(optic neuropathy) - partial or complete destruction of the nerve fibers that transmit visual stimuli from the retina to the brain. Optic nerve atrophy leads to decreased or complete loss of vision, narrowing of visual fields, impairment color vision, pallor of the optic disc. The diagnosis of optic nerve atrophy is made by identifying characteristic signs of the disease using ophthalmoscopy, perimetry, color testing, determination of visual acuity, craniography, CT and MRI of the brain, B-scanning ultrasound of the eye, angiography of retinal vessels, studies of visual VP, etc. With optic atrophy nerve treatment is aimed at eliminating the pathology that led to this complication.
ICD-10
H47.2
General information
Various diseases of the optic nerve in ophthalmology occur in 1-1.5% of cases; of these, 19 to 26% lead to complete atrophy of the optic nerve and incurable blindness. Pathomorphological changes in optic nerve atrophy are characterized by destruction of axons of retinal ganglion cells with their glial-connective tissue transformation, obliteration of the capillary network of the optic nerve and its thinning. Optic nerve atrophy can be a consequence of a large number of diseases that occur with inflammation, compression, swelling, damage to nerve fibers or damage to the blood vessels of the eye.
Causes of optic nerve atrophy
Factors leading to optic nerve atrophy may include eye diseases, central nervous system lesions, mechanical damage, intoxication, general, infectious, autoimmune diseases and etc.
The causes of damage and subsequent atrophy of the optic nerve are often various ophthalmopathologies: glaucoma, pigmentary dystrophy retina, occlusion of the central retinal artery, myopia, uveitis, retinitis, optic neuritis, etc. The danger of damage to the optic nerve may be associated with tumors and diseases of the orbit: meningioma and glioma of the optic nerve, neurinoma, neurofibroma, primary orbital cancer, osteosarcoma, local orbital vasculitis, sarcoidosis, etc.
Among diseases of the central nervous system, the leading role is played by tumors of the pituitary gland and posterior cranial fossa, compression of the area of the optic chiasm (chiasm), purulent-inflammatory diseases (brain abscess, encephalitis, meningitis), multiple sclerosis, traumatic brain injuries and damage to the facial skeleton accompanied by injury optic nerve.
Often optic nerve atrophy is preceded by hypertension, atherosclerosis, starvation, vitamin deficiency, intoxication (poisoning with alcohol substitutes, nicotine, chlorophos, medicinal substances), large simultaneous blood loss (usually with uterine and gastrointestinal bleeding), diabetes mellitus, anemia. Degenerative processes in the optic nerve can develop with antiphospholipid syndrome, systemic lupus erythematosus, Wegener's granulomatosis, Behcet's disease, Horton's disease.
Congenital atrophies of the optic nerve occur with acrocephaly (tower-shaped skull), micro- and macrocephaly, craniofacial dysostosis (Crouzon's disease), and hereditary syndromes. In 20% of cases, the etiology of optic nerve atrophy remains unclear.
Classification
Optic nerve atrophy can be hereditary or non-hereditary (acquired). Hereditary forms of optic atrophy include autosomal dominant, autosomal recessive and mitochondrial. The autosomal dominant form can have a severe or mild course, and is sometimes combined with congenital deafness. An autosomal recessive form of optic nerve atrophy occurs in patients with Wehr, Wolfram, Bourneville, Jensen, Rosenberg-Chattorian, and Kenny-Coffey syndromes. The mitochondrial form is observed when there is a mutation in mitochondrial DNA and accompanies Leber's disease.
Acquired optic nerve atrophy, depending on etiological factors, can be primary, secondary and glaucomatous in nature. The mechanism of development of primary atrophy is associated with compression of peripheral neurons of the visual pathway; The optic disc is not changed, its boundaries remain clear. In the pathogenesis of secondary atrophy, swelling of the optic disc occurs, caused by a pathological process in the retina or the optic nerve itself. The replacement of nerve fibers by neuroglia is more pronounced; The optic disc increases in diameter and loses its clear boundaries. The development of glaucomatous optic atrophy is caused by the collapse of the lamina cribrosa of the sclera against the background of increased intraocular pressure.
Based on the degree of color change of the optic nerve head, initial, partial (incomplete) and complete atrophy are distinguished. Initial degree atrophy is characterized by slight blanching of the optic disc while maintaining the normal color of the optic nerve. With partial atrophy, disc blanching in one of the segments is noted. Complete atrophy manifested by uniform pallor and thinning of the entire optic nerve head, narrowing of the vessels of the fundus.
Based on localization, ascending (if retinal cells are damaged) and descending (if optic nerve fibers are damaged) atrophy is distinguished; by localization - one-sided and two-sided; according to the degree of progression - stationary and progressive (determined during dynamic observation by an ophthalmologist).
