Atrophy of the optic nerve and its treatment. Causes, symptoms and treatment of optic atrophy Partial optic atrophy of both

Date of: 21.10.2019

Atrophy of the optic nerve is clinically a combination of symptoms: visual impairment (decreased visual acuity and the development of visual field defects) and blanching of the optic nerve head. Atrophy of the optic nerve is characterized by a decrease in the diameter of the optic nerve due to a decrease in the number of axons.

Atrophy of the optic nerve is one of the leading places in the nosological structure, second only to glaucoma and degenerative myopia. Atrophy of the optic nerve is considered complete or partial destruction of its fibers with the replacement of their connective tissue.

Atrophy can be partial or complete according to the degree of visual function decline. According to research, it is clear that men in 57.5% and women in 42.5% suffer from partial atrophy of the optic nerve. Most often, bilateral lesion is observed (in 65% of cases).

The prognosis of optic atrophy is always serious, but not hopeless. Due to the fact that pathological changes are reversible, the treatment of partial atrophy of the optic nerve is one of the important directions in ophthalmology. With adequate and timely treatment, this fact allows us to achieve an increase in visual functions even with the long-term existence of the disease. Also, in recent years, the number of this pathology of vascular genesis has increased, which is associated with an increase in general vascular pathology - atherosclerosis, coronary heart disease.

Etiology and classification

Etiology
- hereditary: autosomal dominant, autosomal recessive, mitochondrial;
- non-hereditary.
According to the ophthalmoscopic picture - primary (simple); secondary; glaucomatous.
According to the degree of damage (preservation of functions): initial; partial; incomplete; complete.
According to the topical level of defeat: descending; ascending.
According to the degree of progression: stationary; progressive.
By process localization: one-way; bilateral.

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

Congenital, genetically determined atrophy of the optic nerve is divided into autosomal dominant, accompanied by an asymmetric decrease in visual acuity from 0.8 to 0.1, and autosomal recessive, characterized by a decrease in visual acuity, often to practical blindness already in early childhood.

The processes that damage the optic nerve fibers at various levels (orbit, optic canal, cranial cavity) lead to descending acquired atrophy. The nature of the damage is different: inflammation, trauma, glaucoma, toxic damage, circulatory disturbance in the vessels supplying the optic nerve, metabolic disturbance, compression of the optic fibers by volumetric formation in the orbit or in the cranial cavity, degenerative process, myopia, etc.).

Each etiological factor causes atrophy of the optic nerve with certain ophthalmoscopic features typical of it. Nevertheless, there are characteristics common to atrophy of the optic nerve of any nature: blanching of the optic disc and impaired visual function.

The etiological factors of atrophy of the optic nerve of vascular genesis are diverse: these are vascular pathology, and acute vascular neuropathies (anterior ischemic neuropathy, occlusion of the central artery and retinal vein and their branches), and the consequence of chronic vascular neuropathies (with general somatic pathology). Atrophy of the optic nerve occurs as a result of obstruction of the central and peripheral arteries of the retina that feed the optic nerve.

Ophthalmoscopically revealed narrowing of the vessels of the retina, blanching of part or all of the optic disc. Persistent blanching of only the temporal half occurs with damage to the papillomacular bundle. When atrophy is a consequence of a disease of the chiasm or optic tract, then there are hemianopic types of visual field defects.

Depending on the degree of damage to the optic fibers and, consequently, on the degree of decrease in visual functions and blanching of the optic nerve head, the initial, or partial, and complete atrophy of the optic nerve is distinguished.

Diagnostics

Complaints: a gradual decrease in visual acuity (varying degrees of severity), a change in the field of view (scotomas, concentric narrowing, loss of fields of vision), a violation of color perception.

Anamnesis: the presence of volumetric formations of the brain, intracranial hypertension, demyelinating lesions of the central nervous system, lesions of the carotid arteries, systemic diseases (including vasculitis), intoxications (including alcohol), optic neuritis or ischemic neuropathy, retinal vascular occlusion, medication, possessing a neurotoxic effect during the last year; head and neck injuries, cardiovascular diseases, hypertension, acute and chronic cerebrovascular accidents, atherosclerosis, meningitis or meningo-encephalitis, inflammatory and volumetric processes of the sinuses, profuse bleeding.

Physical examination :

external examination of the eyeball (limitation of the mobility of the eyeball, nystagmus, exophthalmos, ptosis of the upper eyelid)
examination of the corneal reflex - can be reduced on the side of the lesion

Laboratory research

blood chemistry: blood cholesterol, low density lipoproteins, high density lipoproteins, triglycerides; ·
coagulogram;
ELISA for herpes simplex virus, cytomegalovirus, toxoplasmosis, brucellosis, tuberculosis, rheumatic tests (according to indications, to exclude the inflammatory process)

