Examination of the optic nerve. Optic nerve atrophy: treatment, symptoms, causes of complete or partial damage

Atrophy of any organ is characterized by a decrease in its size and loss of functions due to lack of nutrition. Atrophic processes are irreversible and speak of a severe form of any disease. Atrophy optic nerve- complex pathological condition, which is almost untreatable and often ends in loss of vision.

In this article

Functions of the optic nerve

The optic nerve is white matter large brain, as if taken out to the periphery and connected with 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 the person sees. In other words, the optic nerve plays the role of a message provider to the brain and is the most important component of the entire process of converting the light information received by the eyes.

Optic nerve atrophy: a general description

With atrophy of the optic nerve, its fibers are completely or partially destroyed. They are subsequently replaced 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 its background, various disorders develop, including a decrease in 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 diseases end with the fact that the patient completely loses sight 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 a lot of reasons that can lead to this pathology. Among the ophthalmic diseases that can provoke atrophic changes in the optic nerve, the following ailments:

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

Also, atrophy can be associated with tumors and diseases of the orbit: optic nerve glioma, neurinoma, 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. These diseases include:

• multiple sclerosis;
• pituitary tumors;
• meningitis;
• brain abscess;
• encephalitis;
• traumatic brain injury;
• damage to the skeleton of the face with a wound in the optic nerve.

Types and forms of optic nerve atrophy

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

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

According to the scale of damage to the optic nerve fibers, atrophy is divided into partial and complete. Partial (initial) form manifests itself in a severe deterioration of vision, which cannot be corrected contact lenses and glasses. At this stage, you can save the remaining visual functions, but color perception will be severely impaired. Complete atrophy is a lesion of the entire optic nerve, in which a person no longer sees anything with a sore eye. Atrophy of the optic nerve 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 nerve atrophy

The first and main symptom that manifests itself in any form of optic nerve atrophy is visual impairment. 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 may 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 in a few days. In addition to a general decrease in visual acuity, its fields narrow.


The patient almost completely loses peripheral 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 occur in the field of vision. By the location of the scotoma, it is possible to determine the fibers of which area 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 eye are affected. central department retina or directly in it. Disorder of color perception becomes another problem that a person faces with atrophy. Most often, the perception of green and red shades is disturbed, rarely the blue-yellow spectrum.

All these symptoms are signs of the primary form, that is, its initial stage. They can be noticed by the patient himself. Symptoms of secondary atrophy are visible only during examination.

Symptoms of secondary optic nerve atrophy

As soon as a person goes to the doctor with symptoms such as reduced visual acuity and narrowing of its fields, the doctor conducts an examination. One of the main methods is ophthalmoscopy - examination of the fundus with the help of special instruments and devices. Ophthalmoscopy reveals the following signs optic nerve atrophy:

• vasoconstriction;
• varicose veins;
• disc blanching;
• decreased pupillary response 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 study do not allow for an accurate diagnosis. Deterioration of vision, lack of pupillary response to light, vasoconstriction of the eye are signs of many eye ailments, for example, a peripheral form of cataract. In this regard, many different methods are used to diagnose atrophy:

Also held laboratory research. The patient donates blood and urine for analysis. Tests for syphilis, borreliosis and other non-ophthalmic diseases are prescribed.

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 deal with this pathology:

• conservative;
• therapeutic;
• surgical.

At conservative treatment the patient is assigned vasoconstrictor drugs and drugs whose action is aimed at normalizing the blood supply to the optic nerve. The doctor also prescribes anticoagulants, which inhibit the activity of blood clotting.


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

Physiotherapeutic effect involves the appointment of:

The surgical method of treatment is focused on the removal of formations that put pressure on the optic nerve. During the operation, the surgeon can implant the patient with biogenic materials that will help improve blood circulation in the eye and in the atrophied nerve, in particular. The transferred pathology in most cases leads to the fact that a person is assigned a disability. Blind or visually impaired patients are sent to rehabilitation.

Prevention

To prevent atrophy of the optic nerve, it is necessary to start treating ophthalmic diseases in a timely manner.


At the first sign of a decrease in visual acuity, you should immediately make an appointment with an ophthalmologist. With the onset of atrophy, 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, a person may become disabled.

Atrophy of the optic nerve develops due to the complete or partial death of the fibers of this nerve. Necrotic processes in the tissues occur as a result of the transferred pathologies of an infectious and non-infectious nature.

Optic nerve atrophy: causes

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

Optic nerve atrophy is associated inflammatory reactions, circulatory dysfunction, which ultimately leads to the destruction of neurocytes, replacing them 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 therapy, optic nerve atrophy progresses and can provoke the development of complete blindness. Basic clinical sign presented pathology - a sharp decline visual acuity, not amenable to any correction.

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 clinic of the disease can manifest itself with varying degrees of severity. Partial atrophy of the optic nerve is manifested by the following symptoms:

• color perception changes;
• decreased visual acuity;
• the emergence of "tunnel vision";
• disorientation in space;
• decreased peripheral and central vision;
• the appearance of cattle (blind spots);
• problems in the process of reading or other visual work.

Objective symptoms of the above pathology are determined only in the process of 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. According to the state of the pupils and their reaction to light, this pathology can be diagnosed on early stages its development. Dilated pupils, as well as their lack of reaction to bright light, are key indirect symptoms of unilateral or bilateral optic nerve atrophy. During the wakefulness of the child, chaotic floating eye movements are observed. Usually, congenital diseases in children are found during routine examinations at the age of up to a year. It should be noted that atrophy of the optic nerve in children under 2 years of age quite often goes unnoticed.