Symptoms of optic atrophy
The main sign of optic nerve atrophy is a decrease in visual acuity that cannot be corrected with glasses and lenses. With progressive atrophy, a decrease in visual function develops over a period of several days to several months and can result in complete blindness. In case of incomplete optic nerve atrophy pathological changes reach a certain point and do not develop further, and therefore vision is partially lost.
With optic nerve atrophy, disturbances in visual function can manifest themselves as concentric narrowing of the visual fields (disappearance of lateral vision), the development of “tunnel” vision, color vision disorder (mainly green-red, less often - blue-yellow part of the spectrum), the appearance dark spots(scotoma) in areas of the visual field. Typically, an afferent pupillary defect is detected on the affected side - a decrease in the pupillary reaction to light while maintaining a congenial pupillary reaction. Such changes can occur in one or both eyes.
Objective signs of optic nerve atrophy are revealed in the process ophthalmological examination.
Diagnostics
When examining patients with optic atrophy, it is necessary to determine the presence concomitant diseases, the fact of taking medications and contact with chemicals, the presence bad habits, as well as complaints indicating possible intracranial lesions.
During a physical examination, the ophthalmologist determines the absence or presence of exophthalmos, examines the mobility of the eyeballs, checks the reaction of the pupils to light, and the corneal reflex. Visual acuity testing, perimetry, and color vision testing are required.
Basic information about the presence and degree of optic nerve atrophy is obtained using ophthalmoscopy. Depending on the causes and form of optic neuropathy, the ophthalmoscopic picture will differ, but there is typical characteristics, occurring at various types optic nerve atrophy. These include: pallor of the optic disc varying degrees and prevalence, changes in its contours and color (from grayish to waxy), excavation of the disc surface, a decrease in the number of small vessels on the disc (Kestenbaum’s symptom), narrowing of the caliber of the retinal arteries, changes in the veins, etc. The condition of the optic disc is clarified using tomography (optical coherence , laser scanning).
To prevent optic nerve atrophy it is necessary timely treatment ophthalmic, neurological, rheumatological, endocrine, infectious diseases; prevention of intoxication, timely blood transfusion in case of profuse bleeding. At the first signs of visual impairment, consultation with an ophthalmologist is necessary.
Optic nerve atrophy is a serious ophthalmological disease with a significant decrease in the patient’s visual function. Optic nerve atrophy can be caused by inflammation or dystrophy of the optic nerve, its compression or trauma, leading to damage to the nerve tissue.
Causes of optic nerve atrophy of neurological, infectious, phlebological etiology include brain tumors, meningitis, hypertension, profuse bleeding, atherosclerosis and other diseases. Destruction of the nerve fibers of the optic nerve can also be caused by genetic factors or intoxication of the body.
During the development of optic nerve atrophy, the destruction of nerve fibers gradually occurs, their replacement by connective and glial tissue, and then blockage of the vessels responsible for the blood supply to the optic nerve. As a result, the patient's visual acuity decreases and the optic disc becomes pale.
Symptoms of optic atrophy
Symptoms of optic atrophy depend on the form of the disease. A sign of primary optic nerve atrophy, as an independent disease, is the clear boundaries of the pale disc. In this case, the normal excavation (deepening) of the disc is disrupted. With primary atrophy of the optic nerve, it takes on the shape of a saucer with narrowed arterial vessels retina.
Symptoms of secondary optic nerve atrophy include blurred disc boundaries, vasodilation, and prominence (bulging) of its central part. However, it must be taken into account that late stage There are no symptoms of secondary optic nerve atrophy: the vessels narrow, the boundaries of the disc are smoothed, the disc is flattened.
Hereditary atrophy of the optic nerve, for example, in Leber's disease, is manifested by retrobulbar neuritis. This is the name for inflammation of the portion of the optic nerve located behind the eyeball. Visual acuity decreases gradually, but painful sensations are noted during eye movements.
A symptom of optic nerve atrophy against the background of profuse bleeding (uterine or gastrointestinal) is a sharp narrowing of the retinal vessels and loss of its lower half from the field of view.
Symptoms of optic nerve atrophy due to compression by a tumor or injury depend on the location of the damage optic disc. Often, even with the most serious injuries, the quality of vision decreases gradually.
Partial atrophy of the optic nerve is characterized by the least functional and organic changes. The term “partial optic nerve atrophy” means that the destructive process began, affected only part of the optic nerve and stopped. Symptoms of partial optic nerve atrophy can be very different and have different severity. For example, narrowing the field of view down to tunnel syndrome, the presence of scotomas (blind spots), decreased visual acuity.
With significant pallor of the optic nerve, diagnosing the disease is simple. Otherwise, a more detailed study of the patient’s visual functions is required using tests to determine the visual field, X-ray and fluorescein angiographic studies.