Instrumental research

visometry: visual acuity can range from 0.7 to practical blindness. With the defeat of the papillomacular bundle, visual acuity is significantly reduced; with a slight lesion of the papillomacular bundle and the involvement of peripheral nerve fibers of ZN, visual acuity decreases slightly; when only peripheral nerve fibers are affected, it does not change. ·
refractometry: the presence of refractive errors will allow for a differential diagnosis with amblyopia.
amsler test - distortion of lines, fogging of the picture (damage to the papillomacular beam). ·
perimetry: central scotoma (with damage to the papillomacular bundle); various forms of narrowing of the visual field (with damage to the peripheral fibers of the optic nerve); in case of damage to chiasm - bitemporal hemianopsia, in case of damage to the optic tracts - homonymous hemianopsia. When the intracranial part of the optic nerve is damaged, hemianopsia occurs in one eye.
- Kinetic perimetry on colors - narrowing the field of view to green and red, less often to yellow and blue.
- Computer perimetry - determining the quality and quantity of cattle in the field of view, including 30 degrees from the fixation point.
dark adaptation study: impaired dark adaptation. · The study of color vision: (Rabkin table) - violation of color perception (increase in color thresholds), more often the green-red part of the spectrum, less often - yellow-blue.
tonometry: an increase in IOP is possible (with glaucomatous atrophy of the optic nerve).
biomicroscopy: on the affected side, an afferent pupillary defect: a decrease in the direct pupillary reaction to light while maintaining a friendly pupil reaction.
ophthalmoscopy:
- initial atrophy of malignancy - against the background of pink color of the optic disc, blanching appears, which later becomes more intense.
- partial atrophy of the heart disease - blanching of the temporal half of the heart disease, a symptom of Kestenbaum (a decrease in the number of capillaries in the heart wall from 7 or less), the arteries are narrowed,
- incomplete atrophy of ZN - uniform blanching of the optic nerve, Kestenbaum symptom is moderate (a decrease in the number of capillaries in the optic disc), the arteries are narrowed,
- complete atrophy of MV - total blanching of MV, vessels are narrowed (arteries are narrowed more than veins). A symptom of Kestenbaum is sharply expressed (a decrease in the number of capillaries in the optic disc is up to 2-3 or capillaries may be absent).

In primary atrophy of the malignant neoplasm, the boundaries of the optic disc are clear, its color is white, grayish-white, bluish or slightly greenish. In a redless light, the contours remain clear, while the circuits of the optic nonspecific angle normally become fuzzy. In red light with atrophy of the optic disc is blue. With secondary atrophy of the malignant neoplasm, the boundaries of the optic disc are fuzzy, blurred, the disc is gray or dirty gray, the vascular funnel is filled with connective or glial tissue (in the long term, the borders of the disc become clear).

optical coherence tomography of optic nerve disc (in four segments - temporal, superior, nasal and inferior): decrease in the area and volume of the neuroretinal ligament of the optic nerve disc, decrease in the thickness of the layer of nerve fibers of the optic disc and in the macula.
heidelberg retinal laser tomography - reducing the depth of the optic nerve head, the area and volume of the neuroretinal girdle, increasing the area of \u200b\u200bexcavation. With partial atrophy of the optic nerve, the head depth range of the head of the head is less than 0.52 mm, the rim area is less than 1.28 mm 2, the excavation area is more than 0.16 mm 2.
fundus fluorescence angiography: hypofluorescence of the optic disc, narrowing of the arteries, absence or decrease in the number of capillaries in the optic nerve disc;
electrophysiological studies (visual evoked potentials) - a decrease in the amplitude of the PEP and an increase in latency. In case of damage to the papillomacular and axial bundles of ZN, the electrical sensitivity is normal, and if the peripheral fibers are disturbed, the threshold of electric phosphene is sharply increased. Lability is especially sharply reduced with axial lesions. In the period of progression of the atrophic process in ZN, the retino-cortical and cortical time increases significantly;
Doppler ultrasound of the vessels of the head, neck, and eyes: a decrease in blood flow in the orbital, suprablock artery and intracranial part of the internal carotid artery;
MRI of cerebral vessels: foci of demyelination, intracranial pathology (tumors, abscesses, brain cysts, hematomas);
MRI of the orbit: compression of the orbital part of the spacecraft;
X-ray of the orbit according to Riesa is a violation of the integrity of the optic nerve.

Differential diagnosis

The degree of decrease in visual acuity and the nature of visual field defects are determined by the nature of the process that caused atrophy. Visual acuity can range from 0.7 to practical blindness.

Atrophy of the optic nerve with Tabes develops in both eyes, but the degree of damage to each eye can be far from the same. Visual acuity decreases gradually, but because the process with Tabes is always progressing, it ultimately occurs at different times (from 2-3 weeks to 2-3 years), bilateral blindness. The most common form of change in the field of view during tabetic atrophy is a gradually progressive narrowing of the borders in the absence of cattle within the preserved areas. Rarely, in tabes, bitemporal scotomas, bitemporal narrowing of the boundaries of the field of vision, as well as central scotomas are observed. The prognosis for staging optic atrophy is always poor.