Diagnosis of the disease

If you have any vision problems, you should contact an ophthalmologist. It is important to find out what exactly caused the development of the disease. In order to establish the diagnosis of "atrophy of the optic nerve of the eye", you need to do the following:

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

Conservative treatment

Once the diagnosis of optic nerve atrophy is made, treatment should be immediate. Unfortunately, it is impossible to completely cure this disease, but in some it is possible to slow down and even stop the course of the pathological process. Physicians use to treat patients different groups drugs that improve blood circulation. Most often, vasodilators are used ("Papaverine", "Amilnitrite", "Compalamine", "No-shpa", "Stugeron", "Galidor", "Eufilin", "Sermion", "Trental", "Dibazol"), anticoagulants (" Heparin, Calcium Nadroparin, Ticlid), vitamins (thiamine, riboflavin, pyridoxine, cyanocobalamin, ascorutin), enzymes (lidase, fibrinolysin), amino acids (glutamic acid), hormones (Prednisolone, Dexametazole) and immunomodulators ("Eleutherococcus", "Ginseng").

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

Biogenic preparations (Peat, Aloe, Peloid distillate, FiBS), angioprotectors (Emoxipin, Mildronate, Doxium), and water-soluble vitamins are now actively used. Good results are obtained by combining the drug "Emokchipin" with vitamin E (tocopherol). As immunocorrective agents, the drugs "Decaris", "Sodium Nucleinate", "Timalin" are prescribed.

Traditional drug regimens for the treatment of the disease are ineffective, therefore recent times complex therapy in combination with surgical and physiotherapeutic methods is being actively introduced. Practitioners recommend that patients with a diagnosis of "optic nerve atrophy" be treated in combination with blockade of the pterygopalatine ganglion. Despite the widespread use of drug therapy, there are some disadvantages that are revealed when administered. medicines into the body. A number of complications can also occur when using para- and retrobulbar injections.

Physiotherapy treatments

In modern ophthalmology, much attention is paid to drug-free methods of treatment. For this, laser, electro- and reflexotherapy are used. The use of electric current is associated with the excitation of the activity of certain systems of the human body. Magnetic therapy has found wide application in ophthalmology. Walkthrough magnetic field through tissues enhances the movement of ions in them, the formation of intracellular heat, activates redox and enzymatic processes. To eliminate the disease, several sessions should be completed.

Complex therapy of 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 drug electrophoresis (iontophoresis, ionotherapy, ionogalvanization, dielectrolysis, ionoelectrotherapy). Even if a positive result is obtained after a few months, the course of treatment must be repeated.

Therapeutic methods are constantly being improved. Lately to fight atrophy nerve fibers began to use stem cells and tissue regenerative microsurgery. The degree of improvement in visual acuity is different and varies in the range from 20% to 100%, which depends on various factors (the degree of damage to the optic nerve, the nature of the process, etc.).

Surgical methods for correcting hemodynamics

If you have been diagnosed with optic nerve atrophy, surgery in combination with drug therapy- most effective remedy treatment of the disease. There are several ways to surgically improve blood circulation in the caudal 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 the Tenon space. There are a huge number of ways in which scleroplastic materials are injected into the Tenon's space. To achieve the desired result, use the sclera, collagen sponge, cartilage, tissue, solid meninges, autofascia, etc. Most of these operations improve metabolism, 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 the Tenon space.

Vasoconstructive operations

These methods are aimed at the redistribution of blood flow in the eye area. This effect was achieved due to the ligation of the external carotid artery (arteria carotis externa). To apply this technique, you need to perform carotid angiography.

Decompression operations

This method is used to reduce venous stasis in the vessels of the optic nerve. The technique of dissection of the scleral canal and the bone canal of the optic nerve is very difficult to perform and is currently only beginning to develop, therefore it is rarely used.

Folk methods of treatment

With partial atrophy, it is advisable to use plants that exhibit an anti-sclerotic effect: hawthorn, orange, wild rose, seaweed, blueberries, corn, chokeberry, strawberries, soybeans, garlic, buckwheat, coltsfoot, onions. 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, increases the body's immune resistance. For better absorption of vitamin A, carrots should be taken grated along with fats (for example, with sour cream or cream).

Recall that partial atrophy of the optic nerve, which is treated with the use of traditional medicine, has its drawbacks. With such a serious pathology, doctors highly do not recommend self-medication. If you still decide to use folk recipes, then you should consult with specialists: an ophthalmologist, therapist, herbalist or neurosurgeon.

Prevention

Atrophy of the optic nerve - serious illness. To prevent it, you need to follow some rules:

• regularly undergo an examination by an oncologist and an ophthalmologist;
• timely treat infectious diseases;
• do not abuse alcohol;
• monitor blood pressure;
• prevent eye and craniocerebral injuries;
• repeated blood transfusion for profuse bleeding.

Second pair cranial nerves- the most important element of the visual system, because through it the relationship between the retina and the brain is carried out. Although the rest of the structures continue to work correctly, any deformation of the nervous tissue affects the properties of vision. Optic nerve atrophy cannot be cured without a trace, nerve fibers cannot be restored to their original state, so it is better to carry out prevention in time.

Basic information on the disease

Optic nerve atrophy or optic neuropathy is a severe process of destruction of axons (nerve tissue fibers). Extensive atrophy thins the nerve column, healthy tissues are replaced by glial tissues, small vessels (capillaries) are blocked. Each of the processes causes certain symptoms: visual acuity decreases, various defects appear in the field of vision, the shade of the optic nerve head (OND) changes. All pathologies of the optic nerves account for 2% of the statistics eye diseases. The main danger of optic neuropathy is absolute blindness, which is present in 20-25% of people with this diagnosis.