Atrophy of the optic nerve is also indicated by a change in the electrical physiological sensitivity of the optic nerve and an increase in intraocular pressure in the glaucomatous form of the disease.
Treatment of optic atrophy
The most favorable prognosis in the treatment of partial optic nerve atrophy. The main standard in treating the disease is the use of drugs to improve blood supply to the optic nerve, vitamins and physiotherapy.
If the decrease in visual acuity is caused by compression, treatment of optic nerve atrophy is primarily neurosurgical, and only then magnetic and laser stimulation methods, electrotherapy and physiotherapy are used.
The main goal of treatment for optic nerve atrophy is to stop the destruction of optic nerve tissue and maintain existing visual acuity. Fully restore visual function, as a rule, is impossible. But without treatment, optic nerve atrophy can lead to complete blindness of the patient.
Optic nerve atrophy in children
Many congenital eye diseases are diagnosed in a child during the first examination in the maternity hospital: glaucoma, cataracts, ptosis upper eyelid etc. Optic nerve atrophy in children, unfortunately, is not one of them, since its course is often hidden, without external visible symptoms diseases. Therefore, the diagnosis of complete damage to the optic nerve or partial atrophy of the optic nerve in children is established, as a rule, in the second month of the child’s life during a routine examination by an ophthalmologist.
The doctor checks the visual acuity of the newborn, based on the quality of gaze fixation and the child’s ability to follow a moving toy. The infant's field of vision is determined in the same way. If it is not possible to determine visual acuity in this way, then a study of the brain’s reaction to visual stimuli is used.
Using ophthalmological equipment and drugs that dilate the pupil, the baby's fundus is studied. If a clouded optic disc is detected, a diagnosis of optic nerve atrophy is made. In children, treatment of the disease follows the same scheme as in adults, with the prescription of vasodilator therapy, nootropics to improve metabolic processes in the brain and courses of light, laser, electrical and magnetic influences that stimulate vision.
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21-07-2012, 10:15
Description
Toxic lesions of the optic nerves arise as a result of acute or chronic exposure on the optic nerves by exogenous or endogenous toxins.Most Frequent exogenous toxins leading to damage to the optic nerves - methyl or ethyl alcohol, nicotine, quinine, industrial poisons, pesticides used in agricultural production and in everyday life, as well as some medications in case of overdose; There are reports of toxic effects from inhalation of hydrogen peroxide vapor.
Endogenous toxins during pathological pregnancy and helminthic infestation can also have an adverse effect on the optic nerves.
Toxic lesions of the optic nerves occur in the form of bilateral acute or chronic retrobulbar neuritis. Toxic damage to the optic nerves due to the growth of toxic substances in industrial production, agriculture and pharmacology has no tendency to decrease and often ends with the phenomena of atrophy of varying degrees.
ICD-10 CODE
H46. Optic neuritis.
EPIDEMIOLOGY
The disease is diagnosed to a greater extent at the age of 30-50 years. Among the causes of blindness is atrophy of the optic nerves, which often results in toxic damage to the optic nerve, accounting for about 19%.
CLASSIFICATION
Toxic lesions of the optic nerves are divided into toxic neuropathy and toxic optic atrophy.
A classification has been adopted according to which the factors causing intoxication divided into 2 groups.
- First group: methyl and ethyl alcohol, strong tobacco, iodoform, carbon disulfide, chloroform, lead, arsenic and a number of drugs in case of overdose: morphine, opium, barbiturates, sulfonamides. Substances of this group primarily affect the papillomacular bundle. In this case, central and paracentral scotomas arise.
- Second group: quinine derivatives, ergotamine, organic arsenic derivatives, salicylic acid, drugs used in the treatment of tuberculosis.
Taking into account the course of toxic lesions of the optic nerve, four stages are distinguished.
- Stage I- the phenomena of moderate hyperemia of the optic disc, vasodilatation, predominate.
- Stage II- stage of papilledema.
- Stage III- ischemia, vascular disorders.
- IV stage- stage of atrophy, degeneration of the optic nerves.
MAIN CLINICAL FORMS
There are acute and chronic forms of toxic damage to the optic nerves.
ETIOLOGY
Toxic damage to the optic nerves occurs when ingesting liquids containing methyl alcohol, or alcoholic liquids as alcoholic beverages, which, in fact, are the product of poor-quality products from distilleries or random handicrafts. A special place is occupied by the so-called alcohol-tobacco intoxication, the cause of which is prolonged excessive consumption of alcoholic beverages in combination with smoking strong varieties of tobacco.
CLINICAL PICTURE
Particularly significant types of toxic lesions.
Acute toxic damage to the optic nerves occurs when methanol is ingested, which smells and looks like ethyl alcohol.
Acute poisoning is characterized by general manifestations: headache, abdominal pain, vomiting, choking, convulsions, bladder irritation, circulatory disorders, shock.
