscopy. However, the symptoms that can be detected with this test do not allow a definitive diagnosis. Deterioration of vision, lack of pupillary response to light, narrowing of the blood vessels in the eye are signs of many eye diseases, for example, peripheral cataracts. In this regard, many different methods are used to diagnose atrophy:

Laboratory tests are also carried out. The patient donates blood and urine for analysis. Tests are prescribed for syphilis, borreliosis and to determine other non-ophthalmological diseases.

How is optic nerve atrophy treated?

It is impossible to restore fibers that have already been destroyed. Treatment helps stop atrophy and save those fibers that are still functioning. There are three ways to combat this pathology:

• conservative;
• therapeutic;
• surgical.

With conservative treatment, the patient is prescribed vasoconstrictors and medications, the actions of which are aimed at normalizing the blood supply to the optic nerve. The doctor also prescribes anticoagulants, which inhibit blood clotting activity.


Drugs that stimulate metabolism and medications that relieve inflammation, including hormonal ones, help stop the death of fibers.

Physiotherapeutic treatment involves prescribing:

The surgical treatment method is aimed at removing formations that put pressure on the optic nerve. During the operation, the surgeon can implant biogenic materials into the patient, which will help improve blood circulation in the eye and in the atrophied nerve, in particular. The pathology suffered in most cases leads to the fact that a person is assigned a disability. Patients who are blind or visually impaired are sent for rehabilitation.

Prevention

To prevent optic nerve atrophy, it is necessary to begin treating ophthalmological diseases in a timely manner.


At the first signs of a decrease in visual acuity, you should immediately make an appointment with an ophthalmologist. When atrophy begins, not a minute can be lost. If at the initial stage it is still possible to preserve most of the visual functions, then as a result of further atrophic changes the person may become disabled.

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Optic nerve damage (ONI) occurs in 5-5% of cases with TBI, and the intracanal part of the nerve is predominantly affected. Typically, this injury is the result of a blow, most often inflicted in the frontal, orbital, and less often in the frontotemporal region. ONPs are observed in severe TBI, craniobasal fractures extending to the bone structures surrounding the optic nerve (ON): optic canal, anterior sphenoid process, orbital roof. The severity of the ON lesion does not always correlate with the severity of TBI. Loss of vision up to amaurosis can sometimes occur after injury to the fronto-orbital region without loss of consciousness, when no other neurological disorders are noted.

Based on location, damage can be divided into anterior and posterior. Anterior optic nerve injuries are extremely rare. With this pathology, damage to the intraocular section (disc) and part of the intraorbital section of the optic nerve containing the central retinal artery (CRA) is determined. Posterior ZNPs (between the point of entry into the CAS nerve and the chiasm) are more common. Due to its anatomical features, the intracanal section of the optic nerve is most susceptible to traumatic effects. Unlike the mobile intraorbital and intracranial sections, in the bone canal the nerve is tightly fixed by the dura mater. The blood supply to the intracanal section is provided by small branches of the orbital and internal carotid arteries, which form the pial vascular network surrounding the optic nerve. At the time of injury, sudden displacements of the brain and/or fracture of the canal can cause stretching and rupture of the axons of the optic nerve and the vessels supplying it. ZNP are rarely the result of direct compression by a bone fragment in the canal. The main mechanism of damage is considered to be compression due to reactive swelling of the nerve and secondary ischemic disorders. It should be emphasized that the force of the inflicted frontal blow can directly extend to the optic nerve and the presence of a canal fracture is not a prerequisite for intracanal damage.

Pathomorphological changes in the optic nerve can be divided into primary and secondary. Primary injuries include injuries that occurred during the impact: interthecal and intraneural hemorrhages, contusions, nerve ruptures. Secondary damage occurs delayed and is the result of vascular disorders: edema, ischemic necrosis of the optic nerve.

Clinic of optic nerve damage.