Atrophy of the optic nerve can be observed with deformities and diseases of the bones of the skull. Such atrophy is observed with a tower-shaped skull. Visual impairment usually develops in early childhood and rarely after 7 years. Blindness of both eyes is rare, sometimes blindness of one eye is observed with a sharp decrease in vision in the other eye. From the side of the field of view, there is a significant narrowing of the boundaries of the field of view along all meridians; there is no cattle. Atrophy of the optic nerve with a tower-shaped skull, most consider the consequence of stagnant nipples, developing on the basis of increased intracranial pressure. Of other deformations of the skull, atrophy of the optic nerves causes dysostosis craniofacialis (Cruson disease, Apert syndrome, marble disease, etc.).

Atrophy of the optic nerve can be with poisoning by quinine, plasmocide, fern during the expulsion of worms, lead, carbon disulfide, with botulism, with methyl alcohol poisoning. Methyl alcohol atrophy of the optic nerve is not so rare. After drinking methyl alcohol, accommodation paralysis and dilated pupils appear after a few hours, a central scotoma appears, and vision decreases sharply. Then vision is partially restored, but atrophy of the optic nerve gradually increases and irreversible blindness sets in.

Atrophy of the optic nerve can be congenital and hereditary, with birth or postpartum head injuries, prolonged hypoxia, etc.

Diagnosis	Justification for differential diagnosis	Surveys	Diagnosis exclusion criteria
Amblyopia	A significant decrease in vision in the absence of pathology from the anterior segment of the eye and retina.	Physical examinations	A young child has strabismus, nystagmus, and the inability to clearly fix his gaze on a bright subject. In older children - a decrease in visual acuity and the lack of improvement from its correction, disorientation in an unfamiliar place, strabismus, the habit of closing one eye when looking at an object or reading, tilting or turning the head when looking at an object of interest.
		Refractometry	Anisometropic amblyopia develops with uncorrected high degree anisometropia in the eye with more pronounced refractive errors (myopia is more than 8.0 diopters, hyperopia is more than 5.0 diopters, astigmatism is more than 2.5 diopters in any meridian), refractive amblyopia - with a long absence of optical correction of hyperopia , myopia or astigmatism with a difference in refraction of both eyes: hyperopia more than 0.5 diopters, myopia more than 2.0 diopters, astigmatic 1.5 diopters.
		HRT OCT	According to NRT: the depth range of the optic head is more than 0.64 mm, the area of \u200b\u200bthe rim of the optic nerve is more than 1.48 mm 2, the area of \u200b\u200bexcavation of the optic nerve is less than 0.12 mm 2..
Leber's hereditary atrophy	A sharp decrease in vision of both eyes in the absence of pathology from the anterior segment of the eye and retina.	Complaints and medical history	The disease develops in men - members of the same family aged 13 to 28 years. Girls get sick very rarely, and only if the mother is a proband, and the father suffers from this disease. Heredity is associated with the X chromosome. A sharp decrease in vision in both eyes over several days. The general condition is good, sometimes patients complain of a headache.
		Ophthalmoscopy	Initially, there is hyperemia and slight blurring of the boundaries of the optic disc. Gradually, the optic discs become waxy in nature, turn pale, especially in the temporal half.
		Perimetry	In the field of view, the central absolute scotoma is white, the peripheral borders are normal.
Hysterical amblyopia (amaurosis)	Sudden visual impairment or complete blindness in the absence of pathology from the anterior segment of the eye and retina.	Complaints and medical history	Hysterical amblyopia in adults - a sudden visual impairment that lasts from several hours to several months, develops against a background of severe emotional upheaval. More often observed in women aged 16-25 years.
		Physical examinations	Perhaps a complete lack of reaction of the pupils to the light.
		Visometry	A decrease in visual acuity of varying degrees up to blindness. With repeated studies, the data may be completely different from the previous ones.
		Ophthalmoscopy	Optic nerve disc pale pink, clear contours, no symptom of Kestenbaum.
		Perimetry	Concentric narrowing of the field of vision, a violation of the normal type of boundaries is characteristic - the widest field of view is red; less commonly hemianopsia (homonymous or heteronymous).
		VIZ	VIZ data is normal.
Hypoplasia of the optic nerve	Bilateral decrease or complete loss of vision in the absence of pathology from the anterior segment of the eye and retina.	Visometry	Hypoplasia of the optic nerve is accompanied by a bilateral decrease in vision (in 80% of cases from moderate to complete blindness).
		Physical examinations	The afferent pupillary reflex is absent. A one-sided change in the optic nerve disc is often combined with strabismus and can be seen by a relative afferent pupillary defect, as well as a one-sided weak or absent fixation (instead of installation nystagmus).
		Ophthalmoscopy	DZN is reduced in size, pale, surrounded by a weakly pronounced pigment ring. The outer ring (the size of a normal disk) consists of a trellised plate, pigmented sclera and choroid. Options: yellow-white small disk with a double ring or complete absence of a nerve and aplasia of blood vessels. In a two-way process, the disk is often difficult to detect, in which case it is determined along the vessels.
		Perimetry	While maintaining central vision, it is possible to detect defects in the fields of vision.
		Consultation of a neurologist, endocrinologist, laboratory tests	Optical nerve hypoplasia is rarely combined with septic optic dysplasia (Morsier syndrome: lack of a transparent septum (septum pellucidum) and pituitary gland, which is accompanied by disorders of the thyroid gland and other hormonal disorders: growth retardation, hypoglycemia attacks, combination with a slowdown in mental development and brain malformations) .
Optic nerve head coloboma	Pathology of the optic nerve	Ophthalmoscopy	With ophthalmoscopy, the optic disc is enlarged (lengthening of the vertical size), deep excavation or local excavation and increased sickle pigmentation with partial involvement of the lower nasal part of the optic disc in the process. When the choroid is involved in the process, a demarcation line appears, represented by a bare sclera. Lumps of pigment can mask the border between normal tissue and coloboma. On the surface of the optic disc can be glial tissue.
Optic nerve head coloboma	Pathology of the optic nerve	MRI	MRI - sheaths of the optic canal are poorly expressed or absent.
Morning Radiance Syndrome	Pathology of the optic nerve	Physical examinations	In almost all patients with unilateral pathology, strabismus and high myopia of the affected eye are found.
		Visometry	Visual acuity is often reduced, but can be very high.
		Refractometry	Often with a unilateral process - high myopia of the affected eye.
		Ophthalmoscopy	With ophthalmoscopy, the optic disc is enlarged and is located, as it were, in a funnel-shaped cavity. Sometimes the head of the head is elevated, it is also possible to change the position of the head of the head of the head from the staphylomatous cavity to its prominence; around the nerve there are areas of transparent grayish dysplasia of the retina and a block of pigment. The demarcation line between the tissues of the optic disc and the normal retina is indistinguishable. Many abnormally branching vessels are identified. Most patients have zones of local retinal detachment and radial folds of the retina within the excavation.
		Perimetry	Possible defects in the field of vision: central scotomas and an increase in the blind spot.
		Consultations of an otolaryngologist	The "morning light" syndrome occurs as an independent manifestation or can be combined with hypertelorism, splitting of the lips, palate and other abnormalities.