On the part of the eyes, there is a sluggish reaction of the pupils to light, a sharp decrease in vision (fogging).
Ophthalmoscopically, swelling of the optic disc is detected. A few hours later or on the second day after the onset of general symptoms of poisoning in the eyes, a sharp decrease in vision is determined, the pupils react sluggishly to light, and in very severe cases, early blindness is observed. In less severe cases, vision improvement occurs at the end of the 4th or 5th week; it may persist, but the improvement in vision may be replaced by complete blindness. In this case, the immobility of the pupils, “wandering gaze” (lack of fixation) are noted, atrophy of the optic nerves is determined ophthalmoscopically: the optic disc is white, the vessels are narrowed: in this case, paralysis of the external muscles of the eye can be observed.
In acute toxic damage optic nerves As a result of drinking alcohol, the condition of the eyes depends on the amount of liquid taken and the nature of the toxic substance it contains.
In particularly severe cases clinical picture and the condition of the eyes to a certain extent resembles methanol poisoning: this also applies to the general manifestations of poisoning. However, complete blindness occurs only with a large dosage of the drink and the high toxicity of the toxic substance contained in the liquid. Residual vision may be preserved, with a central scotoma and concentric narrowing of the visual field.
Alcohol and tobacco damage to the optic nerves V severe form and rarely occurs acutely. At the same time, in addition to the general “hangover” symptoms, patients complain of decreased vision. Objectively, a decrease in visual acuity and a concentric narrowing of the visual field (especially in colors) are determined. In the fundus, pallor (waxiness) of the optic disc and narrowing of arterial vessels are detected.
Similar eye phenomena are also determined in case of “non-acute” eye damage, with long-term use strong alcoholic drinks in combination with smoking certain types of tobacco. A distinctive feature can be considered a moderate decrease in visual acuity (0.2-0.3), a more favorable state of peripheral vision: these damages quickly disappear when you stop smoking and drinking alcoholic beverages.
DIAGNOSTICS
Anamnesis
Anamnesis for toxic-allergic lesions of the optic nerves is important, and in cases of acute poisoning - main role in the dynamics and treatment undertaken. Anamnestic data are of particular importance in cases of oral ingestion of a toxic liquid to determine its nature and the amount of liquid consumed.
Physical examination
Physical examination includes determination of visual acuity, visual field, color perception, direct and reverse ophthalmoscopy, as well as biomicroscopy.
Instrumental studies
In case of chronic intoxication, the following are carried out: electrophysiological studies, studies of the state of blood circulation in the vessels of the eye, rheoophthalmography, CT.
Laboratory research
The need for laboratory tests arises to determine the nature of the remaining liquid drunk.
A certain role is assigned to the study of the presence of methyl and ethyl alcohol in the blood.
Differential diagnosis
At acute forms toxic damage to the optic nerves differential diagnosis is based on medical history (nature and amount of fluid drunk), laboratory research liquid residues (if any), determination of methyl and ethyl alcohol in blood.
At chronic toxicosis differential diagnosis is based on anamnesis data (duration of alcohol and tobacco abuse), collect comprehensive information about the drugs used pharmacological drugs, an overdose of which can provoke toxic damage to the optic nerves. Contacts with pesticides are identified. CT scan of the skull allows us to identify characteristic features of the orbital areas of the optic nerves, small focal atrophic foci in the structures of the brain.
An example of a diagnosis formulation
Dystrophic damage to the optic nerves (partial atrophy) due to alcohol and tobacco intoxication.
TREATMENT
Treatment is focused on the stage of the disease.
Treatment Goals
At the first stage- detoxification therapy.
At the second stage- intensive dehydration (furosemide, acetazolamide, magnesium sulfate), anti-inflammatory therapy (glucocorticoids).
In the third stage vasodilators are preferred (drotaverine, pentoxifylline, vinpocetine).
In the fourth stage- vasodilators, stimulant therapy, physiotherapy.
At acute poisoning(ethanol surrogate, methanol)- urgent first aid. The patient's stomach is washed several times, a saline laxative is given, repeated cerebrospinal punctures are performed, a 5% sodium bicarbonate solution is administered intravenously, a 1% solution nicotinic acid with 40% glucose solution, intravenously - povidone. Drinking plenty of fluids is prescribed - 5% sodium bicarbonate solution, prednisolone orally.
Locally - retrobulbar injections of a 0.1% atropine sulfate solution of 0.5 ml and a dexamethasone solution of 0.5 ml are performed.
To reduce swelling of the brain and optic nerves use diuretics. Subsequently, subcutaneous administration of vitamins B1, B6, and multivitamin preparations orally.
At chronic toxic damage to the optic nerves a specific individual treatment regimen for patients is required.