Optic neuropathy does not develop by itself, it is always the consequences of other diseases, so a person with atrophy is examined by different specialists. Usually, optic nerve atrophy is a complication of a missed ophthalmic disease (inflammation in the structures of the eyeball, swelling, compression, damage to the vascular or nervous network).

Causes of optic neuropathy

Despite the many causes of optic nerve atrophy known to medicine, in 20% of cases they remain unexplained. Usually these are ophthalmic pathologies, diseases of the central nervous system, autoimmune failures, infections, injuries, intoxications. Congenital forms of AD are often diagnosed together with skull defects (acrocephaly, microcephaly, macrocephaly) and hereditary syndromes.

Causes of atrophy of the optic nerve from the side of the visual system:

• neuritis;
• obstruction of the artery;
• myopia;
• retinitis;
• oncological damage to the orbit;
• unstable eye pressure;
• local vasculitis.

Injury to nerve fibers can occur at the time of a craniocerebral injury or even the slightest injury to the facial skeleton. Sometimes optic neuropathy is associated with the growth of meningioma, glioma, neuroma, neurofibroma and similar formations in the thickness of the brain. Optical disturbances are possible in osteosarcoma and sarcoidosis.

Causes from the side of the central nervous system:

• neoplasms in the pituitary gland or cranial fossa;
• squeezing of chiasms;
• multiple sclerosis.

Atrophic processes in the second pair of cranial nerves often develop as a result of purulent-inflammatory conditions. The main danger is brain abscesses, inflammation of its membranes.

Systemic risk factors

• diabetes;
• atherosclerosis;
• anemia;
• avitaminosis;
• hypertension;
• antiphospholipid syndrome;
• Wegener's granulomatosis;
• systemic lupus erythematosus;
• giant cell arteritis;
• multisystem vasculitis (Behçet's disease);
• nonspecific aortoarteritis (Takayasu's disease).

See also: Danger and prognosis for the optic nerve.

Significant nerve damage is diagnosed after prolonged starvation, severe poisoning, and volumetric blood loss. Negative impact the structures of the eyeball are affected by alcohol and its surrogates, nicotine, chloroform and some groups of medicines.

Optic nerve atrophy in a child

In half of all cases of optic neuropathy in children, the cause is inflammatory infections CNS, brain tumors and hydrocephalus. Less commonly, the state of destruction is caused by skull deformity, cerebral anomalies, infections (mainly "children's"), and metabolic disorders. Special attention should be given to congenital forms of childhood atrophy. They indicate that the baby has brain diseases that arose even at the stage of intrauterine development.

Classification of optic neuropathy

All forms of optic nerve atrophy are hereditary (congenital) and acquired. Congenital are divided according to the type of inheritance, they often indicate the presence of genetic abnormalities and hereditary syndromes that require in-depth diagnosis.

Hereditary forms of AD

1. Autosomal dominant (juvenile). Predisposition to destruction of nerves is transmitted in a heterogeneous way. Usually the disease is detected in children under 15 years of age, it is recognized as the most common, but the weakest form of atrophy. It is always bilateral, although sometimes symptoms appear asymmetrically. Early signs are revealed by 2-3 years, and functional disorders only at 6-20 years. Possible combination with deafness, myopathy, ophthalmoplegia and distraction.
2. Autosomal recessive (infantile). This type of AD is diagnosed less often, but much earlier: immediately after birth or during the first three years of life. Infantile form has a bilateral character, it is often detected in Kenny-Coffey syndrome, Rosenberg-Chattorian, Jensen or Wolfram disease.
3. Mitochondrial (Leber's atrophy). Mitochondrial optic atrophy is the result of a mutation in mitochondrial DNA. This form is classified as a symptomatology of Leber's disease, it occurs suddenly, reminiscent of external neuritis in the acute phase. Most of the patients are men aged 13-28.

Forms of acquired atrophy

• primary (squeezing of neurons in the peripheral layers, the optic disc does not change, the boundaries have a clear appearance);
• secondary (swelling and enlargement of the optic disc, blurred boundaries, replacement of axons with neuroglia is quite pronounced);
• glaucomatous (destruction of the lattice plate of the sclera due to surges in local pressure).

Destruction is ascending, when the axons of specifically cranial nerves are affected, and descending, with the involvement of the nerve tissues of the retina. According to the symptoms, one-sided and bilateral ADD are distinguished, according to the degree of progression - stationary (temporarily stable) and in constant development.

Types of atrophy according to the color of the optic disc:

• initial (slight blanching);
• incomplete (noticeable blanching of one segment of the optic disc);
• full (change in shade over the entire area of ​​the optic disc, severe thinning nerve pillar, capillary constriction).

Symptoms of optic nerve atrophy

The degree and nature of optical disorders directly depends on which segment of the nerve is affected. Visual acuity can critically decrease very quickly. Complete destruction ends with absolute blindness, blanching of the optic disc with white or gray patches, narrowing of the capillaries in the fundus. With incomplete AZN, vision stabilizes at a certain time and no longer deteriorates, and optic disc blanching is not so pronounced.

If the fibers of the papillomacular bundle are affected, visual impairment will be significant, and the examination will show a pale temporal zone of the ONH. In this case, optical disorders cannot be corrected with glasses or even contact lenses. The defeat of the lateral zones of the nerve does not always affect vision, which complicates the diagnosis and worsens the prognosis.