Treatment

Treatment of optic atrophy is a very difficult task. In addition to pathogenetic therapy, tissue therapy, vitamin therapy, spinal puncture in combination with osmotherapy, vasodilators, B vitamins, especially B1 and B12 are used. Currently, magnetic, laser, and electrical stimulation are widely used.

In the treatment of partial optic atrophy, pharmacotherapy is usually used. The use of drugs makes it possible to influence various links in the pathogenesis of optic atrophy. But do not forget about the methods of physiological effects and the various routes of administration of drugs. The issue of optimizing the route of administration of drugs is also relevant in recent years. So, parenteral (intravenous) administration of vasodilator drugs can contribute to systemic vasodilation, which, in some cases, can lead to robbery syndrome and impair blood circulation in the eyeball. The fact of a greater therapeutic effect with topical administration of drugs is considered universally recognized. However, in diseases of the optic nerve, local use of drugs is associated with certain difficulties caused by the existence of a number of tissue barriers. The creation of a therapeutic concentration of the drug in the pathological focus is achieved more successfully with a combination of drug therapy and physiological effects.

Drug treatment (depending on the severity of the disease)
Conservative (neuroprotective) treatment is aimed at increasing blood circulation and improving the trophism of the optic nerve, stimulating the vitally preserved and / or nerve fibers undergoing apoptosis.
Medication includes neuroprotective drugs with direct (directly protect retinal ganglia and axons) and indirect (reduce the effects of factors causing nerve cell death) effects.

Retinoprotectors: ascorbic acid 5% 2 ml intramuscularly once a day for 10 days, in order to reduce vascular wall permeability and stabilize endotheliocyte membranes
Antioxidants: tocopherol 100 IU 3 times a day - 10 days, with the aim of improving tissue oxygen supply, collateral circulation, strengthening the vascular wall
Drugs that improve metabolic processes (direct neuroprotectors): retinalamine for intramuscular injection of 1.0 ml and / or parabulbar administration of 5 mg 0.5 ml parabulbar 1 time per day for 10 days
The list of additional drugs:
- vinpocetine - for adults, 5-10 mg 3 times a day for 2 months. It has a vasodilating, antihypoxic and antiplatelet effect.
- cyanocobalamin 1 ml intramuscularly 1 time per day 5/10 days

They also use electrical stimulation - it is aimed at restoring the function of nerve elements that were functional, but did not conduct visual information; the formation of a focus of persistent excitability, which leads to the restoration of the activity of nerve cells and their connections, previously poorly functioning; improvement of metabolic processes and blood circulation, which contributes to the restoration of the myelin sheath around the axial cylinders of fibers ZN and, accordingly, leads to an acceleration of the conduct of action potential and the revival of the analysis of visual information.

Indications for consultation of narrow specialists:

consultation of a therapist - to assess the general condition of the body;
cardiologist consultation - high blood pressure is one of the main risk factors for the development of occlusion of the retinal vessels and optic nerve;
neurologist consultation - to exclude the demyelinating disease of the central nervous system and to clarify the topical lesion of the optic tract;
consultation of a neurosurgeon - if the patient shows signs of intracranial hypertension or symptoms characteristic of a bulky brain formation;
consultation of a rheumatologist - in the presence of symptoms characteristic of systemic vasculitis;
consultation of a vascular surgeon to resolve the issue of the need for surgical treatment in the presence of signs of an occlusal process in the system of the internal carotid and orbital artery (appearance of scotoma fugax in a patient);
endocrinologist consultation - in the presence of diabetes mellitus / other pathology of the endocrine system;
hematologist consultation (for suspected blood diseases);
consultation of an infectious disease specialist (if vasculitis of viral etiology is suspected).
otolaryngologist consultation - if you suspect inflammation or neoplasm in the maxillary or frontal sinus.