PLD manifests itself as a sharp decrease in visual acuity up to blindness. Visual field impairments are determined in the form of central and paracentral scotomas, concentric narrowing, and sector-shaped loss. The most reliable sign is a decrease or absence (with amaurosis) of the direct reaction of the pupil to light with a preserved friendly reaction. On the opposite (healthy) side, the direct reaction of the pupil to light will be preserved, and the conjugate reaction will be weakened. With ophthalmoscopy, in all cases of anterior PD, a pathology is detected in the fundus, which fits into the picture of occlusion of the central nervous system, anterior ischemic neuropathy, or avulsion of varying severity with hemorrhages along the edge of the disc. In posterior ONs, including intracanal ones, the ON disc and fundus generally appear normal. After 2-4 weeks. disc blanching appears. The closer to the anterior the ON is affected, the faster its atrophy is detected. To clarify the location of the damage, radiography of the openings of the optic canal according to Reza is used, which makes it possible to identify fractures of the walls of the canal. In most cases, linear fractures occur, less often - with displacement of fragments. However, often x-rays do not detect cracks in the canal. Intracanal fractures are more often detected on CT scans of the orbit. At the same time, changes in the optic nerve and soft tissues of the orbit are also determined (meningeal hematoma of the optic nerve, retrobulbar hemorrhage, ratio of the tumor to bone fragments in the orbit, hemorrhage in the sphenoethmoidal sinus). At the same time, the absence of traumatic changes on radiographs and CT is not a basis for excluding intracanal damage.

Treatment of optic nerve damage.

There is currently no generally accepted treatment tactics for intracanal GNP. Surgical treatment is aimed at eliminating compression of the optic nerve and consists of removing one of the walls of the canal, depending on the access, as well as bone fragments and meningeal hematoma of the optic nerve (if any).

There are 2 surgical approaches:

1. intracranial transfrontal (with resection of the upper wall of the canal and dissection of the dura mater in the area of ​​the internal optic opening);
2. extracranial transethmoidal (with resection of the medial wall of the canal). Typically, decompression of the optic nerve is performed within a period of several hours. Up to 7-10 days. after injury. The shorter the time interval between TBI and surgery, the better the results of surgical treatment. Indications for decompression of the optic nerve and the timing of its implementation are not unified.

The problem is that the same clinical data may have different morphological substrates in different patients. When deciding on surgical intervention, the degree of severity and time of onset of visual impairment should be taken into account. If vision loss develops some time after the injury or there is progressive deterioration of vision despite drug treatment, optic decompression is indicated. If vision loss occurs during an injury and is complete, with the absence of a direct reaction of the pupil to light, this, as a rule, indicates severe morphological damage, in most cases leading to persistent visual deficit. In such cases, the effect of the operation is questionable. It is not advisable to perform surgery on patients with partial loss of vision, if visual acuity is higher than 0.1 and the visual field defect is less than 1/4, without observation and attempts at conservative treatment. The presence of radiological and CT signs of a canal fracture is not a necessary condition for surgical intervention. Data on the effectiveness of MN decompression remain controversial. This is explained by the fact that operations are often performed when the damage is irreversible. However, some neurosurgeons believe that surgical intervention does not have significant advantages over conservative treatment and use MN decompression only as an addition to other cranial surgeries. Drug treatment includes the use of decongestants (mannitol, Lasix) and vasoactive agents (Trental, Sermion, Complamin, Cavinton), corticosteroids, drugs that improve microcirculation (reopolyglucin, etc.).

The prognosis for vision recovery after damage to the optic nerve is poor when vision loss occurs at the time of injury. In most cases, amaurosis is irreversible, although occasionally some improvement may occur within a few hours or days after the injury, regardless of the type of treatment performed. Better results can be expected with delayed vision loss or when the initial visual defect is partial, and the diagnosis is timely and therapy is adequate. The prognosis depends on the severity of the lesion and is largely determined at the time of traumatic exposure.