ASD is characterized by a variety of visual field defects. The following symptoms allow suspecting optic neuropathy:, concentric constriction, effect, weak pupil reaction. In many patients, the perception of colors is distorted, although more often this symptom develops when axons die after neuritis. Often the changes affect the green-red part of the spectrum, but the blue-yellow parts of it can also be distorted.

Diagnosis of optic nerve atrophy

expressive clinical picture, physiological changes and functional disorders greatly simplify the diagnosis of AD. Difficulties may arise when actual vision does not match the degree of destruction. For an accurate diagnosis, an ophthalmologist must study the patient's history, establish or refute the fact of taking certain medications, contact with chemical compounds, injuries, bad habits. Differential diagnosis carried out on the subject of peripheral opacification of the lens and amblyopia.

Ophthalmoscopy

Standard ophthalmoscopy allows to establish the presence of ASD and accurately determine the degree of its spread. This procedure is available in many conventional clinics and is inexpensive. The results of the study may differ, however, some signs are detected in any form of neuropathy: a change in the shade and contour of the ONH, a decrease in the number of vessels, narrowing of the arteries, and various defects in the veins.

Ophthalmoscopic picture of optic neuropathy:

1. Primary: clear disc borders, normal or reduced size of the ONH, there is a saucer-shaped excavation.
2. Secondary: grayish tint, blurred disc borders, enlargement of the optic disc, no physiological excavation, peripapillary reflex to light sources.

Coherence tomography

To study the nerve disk in more detail allows optical coherence or laser scanning tomography. Additionally, the degree of mobility of the eyeballs is assessed, the reaction of the pupils and the corneal reflex are checked, they are carried out with tables, visual field defects are examined, color perception is checked, and eye pressure is measured. Visually, the oculist establishes the presence.

Plain radiography of the orbit reveals the pathology of the orbit. Fluorescein angiography shows dysfunction of the vasculature. Doppler ultrasound is used to study local blood circulation. If the atrophy is due to infection, laboratory tests such as enzyme immunoassay(ELISA) and polymerase chain reaction (PCR).

Electrophysiological tests play a key role in confirming the diagnosis. Atrophy of the optic nerve changes the threshold sensitivity and lability of the nervous tissue. The rapid progression of the disease increases the indicators of retino-cortical and cortical time.

The level of reduction depends on the localization of neuropathy:

• when the papillomacular bundle is destroyed, the sensitivity remains at a normal level;
• damage to the periphery causes a sharp increase in sensitivity;
• atrophy of the axial bundle does not change sensitivity, but sharply reduces lability.

If necessary, check the neurological status (X-ray of the skull, CT or MRI of the brain). When a patient is diagnosed with a neoplasm in the brain or an unstable intracranial pressure appoint a consultation with an experienced neurosurgeon. With tumors of the orbit, it is necessary to include in the course of an ophthalmo-oncologist. If the destruction is associated with systemic vasculitis, you need to contact a rheumatologist. Pathologies of the arteries are dealt with by an ophthalmologist or vascular surgeon.

How is optic nerve atrophy treated?

The treatment regimen for each patient with optic neuropathy is always individual. The doctor needs to get all the information about the disease in order to make an effective plan. People with atrophy require urgent hospitalization, others are able to maintain ambulatory treatment. The need for surgery depends on the cause of AD and symptoms. Any therapy will be ineffective when vision is weakened to 0.01 units and below.

It is necessary to begin treatment of optic nerve atrophy by identifying and eliminating (or stopping) the root cause. If cranial nerve injury is due to intracranial tumor growth, aneurysm, or unstable cranial pressure, neurosurgery should be performed. Endocrine factors affect hormonal background. Post-traumatic compression is corrected surgically by removing foreign bodies, removing chemicals or limiting hematomas.

Conservative therapy for optic neuropathy is primarily aimed at inhibiting atrophic changes, as well as maintaining and restoring vision. Drugs are shown to expand the vasculature and small vessels, reducing capillary spasm and accelerating blood flow through the arteries. This allows all layers of the optic nerve to be supplied with sufficient nutrients and oxygen.

Vascular Therapy for AD

• intravenously 1 ml nicotinic acid 1%, glucose for 10-15 days (or orally, 0.05 g three times a day after meals);
• Nikoshpan tablet three times a day;
• intramuscularly 1-2 ml No-shpy 2% (or 0.04 g orally);
• intramuscularly 1-2 ml Dibazol 0.5-1% daily (or inside 0.02 g);
• 0.25 g of Nigexin three times a day;
• subcutaneously, 0.2-0.5-1 ml of sodium nitrate in an ascending concentration of 2-10% in a course of 30 injections (increase every three injections).

Decongestants are needed to reduce swelling, which helps reduce nerve and vascular compression. Anticoagulants are used to prevent thrombosis, the vasodilator and anti-inflammatory Heparin is recognized as the best. It is also possible to prescribe antiplatelet agents (prevention of thrombosis), neuroprotectors (protection of nerve cells), glucocorticosteroids (fight against inflammatory processes).

Conservative treatment of AD

1. To reduce inflammation in the nervous tissue and relieve swelling, a solution of dexamethasone is prescribed in the eye, intravenous glucose and calcium chloride, intramuscular diuretics (Furosemide).
2. A solution of strychnine nitrate 0.1% in a course of 20-25 subcutaneous injections.
3. Parabulbar or retrobulbar injections of Pentoxifylline, Atropine, xanthinol nicotinate. These funds help to speed up blood flow and improve the trophism of the nervous tissue.
4. Biogenic stimulants (FiBS, aloe preparations) in a course of 30 injections.
5. Nicotinic acid, sodium iodide 10% or Eufillin intravenously.
6. Vitamins orally or intramuscularly (B1, B2, B6, B12).
7. Antioxidants (glutamic acid).
8. Orally Cinnarizine, Riboxin, Piracetam, ATP.
9. Pilocarpine instillations to reduce eye pressure.
10. Nootropic drugs (Lipocerebrin).
11. Means with an antikinin effect (Prodectin, Parmidin) for symptoms of atherosclerosis.