Indicators of treatment effectiveness:

increase in the electrical sensitivity of the optic nerve by 2-5% (according to computer perimetry),
increase in amplitude and / or decrease in latency by 5% (according to VIZ).

Atrophy of the optic nerve is understood as the gradual death of the optic nerve and its replacement with connective tissue. A whole group of various pathological conditions can lead to this disease. Partial or total atrophy of the optic nerve is distinguished from the degree of damage to the optic nerve and how much vision is reduced. With partial atrophy, residual vision persists, but color sensation suffers, visual fields are narrowed, it is impossible to correct it with glasses or lenses. However, the process stops there.

Causes of the disease

The causes of incomplete atrophy of the optic nerve may be:

Eye diseases (damage to the retina, optic nerve fibers, glaucoma, inflammatory diseases, myopia, tumor compression of the optic nerve);

Brain damage with;

Infectious diseases (meningitis, encephalitis, arachnoiditis, brain);

Diseases of the central nervous, cardiovascular systems (multiple sclerosis, granulomas, cerebral vessels, cysts, hypertension);

Burdened by heredity;

Various intoxications, poisoning with alcohol substitutes;

The consequences of the injury.

The following types of disease are distinguished:

Congenital atrophy - manifests itself at birth or after a short period of time after the birth of the baby.

Acquired atrophy is a consequence of adult diseases.

Symptoms of partial atrophy of the optic nerve

Manifestations of the disease can have varying degrees of severity. The main manifestations of partial atrophy of the optic nerve will be:

Decreased visual acuity;

The appearance of pain when trying to move the eyeballs;

Narrowing or loss of visual fields, may be before the appearance of the tunnel syndrome (a person sees only what is directly in front of the eyes and nothing on the sides);

Blind spots (scotomas) appear.

Diagnosis of the disease

Usually, the diagnosis of the disease is not difficult. With a decrease in vision, a person most often goes to the optometrist himself, who makes the correct diagnosis, prescribing treatment.

When examining the optic nerve, the doctor will certainly see changes in the nerve disc and its pallor. To clarify the diagnosis, more detailed studies of visual functions are prescribed, visual fields are studied, intraocular pressure is measured, fluorescence-angiographic, radiological, electrophysiological studies are used. It is very important to find the cause of the disease, because in some situations the patient will need to undergo surgery.

Treatment of partial optic atrophy

The prognosis for the treatment of partial optic atrophy is favorable. The main goal of treatment is to stop changes in the tissues of the optic nerve, aimed at being able to save what is still left. It is impossible to completely restore visual acuity, but without treatment, the disease will lead to blindness. The main method of therapy will depend on what the cause of atrophy of the optic nerve is.

The drugs used in the treatment are drugs to improve blood supply to the nerve, improve metabolism, vasodilator drugs, multivitamins, biostimulants. These drugs reduce edema, inflammation in the optic nerve head, improve its nutrition, blood supply, and stimulate the activity of the remaining nerve fibers.

If the patient needs surgical treatment, then it will be the main method of therapy. The emphasis is on the treatment of the underlying disease, the elimination of the cause, which led to partial atrophy of the optic nerve. To achieve the best result, magnetic, electro, laser stimulation of the optic nerve, ultrasound, electrophoresis, oxygen therapy can be prescribed. The earlier treatment is started, the more favorable the prognosis of the disease. Nerve tissue is practically impossible to recover, so the disease cannot be started, it must be treated in a timely manner.

Prognosis for optic atrophy

Any disease, if treatment is started as early as possible, is better amenable to therapy. A similar thing can be said about optic atrophy. With timely treatment, it is possible to restore the nerve, avoid the consequences and maintain vision. A neglected disease can lead to blindness, therefore, at the first signs of a decrease in visual acuity, a narrowing of the visual fields, a change in color perception, you should immediately contact an optometrist. And the doctor will do everything possible in the treatment to preserve vision with your help.

Expert Editor: Mochalov Pavel Aleksandrovich | D.M.N. general practitioner

Education: Moscow Medical Institute I. Sechenov, specialty - "Medical business" in 1991, in 1993 "Occupational diseases", in 1996 "Therapy".

Atrophy of the optic nerve (optical neuropathy) is a condition in which partial or complete destruction of nerve fibers occurs, through which impulses pass from the retina of the eye to the brain. With this disease, vision decreases or is lost altogether, there is a violation of color vision, narrowing of the fields of vision, the optic nerve disc pales.

The first step to treating optic atrophy is to consult an ophthalmologist and make a correct diagnosis. The service site will help you choose the best medical center: all Moscow clinics with addresses, phone numbers, ratings and user reviews are collected here.