- By analyzing anamnestic, physical, instrumental methods examinations to establish the nature of the toxic agent, determine the timing of its exposure, and the resulting toxic damage to the optic nerves.
- Unconditional elimination from further exposure to a toxic agent, depending on the reasons that prompted contact with it: with careful replacement pharmacological analogues toxic drug if treatment of an underlying other disease is required.
- Detoxification at relatively short term the occurrence of toxic damage to the optic nerves.
- Nootropic therapy, vitamin therapy (group B), vasoprotective therapy.
- At the first signs of partial atrophy of the optic nerves - magnetic therapy, physioelectric therapy, combined electrolaser therapy.
- To carry out these treatment methods, serial production of the necessary equipment has been developed.
Indications for hospitalization
Patients with acute toxic damage to the optic nerves (poisoning) are subject to immediate hospitalization; Delay in providing urgent assistance is fraught with serious consequences, including complete blindness or death.
For chronic toxic damage to the optic nerves for the first course emergency treatment Hospitalization is indicated to develop the most effective comprehensive individual treatment cycle. Subsequently, courses of treatment using methods that have proven to be the most effective can be carried out on an outpatient basis.
Surgery
In case of partial atrophy of the optic nerves of toxic origin, some surgical methods are used: electrical stimulation, with the introduction of an active electrode to the optic nerve, catheterization of the superficial temporal artery[with infusion of sodium heparin (500 units), dexamethasone 0.1% 2 ml, Actovegin 2 times a day for 5-7 days].
Indications for consultation with other specialists
In all cases, both with acute toxic lesions of the optic nerves and with chronic ones, consultations with other specialists are necessary; for acute cases - a therapist, toxicologist, neurologist.
For chronic lesions - a neurologist, therapist, cardiologist, gastroenterologist.
Approximate periods of incapacity for work
Depending on the stage of the disease, 30-45 days.
Subsequently, the assessment of disability depends on visual acuity, changes in the visual field (central scotomas - absolute or relative), and a decrease in indicators of optic nerve lability.
The average period of disability for patients with toxic damage to the optic nerves caused by the use of alcohol substitutes is from 1.5 to 2 months.
Further management
Those patients with toxic damage to the optic nerves who have not been assigned a disability group due to sufficiently high visual acuity require an additional 2-3 courses of two-week therapy in outpatient setting at intervals of 6-8 months. Courses of treatment should include drugs that improve blood circulation, angioprotectors, biostimulants, as well as physical therapy and electrical stimulation of the optic nerves.
PATIENT INFORMATION
In case of toxic damage to the optic nerves due to alcohol and tobacco intoxication, a complete cessation of alcohol consumption and smoking is recommended.
Article from the book: .
Optic nerve atrophy develops as a result of complete or partial death of the fibers of this nerve. Necrotic processes in tissues arise as a result of past pathologies of an infectious and non-infectious nature.
Optic nerve atrophy: causes
This pathology is rarely recorded in ophthalmological practice. The main causes of optic nerve atrophy include the following factors:
Optic nerve atrophy is accompanied by inflammatory reactions, circulatory dysfunction, which ultimately leads to the destruction of neurocytes and their replacement with glial tissue. In addition, with increased intraocular pressure collapse of the optic disc membrane develops.
Optic nerve atrophy: symptoms
Clinical signs of pathology depend on the form of atrophy. Without appropriate and timely treatment, optic nerve atrophy progresses and can provoke the development of complete blindness. Basic clinical sign The presented pathology is a sharp decrease in visual acuity that cannot be corrected.
Partial atrophy of the optic nerve is accompanied by partial preservation of vision. Visual acuity is reduced and cannot be restored with lenses or glasses. The clinical picture of the disease can manifest itself with to varying degrees expressiveness. Partial atrophy of the optic nerve is manifested by the following symptoms:
- color perception changes;
- decreased visual acuity;
- the appearance of “tunnel vision”;
- violation of orientation in space;
- decreased peripheral and central vision;
- the appearance of scotomas (blind spots);
- problems with reading or other visual work.
Objective symptoms of the above pathology are determined only during an ophthalmological examination.
Features of the development of the disease in childhood
Optic nerve atrophy in children can be congenital or acquired. In the first case, children are already born with impaired vision. Based on the condition of the pupils and their reaction to light, this pathology can be diagnosed in the early stages of its development. Dilated pupils, as well as their lack of reaction to bright light, are key indirect symptoms unilateral or bilateral optic nerve atrophy. While the child is awake, chaotic floating eye movements are observed. Usually, congenital diseases in children they are detected during routine examinations before the age of one year. It is worth noting that optic nerve atrophy in children under 2 years of age quite often goes unnoticed.