In addition to medicines prescribed physiotherapy. Oxygen therapy (administration of oxygen) and blood transfusion (urgent blood transfusion) are effective in AD. In the recovery process, laser and magnetic procedures are prescribed, electrical stimulation and electrophoresis are effective (administration of drugs using electric current). If there are no contraindications, acupuncture is possible (use of needles on active points of the body).

Surgical treatment of optic neuropathy

One of the methods surgical treatment optic nerve is a correction of hemodynamics. The procedure can be performed under local anesthesia: a collagen sponge is placed in the subtenon space, which stimulates aseptic inflammation and dilates blood vessels. Thus, it is possible to provoke the proliferation of connective tissue and a new vascular network. The sponge dissolves on its own after two months, but the effect persists for a long time. The operation can be carried out repeatedly, but with an interval of several months.

New branches in the vascular network help to improve the blood supply to nerve tissues, which stops atrophic changes. Correction of blood flow allows you to restore vision by 60% and eliminate up to 75% of visual field defects with timely treatment to the clinic. If the patient has severe comorbidities or atrophy has developed before late stage, even hemodynamic correction will be ineffective.

With partial atrophy of the optic nerve, the use of a collagen implant is practiced. It is impregnated with antioxidants or drugs to expand the capillaries, after which it is injected into the eyeball without sutures. This method is effective only with stable eye pressure. The operation is contraindicated in patients over 75 years of age, with diabetes mellitus, severe somatic disorders and inflammation, as well as vision less than 0.02 diopters.

Prognosis for optic nerve atrophy

To prevent AD, it is necessary to regularly check the condition of those organs that regulate the functioning of the visual system (CNS, endocrine glands, joints, connective tissue). In a severe case of infection or intoxication, as well as in case of severe bleeding, urgent symptomatic therapy should be carried out.

It is impossible to completely restore your vision after neuropathy even in the best clinic. A successful case is recognized when the patient's condition has stabilized, the ADS does not progress for a long time, and vision is partially restored. In many people, visual acuity remains permanently reduced, and there are also defects in lateral vision.

Some forms of atrophy are constantly progressing even during adequate treatment. The task of the ophthalmologist is to slow down atrophic and other negative processes. Having stabilized the symptoms, it is necessary to constantly carry out the prevention of ischemia and neurodegeneration. For this, long-term maintenance therapy is prescribed, which helps to improve the lipid profile of the blood and prevent the formation of blood clots.

The course of treatment for optic nerve atrophy should be repeated regularly. It is very important to eliminate all factors that can affect the axons of the optic nerve. A patient with optic neuropathy should visit specialists regularly as indicated. It is necessary to constantly carry out the prevention of complications and establish a lifestyle. Refusal of therapy for optic neuropathy inevitably leads to disability due to the total death of the nerves and irreversible blindness.

Any changes in the layers of the optic nerve adversely affect a person's ability to see. Therefore, it is necessary to undergo examinations in time for people with a predisposition and treat all diseases that contribute to optic nerve atrophy. Therapy will not help restore vision to 100% when the optic neuropathy has already developed sufficiently.

More recently, optic nerve atrophy was considered an incurable disease and inevitably led to blindness. Now the situation has changed. The process of destruction of nerve cells can be stopped and thereby preserve the perception of the visual image.

Atrophy, which is the death of nerve fibers, leads to loss of vision. This happens because the cells lose their ability to conduct nerve impulses responsible for transmitting the image. Timely access to a doctor will help stop the development of the disease and avoid blindness.

Classification of optic nerve atrophy

The death of nerve fibers in the visual organs has the following classification:

• primary atrophy. It occurs due to disruptions in the nutrition of nerve fibers and circulatory disorders. The disease has an independent nature.
• secondary atrophy. A mandatory factor in the existence of a disease is the presence of other diseases. In particular, these are deviations associated with the optic nerve head.
• congenital atrophy. The tendency of the organism to the appearance of the disease is observed from birth.
• glaucomatous atrophy. Vision remains at a stable level for a long time. Cause of illness vascular insufficiency cribriform plate as a result of increased intraocular pressure.
• partial atrophy. Part of the optic nerve is affected, which ends the spread of the disease. Vision is deteriorating.
• complete atrophy. The optic nerve is completely affected. If the development of the disease is not stopped, blindness may occur.
• complete atrophy. The deviation has already formed. The spread of the disease stopped at a certain stage.
• progressive atrophy. The rapid development of the atrophic process, which can lead to complete blindness.
• descending atrophy. Irreversible changes in the optic nerves develop slowly.

An explanation of how partial atrophy differs from complete we see here:

It is important to correctly diagnose the disease in time to avoid consequences leading to blindness. In the early stages, atrophy is treated and vision can be stabilized.