Causes of optic atrophy

The causes of atrophy can be different - eye diseases, disorders of the blood supply to the retina, trauma, intoxication, infection, autoimmune diseases. Atrophy can be congenital (primary) or acquired (secondary). Atrophy of the optic nerve often develops with tumors of the orbit or brain. In any case, the main pathogenetic moment is a violation of the trophism of nerve fibers, blood pressure, resulting in inflammation and all the symptoms of the disease.

Symptoms of optic atrophy

Atrophy of the optic nerve may be complete or partial. Partial atrophy is characterized by incomplete loss of vision, scotomas, "tunnel" vision appear. With complete atrophy, all fibers of the optic nerve are thinned, the optic disc evenly turns pale, and the retinal vessels are narrowed. The process of reducing visual acuity can take only a few days and result in complete blindness.

Treatment of optic atrophy

The method of treatment of optic atrophy depends on its cause and the condition of the patient. First, they treat the underlying disease, while fighting inflammation and edema of the nerve. For this, medication and physiotherapy are prescribed.

Atrophy of the optic nerve is a disease in which there is a decrease in vision, sometimes until it is completely lost. This happens when nerve fibers that carry information about what a person sees from the retina 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 partial death of the nerve, helps stop the loss of visual function and restore it. If the nerve has completely atrophied, then vision cannot be restored.

The optic nerve is an afferent nerve fiber extending from the retina to the occipital optic part of the brain. Thanks to this nerve, information about a picture visible to a person is read from the retina, and transmitted to the visual department, and in it is already transformed into a familiar image. When atrophy occurs, nerve fibers begin to die and are replaced by connective tissue, which is similar to scar tissue. In this condition, the functioning of the capillaries that feed the nerve ceases.

How is the disease classified?

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

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

Depending on what degree the lesion has, 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;
full - 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 one eye begins to see poorly. With damage to the nerves of two eyes, they speak of bilateral atrophy. According to the stability of the visual function, pathology can be stationary, in which visual acuity decreases and then keeps at the same level and progressing, when vision becomes worse.

Why the optic nerve may atrophy

The causes of optic atrophy are diverse. A congenital form of the disease in children arises from 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 supplying the nerve or the nerve itself with a neoplasm in the skull;
myopia;
atherosclerosis, leading to plaques in the vessels;
vascular thrombosis; v
inflammation of the vascular walls during syphilis or vasculitis;
disturbances in the structure of blood vessels due to diabetes mellitus or an increase in 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.

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

retrobulbar neuritis;
traumatic injuries of the place where the optic nerves intersect;
neoplasm in the pituitary gland of the brain.

Unilateral disease occurs due to diseases of the eyes or eye sockets, as well as from the initial stage of cranial diseases. Both eyes may suffer from atrophy at once due to:

intoxication;
syphilis;
neoplasms in the skull;
poor circulation in the vessels of the nerve during atherosclerosis, diabetes mellitus, hypertension.

What is the clinical picture of the disease?

Symptoms of optic atrophy depend on the form of the disease. When this disease occurs, vision cannot be corrected with glasses. The most basic sign is a decrease in visual acuity. The second symptom is a change in the fields of visual function. According to this symptom, the doctor can understand how deeply the lesion arose.

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

When nerve fibers are concentrated as close as possible to the retina or directly in it, dark spots occur 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, arising due to any ophthalmic disease, the following symptoms occur:

the veins of the eyes expand;
vessels are narrowing;
the boundaries of the optic nerve become smoothed;
the retinal disc turns pale.

Important! If there is even a slight clouding in the eye (or both eyes), it is necessary to visit an ophthalmologist as soon as possible. Only in time to detect the disease, you can stop it at the stage of partial atrophy and restore vision, not allowing complete atrophy.

What are the features of pathology in children

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

Important! A child under two or three years old cannot report that he does not see well, and older children who have an inborn problem may not be aware that they can see something different. That is why it is necessary that the ophthalmologist inspects the child 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 in some direction, trying to consider something. The forced inclination of the head to some extent compensates for the function of the affected nerve and slightly sharpens the vision. The main clinical picture in case of optic atrophy in a child is the same as in an adult.

If timely diagnosis and treatment are carried out, provided that the disease is not genetic, during which the nerve fibers are completely replaced by fibrous tissue during intrauterine development, the prognosis for the restoration of the optic nerve in babies is more favorable than in adult patients.

How is the disease diagnosed

Diagnosis of optic atrophy is carried out by an ophthalmologist, and primarily includes examination of the fundus and determination of visual fields using computer peripetria. It also determines which colors the patient distinguishes. Instrumental diagnostic methods include:

x-ray of the cranium;
magnetic resonance imaging;
angiography of the vessels of the eye;
video ophthalmological research;
Ultrasound of the vessels of the head.

Thanks to these studies, you can not only identify the death of the optic nerve, but also understand why it happened. You may also need to consult related professionals.