Diagnosis of the disease
If you notice any vision problems, you should consult an ophthalmologist. It is important to find out what exactly caused the development of the disease. In order to establish a diagnosis of “optic atrophy of the eye”, you need to do the following:
- ophthalmological examination (visual acuity testing, computer perimetry, fundus examination, video-ophthalmography, spheroperimetry, Dopplerography, color perception study);
- X-ray of the skull;
- tonometry;
- fluorescein angiography;
- magnetic resonance and computed tomography;
- laboratory blood test.
Conservative treatment
Once a diagnosis of optic atrophy is made, treatment should be immediate. Unfortunately, it is impossible to completely cure this disease, but in some cases it is possible to slow down and even stop the pathological process. Doctors use different groups drugs that improve blood circulation. The most commonly used drugs are vasodilators ("Papaverine", "Amylnitrite", "Compalamin", "No-shpa", "Stugeron", "Galidor", "Eufilin", "Sermion", "Trental", "Dibazol"), anticoagulants (" Heparin", "Nadroparin calcium", "Tiklid"), vitamins (thiamine, riboflavin, pyridoxine, cyanocobalamin, ascorutin), enzymes (lidase, fibrinolysin), amino acids (glutamic acid), hormones (Prednisolone, Dexamethasole) and immunomodulators (“Eleutherococcus”, “Ginseng”).
Many experts recommend using the drug Cavinton as a vasodilator of intraocular vessels. This medication does not increase ophthalmotonus, so it can be used to treat patients with normal blood pressure, as well as with moderate hypertension.
Nowadays, biogenic preparations (Peat, Aloe, Peloid distillate, FiBS), angioprotectors (Emoxipin, Mildronate, Doxium), and water-soluble vitamins are actively used. Good results are obtained by combining the drug “Emokchipin” with vitamin E (tocopherol). The medications “Dekaris”, “Sodium Nucleinate”, “Timalin” are prescribed as immunocorrective agents.
Traditional drug treatment regimens for the disease are ineffective, therefore Lately Complex therapy in combination with surgical and physiotherapeutic methods is being actively introduced. Practitioners recommend that patients diagnosed with optic nerve atrophy be prescribed treatment in combination with a blockade of the pterygopalatine ganglion. Despite the widespread use of drug therapy, there are some disadvantages that are revealed when drugs are introduced into the body. A number of complications can arise when using para- and retrobulbar injections.
Physiotherapeutic treatments
In modern ophthalmology great attention is given to non-drug treatment methods. For this purpose, laser, electrotherapy and reflexology are used. The use of electric current is associated with the stimulation of the activity of certain systems of the human body. Wide Application Magnetic therapy was found in ophthalmology. Walkthrough magnetic field through tissues it enhances the movement of ions in them, the formation of intracellular heat, and activates redox and enzymatic processes. To eliminate the disease, you should undergo several sessions.
Complex therapy for optic nerve atrophy involves the use of phonophoresis, electrophoresis and ultrasound. Although according to the literature, the effectiveness of such treatment is only 45-65%. In addition to the above methods of therapy, doctors also use galvanization, hyperbaric oxygenation and medicinal electrophoresis (iontophoresis, ionotherapy, ionogalvanization, dielectrolysis, ionoelectrotherapy). Even if a positive result is obtained, the course of treatment must be repeated after several months.
Therapy methods are constantly being improved. Recently, stem cells and tissue regenerative microsurgery have been used to combat nerve fiber atrophy. The degree of improvement in visual acuity varies and ranges from 20% to 100%, depending on various factors(degree of damage to the optic nerve, nature of the process, etc.).
Surgical methods for hemodynamic correction
If you have been diagnosed with optic nerve atrophy, surgery in combination with drug therapy is the most effective remedy treatment of the disease. There are several known methods for surgically improving blood circulation in the caudal part of the eyeball. All methods of surgical intervention are divided into several groups:
- extrascleral;
- vasoconstructive;
- decompression
Extrascleral operations
This type surgical intervention aimed at creating aseptic inflammation in Tenon's space. There are a huge number of ways in which scleroplastic materials are injected into Tenon’s space. For achievement desired result they use sclera, collagen sponge, cartilage, breath tissue, dura mater, autofascia, etc. Most of these operations improve metabolism and stabilize hemodynamics in the posterior part of the eye. To strengthen the sclera and improve blood circulation in the eye, autologous blood, blood proteinases, hydrocortisone, talc, and a 10% solution of trichloroacetic acid are injected into Tenon's space.
Vasoconstructive operations
These methods are aimed at redistributing blood flow in the eye area. This effect was achieved through ligation of the external carotid artery (arteria carotis externa). To apply this technique, carotid angiography must be performed.
Decompression operations
This method is used to reduce venous stasis in the vessels of the optic nerve. The technique of dissecting the scleral canal and the bony canal of the optic nerve is very difficult to perform and is currently just beginning to develop, so it is rarely used.