Optic nerve atrophy ICD-10 code

H47.2 Optic nerve atrophy
Paleness of the temporal half of the optic disc

Causes of atrophy

Despite the fact that there are a lot of causes of optic nerve atrophy, in 20% of cases the exact factor that results in the development of the disease cannot be established. The most influential causes of atrophy include:

• Pigmentary retinal dystrophy.
• Inflammation of nerve tissues.
• Defects of blood vessels located in the retina.
• Increased intraocular pressure.
• Spasmodic manifestations related to the vessels.
• Purulent inflammation of the brain tissue.
• Inflammation of the spinal cord.
• Multiple sclerosis.
• Diseases of an infectious type (from simple SARS to more serious diseases).
• Malignant or benign tumors.
• Various injuries.

Primary descending atrophy can be caused by hypertension, atherosclerosis, or deviations in the development of the spine. The causes of the secondary type of the disease are poisoning, inflammation and injury.

Why does atrophy occur in children

Children are not protected from the appearance of this disease. Optic nerve atrophy occurs in them for such reasons:

• Genetic deviation.
• Intrauterine and other types of poisoning.
• Wrong course of pregnancy.
• Hydrocephalus of the brain.
• Deviations in the development of the central nervous system.
• Diseases affecting the apple of the eye.
• Skull deformed from birth.
• Inflammatory processes in the brain.
• The formation of tumors.

As we can see, the main causes of damage to nerve cells visual organs in children, these are genetic abnormalities and the wrong way of life of the mother during pregnancy.

One case of infantile atrophy is presented in this commentary:

Symptoms of the disease

Consider the clinical picture for each type of atrophy. The primary form of this disease is characterized by the isolation of the boundaries of the nerves of the disc of the eye, which has acquired an in-depth look. The arteries inside the eye are constricted. With a secondary type of disease, the reverse process is noticeable. Nerve boundaries blur, and blood vessels dilate.

congenital atrophy is associated inflammatory process behind eyeball. In this case, it is impossible to focus vision without the occurrence of unpleasant sensations. The resulting image loses the sharpness of the lines and looks blurry.

A partial form of the disease reaches a certain stage of its development and stops developing. Its symptoms depend on the stage that the disease has reached. This form of atrophy can be indicated by partial loss of vision, flashes of light before the eyes, hallucinatory images, the spread of blind spots, and other abnormalities.

Common signs for all types of optic nerve atrophy are such manifestations:

• Limitation of the functionality of the eyes.
• external change visual disc.
• If the capillaries in the macula are damaged, the disease affects central vision, which is reflected in the appearance of seals.
• The field of view narrows.
• The perception of color spectra changes. This problem is primarily related to green shades, and then with the red ones.
• If affected nervous tissues periphery, the eyes do not adapt well to changes in distance and illumination.

The main difference between partial and complete atrophy is the degree of reduction in severity. visual perceptions. In the first case, vision is preserved, but it deteriorates greatly. Complete atrophy implies the onset of blindness.

hereditary atrophy. Types and symptoms

Hereditary atrophy of the optic nerves has several forms of manifestation:

• Infantile. Decreased vision in full occurs from 0 to 3 years. The disease is recessive.
• Juvenile blindness. The optic disc turns pale. Vision is reduced to 0.1-0.2. The disease develops in the period from 2 to 7 years. She is dominant.
• Opto-oto-diabetic syndrome. Appears in the age range from 2 to 20 years. Accompanying illnesses- various types of diabetes, deafness, problems with urination, cataracts, pigmented retinal dystrophy.
• Ber's syndrome. Serious disease, which is characterized by a decrease in vision in the first year of life to 0.1-0.05. Associated abnormalities - strabismus, symptoms of neurological disorders and mental retardation, damage to the organs of the pelvic region.
• Atrophy depending on gender. In most cases, the disease develops in male children. From early childhood, it begins its manifestation and gradually worsens.
• Lester's disease. The age from 13 to 30 years is the period in which the disease occurs in 90% of cases.

Symptoms

Hereditary atrophy develops in stages, despite its acute onset. Over a period of several hours to days, vision rapidly decreases. At first, defects in the optic disc are not noticeable. Then its boundaries lose their clarity, small vessels change in structure. A month later, the disk is cloudier on the side closer to the temple. In most cases, reduced vision remains with the patient for life. Only in 16% of patients it is restored. Irritability, nervousness, headaches, increased fatigue are those signs that indicate the development of hereditary atrophy of the optic nerve.

Diagnosis of optic nerve atrophy

Such studies help to identify the presence of atrophy:

• Spheroperimetry - determination of the visual field.
• Determination of the degree of visual acuity.
• Examination of the fundus with a slit lamp.
• Measurement of intraocular pressure.
• Computer perimetry - helps to determine the damaged tissue area.
• Dopplerography using laser equipment - shows the characteristics of blood vessels.

If a defect in the optic disc is detected, a brain examination is prescribed. An infectious lesion is detected after receiving the results of a blood test. Examinations and collection of data on symptomatic manifestations help to make an accurate diagnosis.

Treatment of optic nerve atrophy

The goal of treatment is to maintain the ability to see at the level that was noted at the time of detection of the disease. Improve vision in atrophy ophthalmic nerves it is impossible, since the tissues that died as a result of damage are not restored. Most often, ophthalmologists choose such a treatment regimen:

1. Stimulant drugs.
2. Drugs that dilate blood vessels. Among them are Papaverine and Noshpa.
3. tissue therapy. For these purposes, the use of vitamin B and intravenous administration nicotinic acid.
4. Medicines against atherosclerosis.
5. Drugs that regulate blood clotting. This may be Heparin or subcutaneous injections of ATP.
6. ultrasonic impact.
7. Reflex therapy in the form of acupuncture.
8. The use of trypsin enzymes.
9. Intramuscular administration of Pyrogenal.
10. The procedure of vagosympathetic blockade according to Vishnevsky. It is an injection of a 0.5% solution of Novocaine into the area of ​​the carotid artery in order to dilate blood vessels and block sympathetic innervation.