How to treat optic atrophy

How to treat optic atrophy should be decided by the doctor based on studies. It is immediately worth noting that the treatment for this disease is very difficult, because the nerve tissue is very poorly regenerated. It is necessary to conduct complex systematic therapy, which should take into account the cause of the pathology, its prescription, the patient's age, and his general condition. If some process taking place inside the skull (for example, a tumor or inflammation) has led to the death of a nerve, then the neurosurgeon and neuropathologist should begin the treatment.

Drug treatment

With the help of drugs, it is possible to enhance blood circulation and trophic nerve, as well as stimulate the vital activity of healthy nerve fibers. Medication includes taking:

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

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

Microchirurgic 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 completely, then even by surgical intervention it is impossible to restore visual function.

Treatment with folk remedies

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

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

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

astragalus woolly;
small periwinkle;
hawthorn (flowers and fruits);
chokeberry;
baikal skullcap (root);
daurian black cohosh;
large-flowered magnolia (leaves);
swampy dried up.

Blueberries are good for vision, it contains many vitamins, as well as anthocyanoside, which has 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 occurring against a background of low blood pressure, then tinctures will be useful, for the preparation of which are used:

leaves of Chinese magnolia vine;
the roots of the temptation;
levzea;
ginseng;
eleutherococcus;
sea-buckthorn (fruits and pollen).

If incomplete necrosis of the nerves has occurred or senile degenerative changes in the eyes occur, then the use of anti-sclerotic plants is necessary:

orange;
cherry;
hawthorn;
cabbage;
corn;
sea \u200b\u200bkale;
dandelion;
chokeberry;
garlic and onions.

Carrots (contains a lot of carotene) and beets (rich in zinc) have useful properties

What is the prognosis for optic 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 field. No treatment is able to fully restore visual function. If the disease progresses, and treatment is absent, then this leads to disability due to complete blindness.

In order to prevent necrosis of the nerve fibers, it is necessary to undergo timely treatment of 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.

2708 08/02/2019 6 min.

Any sensations in the human body, both external and internal, are possible only due to the functioning of nerve tissue, the fibers of which are found in almost every organ. Eyes are not an exception in this regard, therefore, when destructive processes in the optic nerve begin, a person is threatened with partial or complete loss of vision.

Disease definition

Atrophy of the optic nerve (or optical neuropathy) is a process of death of nerve fibers, which proceeds gradually and is most often the result of malnutrition of the nervous tissue due to poor blood supply.

Image transmission from the retina to the visual analyzer in the brain occurs through a kind of “cable” consisting of many nerve fibers and packaged in “isolation”. The thickness of the optic nerve is not more than 2 mm, however, it contains more than a million fibers. Each part of the image corresponds to a certain part of them, and when some of them cease to function, “silent zones” appear in the image perceived by the eye (image disturbance).

When cells of nerve fibers die, they are gradually replaced by connective tissue or auxiliary nervous tissue (glia), which is normally designed to protect neurons.

Kinds

Depending on the causative factors, two types of optic atrophy are distinguished:

Primary The disease is caused by the affected X-chromosome, therefore only men aged 15-25 suffer from it. Pathology develops according to the recessive type and is inherited;
Secondary It arises as a result of an eye or systemic disease associated with a violation of the blood supply or stagnation of the optic nerve. Such a pathological condition can occur at any age.

Classification is also carried out according to the location of the lesion:

The following types of atrophy are also distinguished: initial, complete and incomplete; unilateral and bilateral; stationary and progressive; congenital and acquired.

Causes of occurrence

The frequency of various pathological processes in the optic nerve is only 1-1.5%, and in 19-26% of them the disease ends in complete atrophy and incurable blindness.

The cause of the development of optic atrophy can be any disease that results in edema, compression, inflammation, damage to nerve fibers or damage to the vascular system of the eyes:

Ocular pathologies: retinal pigment dystrophy, etc.
Glaucoma and increased IOP;
Systemic diseases: hypertension, atherosclerosis, spasms of blood vessels;
Toxic effects: smoking, alcohol, quinine, drugs;
Brain diseases: abscess, multiple sclerosis, arachnoiditis;
Traumatic injuries;
Infectious diseases: meningitis, encephalitis, syphilitic lesion, tuberculosis, flu, measles, etc.

Is it possible to cure glaucoma?

Whatever the reason for the onset of atrophy of the optic nerve, nerve fibers die irrevocably, and the main thing is to quickly diagnose in order to slow down the process in time.

Symptoms

The main sign of the onset of pathology can serve as a steadily progressive deterioration in vision in one or both eyes, and it does not lend itself to conventional methods of correction.

Visual functions are gradually lost:

The manifestation of symptoms may proceed depending on the severity of the lesions for several days or months, but without a timely response invariably leads to complete blindness.

Possible complications

The diagnosis of optic atrophy should be made as early as possible, otherwise loss of vision (partial or complete) is inevitable. Sometimes the disease affects only one eye - in this case, the consequences are not so severe.

Rational and timely treatment of the disease, which caused atrophy, allows in some cases (not always) to maintain vision. If the diagnosis is made at the stage of an already developed disease, the prognosis is most often unfavorable.

If the disease began to develop in patients with indicators of vision below 0.01, then therapeutic measures are likely to give no result.