Traditional methods of treatment
In case of partial atrophy, it is advisable to use plants that exhibit an anti-sclerotic effect: hawthorn, orange, rose hip, seaweed, blueberry, corn, chokeberry, strawberry, soybean, garlic, buckwheat, coltsfoot, onion. Carrots are rich in beta-carotene, water-soluble vitamins (ascorbic, pantothenic, folic acid, thiamine, pyridoxine), contains a significant amount of macro- (potassium, sodium, calcium, phosphorus, chlorine, sulfur) and microelements (copper, chromium, zinc, iron, iodine, molybdenum, boron). It improves vision and increases the body's immune resistance. For better absorption of vitamin A, carrots should be taken in grated form along with fats (for example, with sour cream or cream).
Let us remember that partial atrophy of the optic nerve, which is treated using traditional medicine, has its drawbacks. With such a serious pathology, doctors strongly discourage self-medication. If you still decide to use traditional recipes, then you should consult with specialists: an ophthalmologist, therapist, herbalist or neurosurgeon.
Prevention
Optic atrophy is a serious disease. To prevent it, you need to follow some rules:
- undergo regular examinations with an oncologist and ophthalmologist;
- promptly treat infectious diseases;
- do not abuse alcohol;
- monitor blood pressure;
- prevent eye and traumatic brain injuries;
- repeated blood transfusion for profuse bleeding.
A rapid decrease in vision may indicate various eye diseases. But rarely does anyone think that it can be caused by such a dangerous disease as optic nerve atrophy. The optic nerve is an important component in the perception of light information. Therefore, it is worth taking a closer look at this disease so that it is possible to identify the symptoms in the early stages.
What it is?
The optic nerve is a nerve fiber responsible for processing and transmitting light information. The main function of the optic nerve is to deliver nerve impulses to the brain area.
The optic nerve is attached to retinal ganglion neurocytes, which make up the optic disc. Light rays, converted into a nerve impulse, are transmitted along the optic nerve from the retinal cells to the chiasma (the segment where the optic nerves of both eyes intersect).
Where is optic nerve
Its integrity ensures high. However, even the smallest injuries to the optic nerve can lead to severe consequences. The most common disease of the optic nerve is its atrophy.
Optic atrophy is an eye disease in which the optic nerve deteriorates, resulting in decreased vision. With this disease, the fibers of the optic nerve completely or partially die and are replaced connective tissue. As a result, light rays falling on the retina of the eye are converted into an electrical signal with distortions, which narrows the field of view and reduces its quality.
Depending on the degree of damage, optic nerve atrophy can be partial or complete. Partial atrophy of the optic nerve differs from complete atrophy by a less pronounced manifestation of the disease and preservation of vision at a certain level.
Vision correction using traditional methods (contact lenses) for this disease is absolutely ineffective, since they are aimed at correcting the refraction of the eye and have nothing to do with the optic nerve.
Causes
Optic nerve atrophy is not an independent disease, but is a consequence of some pathological process in the patient’s body.
Optic atrophy
The main causes of the disease include:
- Eye diseases (diseases of the retina, eyeball, eye structures).
- Pathologies of the central nervous system(brain damage due to syphilis, brain abscess, skull injury, brain tumors, multiple sclerosis, encephalitis, meningitis, arachnoiditis).
- Diseases of cardio-vascular system(cerebral atherosclerosis, arterial hypertension, vasospasm).
- Long-term toxic effects of alcohol, nicotine and narcotic drugs. Alcohol poisoning with methyl alcohol.
- Hereditary factor.
Optic nerve atrophy can be congenital or acquired.
Congenital optic atrophy occurs as a result of genetic diseases(in most cases of Leber's disease). In this case, the patient has low quality of vision from birth.
Acquired optic atrophy appears as a result of certain diseases in older age.
Symptoms
The main symptoms of partial visual atrophy may be:
- Deterioration in the quality of vision and the inability to correct it with traditional correction methods.
- Pain when moving the eyeballs.
- Change in color perception.
- Narrowing of visual fields (up to the manifestation of tunnel syndrome, in which the ability to peripherally view is completely lost).
- The appearance of blind spots in the field of vision (scotomas).
Methods laser correction view can be seen in .
Stages of optic nerve atrophy
Diagnostics
Typically, diagnosing this disease does not cause any particular difficulties. As a rule, the patient notices a significant decrease in vision and consults an ophthalmologist, who makes the correct diagnosis. Great importance has the identification of the cause of the disease.
To identify optic nerve atrophy in a patient, a complex diagnostic methods:
- (visual acuity test).
- Spheroperimetry (determination of visual fields).
- Ophthalmoscopy (detection of pallor of the optic nerve head and narrowing of the fundus vessels).
- Tonometry (measurement of intraocular pressure).
- Video-ophthalmography (study of the optic nerve relief).