If we talk about the use of physiotherapy techniques, then in addition to acupuncture, such methods of treatment are used:

1. Color and light stimulation.
2. Electrical and magnetic stimulation.
3. Massages to eliminate ischemic manifestations.
4. Meso- and ozone therapy.
5. Treatment with leeches (gerudotherapy).
6. Healing Fitness.
7. In some cases, blood transfusion is possible.

Here is a possible clinical picture with atrophy and a scheme for its treatment:

A complex of medical and physiotherapeutic measures helps to speed up the healing process. Treatment is aimed at improving metabolism and blood circulation. Spasms and thrombosis that disrupt these processes are eliminated.

Some cases of the disease provide for the possibility of surgical intervention. Placed in the retrobulbar space medical preparation, the patient's own tissues or donor materials, which contribute to the restoration of damaged areas and the growth of new blood vessels. It is also possible to install an electrical stimulator. It remains in the orbit of the eye for several years. In most cases of treatment of a timely noticed disease, vision can be preserved.

Disease prevention

Measures that will minimize the risk of atrophy are a standard list:

• Treat diseases of infectious origin in time.
• Eliminate the possibility of injury to the brain and visual organs.
• Visit the oncologist regularly to notice oncological diseases in time.
• Avoid excessive consumption of alcoholic beverages.
• Track Status blood pressure.

Periodic examination by an ophthalmologist will help to establish the presence of the disease in time and take measures to combat it. Timely treatment This is a chance to avoid complete loss of vision.

Optic nerve atrophy is a disease in which there is a decrease in vision, sometimes to its complete loss. This happens when the nerve fibers that carry information about what a person sees from the retina of the eye to the visual part of the brain die partially or completely. Such a pathology can occur due to many reasons, because a person can encounter it at any age.

Important! Timely detection and treatment of the disease, if the death of the nerve is partial, helps to stop the loss of visual function and restore it. If the nerve has atrophied completely, then vision will not be restored.

The optic nerve is an afferent nerve fiber that runs from the retina to the occipital visual region of the brain. Thanks to this nerve, information is read from the retina visible to man picture, and is transmitted to the visual department, and in it it is already transformed into a familiar image. When atrophy occurs, nerve fibers begin to die off and are replaced by connective tissue that looks like scar tissue. In this condition, the functioning of the capillaries that feed the nerve stops.

How is the disease classified?

According to the time of occurrence, there is congenital and acquired atrophy of the optic nerve. By localization, the pathology can be:

1. ascending - the layer of nerve fibers located on the retina of the eye is affected, and the lesion itself is sent to the brain;
2. descending - the visual part of the brain is affected, and the lesion is directed to the disk on the retina.

Depending on the degree of the lesion, atrophy can be:

• initial - only some fibers are affected;
• partial - the diameter of the nerve is affected;
• incomplete - the lesion is common, but vision is not completely lost;
• complete - the optic nerve dies, leading to a complete loss of visual function.

With a unilateral disease, one nerve is damaged, as a result of which it begins to see poorly in one eye. When the nerves of the two eyes are affected, they speak of bilateral atrophy. According to the stability of the visual function, the pathology can be stationary, in which visual acuity falls and then stays at the same level, and progressive, when vision becomes worse.

Why can the optic nerve atrophy

The causes of optic nerve atrophy are varied. The congenital form of the disease in children occurs due to genetic pathologies such as Leber's disease. In this case, partial atrophy of the optic nerve most often occurs. The acquired form of pathology occurs due to various diseases of a systemic and ophthalmic nature. Nerve death can occur due to:

• compression of the vessels feeding the nerve or the nerve itself by a neoplasm in the skull;
• myopia;
• atherosclerosis leading to plaques in the vessels;
• thrombosis of nerve vessels; v
• inflammation of the vascular walls during syphilis or vasculitis;
• vascular disorders due to diabetes or increased blood pressure;
• eye injury;
• intoxication of the body during respiratory viral infections, with the use of large doses of alcohol, drugs or due to excessive smoking.

The ascending form of the disease occurs with eye diseases such as glaucoma and myopia. Causes of descending optic nerve atrophy:

1. retrobulbar neuritis;
2. traumatic damage to the place where the optic nerves cross;
3. neoplasm in the pituitary gland of the brain.

Unilateral disease occurs due to diseases of the eyes or orbits, as well as from the initial stage of cranial diseases. Both eyes can immediately suffer from atrophy due to:

• intoxications;
• syphilis;
• neoplasms in the skull;
• poor blood circulation in the vessels of the nerve during atherosclerosis, diabetes, hypertension.

What is the clinical picture of the disease

Symptoms of optic nerve atrophy depend on the form of the disease. When this disease occurs, vision cannot be corrected with glasses. The most common symptom is decreased visual acuity. The second symptom is a change in the fields of visual function. On this basis, the doctor can understand how deeply the lesion has arisen.

The patient develops "tunnel vision", that is, a person sees as he would see if he put a tube to his eye. Peripheral (lateral) vision is lost and the patient sees only those objects that are directly in front of him. In most cases, such vision is accompanied by scotomas - dark spots in any part of the visual field. Later, a color perception disorder begins, the patient first ceases to distinguish green color, then red.

With damage to nerve fibers concentrated as close as possible to the retina or directly in it, dark spots appear in the center of the visible image. With a deeper lesion, half of the image from the side of the nose or temple may disappear, depending on which side the lesion occurred. With secondary atrophy that has arisen due to any ophthalmic disease, the following symptoms occur:

• the veins of the eyes dilate;
• the vessels constrict;
• the boundaries of the optic nerve area become smoothed;
• retinal disc becomes pale.