Diagnostics

A targeted ophthalmic examination is the first mandatory step in case of suspected illness. In addition, consultation with a neurosurgeon or neurologist may be required.

To detect atrophy of the optic nerve, the following types of examinations can be performed:

Fundus examination (or biomicroscopy);
- determination of the degree of visual impairment (myopia, hyperopia, astigmatism);
- study of visual fields;
Computer perimetry - allows you to identify the affected area of \u200b\u200bthe nervous tissue;
Assessment of color perception - determination of the localization of lesions of nerve fibers;
Video phthalmography - revealing the nature of damage;
Craniography (X-ray of the skull) - the main object in this case is the region of the Turkish saddle.

Read more about aK is undergoing fundus examination by .

To clarify the diagnosis and additional data, it is possible to conduct studies: CT, magnetic resonance, laser dopplerography.

Treatment

With partial damage to nerve fibers, treatment must be started quickly and intensively. First of all, the efforts of doctors are aimed at eliminating the causes of the pathological condition in order to stop the progression of the disease.

Drug therapy

Since the restoration of dead nerve fibers is impossible, therapeutic measures are carried out to stop the pathological process by all known means:

Vasodilators: Niacin, No-spa, Dibazole, Eufillin, Complamin, Papaverine, etc. The use of these drugs helps to stimulate blood circulation;
Anticoagulants: Heparin, Tiklid. Drugs prevent thickening of the blood and the formation of blood clots;
Biogenic stimulants: Vitreous humor, Aloe extract, Peat. Enhance metabolism in nerve tissues;

Heparin ointment is used in the treatment of optic nerve arthophy

Vitamins: Ascorutin, B1, B6, B2. They are the catalysts for most biochemical reactions that occur in the tissues of the eyes, just like amino acids and enzymes;
Immunostimulants: Ginseng, Eleutherococcus. Necessary to stimulate the processes of regeneration and suppression of inflammation in infectious lesions;
Hormonal drugs: Dexamethasone, Prednisone. Used in the absence of contraindications to relieve symptoms of inflammation;
Improving the central nervous system:, Nootropil, Cavinton, Cerebrolysin, Fezam.

Instruction D examethasone for the eyes is located.

Dexamethasone is used in the treatment of optic nerve arthophy

In each case, treatment is prescribed individually under the supervision of the attending physician.

In the absence of contraindications, an additional effect can be achieved using acupuncture, as well as methods of physiotherapeutic treatment:

Ultrasound;
Electrophoresis;
Optical and laser stimulation of the optic nerve;
Magnetotherapy.

Such procedures can have a positive effect in case of incomplete loss of functionality by nerve cells.

Surgically

Surgical methods are resorted to under the threat of complete blindness, as well as in other situations requiring surgical intervention. The following types of operations can be used for this:

Various surgical treatment techniques have been successfully practiced in clinics in Russia, Israel and Germany.

Folk remedies

Treatment of atrophy of the optic nerve should be carried out with medications under the guidance of a qualified doctor. However, such therapy often takes a long time, and in this case, folk remedies can provide invaluable help - after all, the action of most of them is aimed at stimulating metabolism and increasing blood circulation:

Dissolve 0.2 g of mummy in a glass of water, drink before dinner on an empty stomach, and also in the evening in a glass of the product for 3 weeks (20 days);
Make an infusion of crushed astragalus grass (2 tbsp. Dried raw materials per 300 ml of water), insist 4 hours. Within 2 months take 100 ml of infusion 3 r. in a day;
Peppermint is called eye grass, it is useful to eat it, and bury the eyes with juice mixed with equal amounts of honey and water in the morning and evening;
You can eliminate eye fatigue after prolonged work on a computer using lotions from infusions of dill, chamomile, parsley, blue cornflower and ordinary tea leaves;
Grind immature pine cones and cook 1 kg of raw material for 0.5 hours. After filtering add 1 tbsp. honey, stir and refrigerate. Consume 1 p. per day - in the morning before meals 1 tsp. ;
Pour 1 tbsp. l parsley leaves 200 ml of boiling water, let it brew in a dark place for 24 hours, after which take 1 tbsp. l in a day.

Folk remedies should be used in treatment only after consulting an ophthalmologist, since most plant components have an allergenic effect and can have an unexpected effect in the presence of some systemic pathologies.

Prevention

In order to avoid atrophy of the optic nerve, it is worth paying attention to preventive measures not only for ocular, but also for systemic diseases:

Timely treat eye and systemic infectious diseases;
Prevent ocular and head injuries;
Do preventive examinations in an oncology clinic;
Limit or exclude alcohol from your life;
Take control of blood pressure.

Color blindness test online can be found.

Video

findings

Atrophy of the optic nerve is an almost incurable disease in the late stages that threatens the patient with complete blindness. However, partial atrophy can be suspended, and the main direction before the development of medical tactics should be an extensive diagnosis - after all, it will help to establish the cause of the changes and try to stop them.

Therefore, try to pay increased attention not only to eye health, but also to the entire body. After all, everything is interconnected in it, and vascular or nerve diseases can affect the quality of vision.

Also read about red spots under the eyes.