- (examination of areas of the affected nerve).
- Computed tomography and nuclear magnetic resonance(brain examination to identify possible reasons, causing optic nerve atrophy).
Read what computer perimetry determines in ophthalmology.
In addition to an ophthalmological examination, the patient may be prescribed an examination by a neurologist or neurosurgeon. This is necessary because the symptoms of optic nerve atrophy may be symptoms of an incipient intracranial pathological process.
Treatment
Treatment of optic nerve atrophy is quite complex. Destroyed nerve fibers cannot be restored, so first of all it is necessary to stop the process of changes in the tissues of the optic nerve. Since the nerve tissue of the optic nerve cannot be restored, visual acuity cannot be raised to the previous level. However, the disease must be treated to avoid its progression and blindness. The prognosis of the disease depends on the timing of the start of treatment, so it is advisable to immediately consult an ophthalmologist when the first symptoms of the disease are detected.
The difference between partial optic nerve atrophy and complete one is that this form of the disease is treatable and it is still possible to restore vision. The main goal in the treatment of partial optic nerve atrophy is to stop the destruction of optic nerve tissue.
The main efforts should be aimed at eliminating. Treatment of the underlying disease will stop the destruction of optic nerve tissue and restore visual function.
During the treatment of the underlying disease that caused optic nerve atrophy, complex therapy is carried out. Additionally, during treatment, medications can be used to improve blood supply and nutrition to the optic nerve, improve metabolism, eliminate swelling and inflammation. It would be a good idea to take multivitamins and biostimulants.
The main drugs used are:
- Vasodilators. These drugs improve blood circulation and trophism in the tissues of the optic nerve. Among the drugs in this group one can highlight complamin, papaverine, dibazol, no-shpu, halidor, aminophylline, trental, sermion.
- Drugs that stimulate the restoration of altered tissues of the optic nerve and improve metabolic processes in him. These include biogenic stimulants (peat, aloe extract), amino acids ( glutamic acid), vitamins and immunostimulants (eleuthorococcus, ginseng).
- Drugs that dissolve pathological processes and metabolic stimulants (phosphadene, pyrogenal, preductal).
It is necessary to understand that drug therapy does not treat optic nerve atrophy, but only helps to improve the condition of the nerve fibers. To cure optic nerve atrophy, it is necessary to first cure the underlying disease.
Physiotherapeutic procedures, which are used in combination with other treatment methods, are also important. Also, methods of magnetic, laser and electrical stimulation of the optic nerve are effective. They help improve the functional state of the optic nerve and visual functions.
The following procedures are used as additional treatment:
- Magnetic stimulation. During this procedure, the optic nerve is exposed to a special device that creates an alternating magnetic field. Magnetic stimulation helps improve blood supply, saturate the tissues of the optic nerve with oxygen, and activate metabolic processes.
- Electrical stimulation. This procedure is carried out using a special electrode, which is inserted behind the eyeball to the optic nerve and apply electrical impulses to it.
- Laser stimulation. The essence of this method is non-invasive stimulation of the optic nerve through the cornea or pupil using a special emitter.
- Ultrasound therapy. This method effectively stimulates blood circulation and metabolic processes in the tissues of the optic nerve, improves the permeability of the blood-ophthalmic barrier and the sorption properties of eye tissues. If the cause of optic nerve atrophy is encephalitis or tuberculous meningitis, then the disease will be quite difficult to treat with ultrasound.
- Electrophoresis. This procedure characterized by the effect of low-power direct current and drugs on the eye tissue. Electrophoresis helps to dilate blood vessels, improve cell metabolism and normalize metabolism.
- Oxygen therapy. This method consists of saturating the tissues of the optic nerve with oxygen, which helps improve metabolic processes in them.
During treatment of optic nerve atrophy, it is imperative to maintain a high-quality diet rich in various vitamins and minerals. Need to use more often fresh vegetables and fruits, cereals, meat, dairy products.
See what foods improve vision.
It is not recommended to treat the disease with folk remedies, since in this case they are ineffective. If you only hope for folk remedies, you can lose precious time when the quality of vision could still be preserved.
Complications
It must be remembered that optic nerve atrophy is serious illness and you should not treat it yourself. Incorrect self-treatment can lead to dire consequences - complications of the disease.
The most serious complication may be complete loss of vision. Ignoring treatment leads to further development of the disease and a steady decrease in visual acuity, as a result of which the patient will no longer be able to lead his previous lifestyle. Very often, with optic nerve atrophy, the patient becomes disabled.
Also read about heterochromia.
Prevention
To avoid the occurrence of optic nerve atrophy, it is necessary to treat diseases in a timely manner, consult an ophthalmologist in a timely manner if visual acuity decreases, and not expose the body to alcohol and drug intoxication. Only if you pay due attention to your health can you reduce the risk of disease.
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