Important! If even a slight clouding appears in the eye (or both eyes), it is necessary to visit an ophthalmologist as soon as possible. Only by detecting the disease in time, it is possible to stop it at the stage of partial atrophy and restore vision, preventing complete atrophy.

What are the features of pathology in children

With a congenital form of the disease, it can be determined that the baby's pupils react poorly to light. When a child grows up, parents may notice that he does not react to an object brought to him from a certain side.

Important! A child under two or three years of age may not be able to report that he has poor vision, and older children, who have a problem that is innate, may not be aware that they can see in some other way. That is why it is necessary that the child be examined by an ophthalmologist annually, even if there are no symptoms visible to the parent.

Parents should take the child to the doctor if he rubs his eyes or unconsciously tilts his head to one side, trying to see something. The forced tilt of the head to some extent compensates for the function of the affected nerve and slightly sharpens vision. The main clinical picture of optic nerve atrophy in a child is the same as in an adult.

If diagnosed and treated in a timely manner, provided that the disease is not genetic, during which the nerve fibers are completely replaced fibrous tissue even during fetal development, the prognosis for the restoration of the optic nerve in babies is more favorable than in adult patients.

How the disease is diagnosed

Diagnosis of atrophy of the optic nerve is carried out by an ophthalmologist, and primarily includes an examination of the fundus and the determination of visual fields using computer peripetry. It also determines which colors the patient can distinguish. To instrumental methods diagnoses include:

• x-ray of the cranium;
• Magnetic resonance imaging;
• angiography of the vessels of the eye;
• video ophthalmological examination;
• Ultrasound of the vessels of the head.

Thanks to these studies, it is possible not only to identify the death of the optic nerve, but also to understand why it happened. It may also be necessary to consult related specialists.

How is optic nerve atrophy treated?

How to treat atrophy of the optic nerve should be decided by the doctor based on the studies. It should be noted right away that the treatment of this disease is very difficult, because nerve tissues regenerate very poorly. It is necessary to carry out complex systematic therapy, which should take into account the cause of the pathology, its prescription, the age of the patient, and his general condition. If some process inside the skull led to the death of the nerve (for example, a tumor or inflammation), then the treatment should be started by a neurosurgeon and a neuropathologist.

Medication treatment

With the help of drugs, you can increase blood circulation and nerve trophism, as well as stimulate the vital activity of healthy nerve fibers. Medical treatment includes admission:

• vasodilators - No-Shpy and Dibazol;
• vitamin B;
• biogenic stimulants, for example, aloe extract;
• drugs that improve microcirculation, such as Eufillin and Trental;
• steroidal anti-inflammatory drugs - Hydrocortisone and Dexamethasone;
• antibacterial drugs, if atrophy has an infectious-bacterial pathogenesis.

In addition, physiotherapy procedures to stimulate the optic nerve, such as laser stimulation, magnetic therapy, or electrophoresis, may be required.

Microsurgical treatment is aimed at eliminating the compression of the nerve, as well as at increasing the diameter of the vessels that feed it. Conditions can also be created in which new vessels can grow. Surgery can only help with partial atrophy, if the nerves die off completely, then even through surgery it is impossible to restore visual function.

Treatment with folk remedies

Treatment of optic nerve atrophy folk remedies It is permissible only at the initial stage of the disease, but it is not aimed at improving vision, but at eliminating the root cause of the disease.

Important! Self-medication without prior medical consultation can only aggravate the situation and lead to irreversible consequences.

If the disease is caused by high blood pressure, then plants with antihypertensive properties are used in therapy:

• astragalus woolly-flowered;
• small periwinkle;
• hawthorn (flowers and fruits);
• chokeberry;
• Baikal skullcap (root);
• Dahurian black cohosh;
• large-flowered magnolia (leaves);
• drier dryer.

Blueberries are useful for vision, they contain many vitamins, as well as anthocyanosides, which have a positive effect on the visual apparatus. For treatment, you need to mix one kilogram of fresh berries with one and a half kilograms of sugar and refrigerate. This mixture is taken in half a glass for a month. The course must be repeated twice a year, which will benefit even with good vision.

If dystrophic processes occur in the retina of the eye, especially those occurring against the background of low blood pressure, then tinctures will be useful, for the preparation of which are used:

1. leaves of Chinese magnolia vine;
2. lure roots;
3. leuzea;
4. ginseng;
5. eleutherococcus;
6. sea ​​buckthorn (fruits and pollen).

If incomplete necrosis of nerves occurs or senile degenerative changes in the eyes, it is necessary to take anti-sclerotic plants:

1. orange;
2. cherry;
3. hawthorn;
4. cabbage;
5. corn;
6. seaweed;
7. dandelion;
8. chokeberry;
9. garlic and onion.

Useful properties have carrots (contains a lot of carotene) and beets (rich in zinc)

What is the prognosis for optic nerve atrophy and its prevention

When diagnosing and starting therapy at an early stage of development, it is possible to maintain and even slightly increase visual acuity, as well as expand its fields. No treatment can fully restore visual function. If the disease progresses and there is no treatment, then this leads to disability due to complete blindness.

In order to prevent the necrosis of nerve fibers, it is necessary to undergo treatment in a timely manner. ophthalmic diseases, as well as diseases of the endocrine, neurological, infectious and rheumatological nature. Very important in prevention is the prevention of intoxication damage to the body.