Optic disc atrophy. Optic nerve atrophy: what causes it, how it manifests and is treated. Effective drug treatment of the patient

Such a serious ophthalmological disease as descending atrophy optic nerve begins to develop due to degenerative processes.

Sclerotic changes occur in the fibers of nerve tissue.

As the disease progresses, vision not only deteriorates, but may even disappear completely. It's connected with the death of nerve fibers that carry information about the retinal image to the brain.

Why does descending optic atrophy occur and how to recognize it?

Illness provoke the following reasons:

Consequences glaucoma.
Vasoconstriction, compressing the optic nerve - a tumor appears in the cranial cavity, resulting in the formation brain abscess.
Complications myopia.
Development in blood vessels atherosclerotic plaques— we are talking about the vessels that supply the optic nerves with blood. Thrombosis begins, the walls become inflamed. Violation of the structure of blood vessels often contributes to syphilis, vasculitis, diabetes or hypertension.
Injuries eyes.
Intoxication(ARVI, use of alcohol substitutes, narcotic substances, nicotine and quinine).

When the fibers of one optic nerve pathology is considered unilateral. Atrophy in both eyes cause the following disorders and diseases:

syphilis;
intoxication;
tumor in the cavities of the skull;
blood supply disturbance(for atherosclerosis, diabetes mellitus, hypertension).

Symptoms of complete and partial atrophy

Symptoms of the disease depends on the type atrophy. The main sign of pathology is decreased visual acuity.

Important! Improve vision in case of atrophy glasses or contact lenses will not work.

Another characteristic symptom illness - visual field change. During the diagnosis of the disease, the patient describes in detail his feelings, according to which the doctor determines at what stage the disease is. The patient may observe the following phenomena:

you can see everything as if through a tube - tunnel vision;
before my eyes regularly spots appear, reminiscent of a mosaic;
image fragment, which is located in the bow, absent, the same thing is noticed from the side of the temples.

In patients disturbances are observed in color vision. A person does not distinguish the color red and does not perceive green shades.

Characteristic sign illness - slow recovery of vision when leaving the dark into the light and vice versa. This symptom often appears at the beginning of the disease, after which it actively progresses.

Reference. Atrophy may be partial, in this case vision remains relatively sharp.

Diagnostic methods

As diagnostic measures are carried out:

fundus analysis— the examination is carried out through the pupil; for convenience, it is first dilated with special drops;
acuity test vision;
calculation of the boundaries of the field of view ( spheroperimetry);
grade correct color perception;

Photo 1. You can check color perception using Rabkin’s polychromatic tables. Normally, the eye distinguishes all numbers.

perimetry using a computer, through which the affected areas of the optic nerve are identified;
videoophthalmography— determination of the nature of damage to nerve fibers;
x-ray skulls;
computed and magnetic resonance imaging;
dopplerography using a laser is an optional, additional diagnostic method.

Treatment. Is it possible to avoid disability?

During the treatment process, doctors do everything to “revitalize” nerve fibers V maximum quantity.

Important! The earlier the disease was identified and treatment started, the more chances for successful correction of the disease.

Nerves are stimulated by laser, alternating magnetic fields, electric current .

Also used as therapy:

medicinal impact;
blood transfusion;
taking B vitamins and special tonics, promoting vasodilation;
surgical intervention in severe cases.

Reference. Even if partial optic atrophy is diagnosed, disability must be registered. The purpose of the group depends on the stage of the pathology and the possibility of its correction.

Optic atrophy is a disease in which vision decreases, sometimes to the point of complete loss. This occurs when the nerve fibers that carry information about what a person sees from the retina to the visual part of the brain partially or completely die. This pathology can arise due to many reasons, so 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 stop the loss of visual function and restore it. If the nerve has completely atrophied, 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 about visible to humans 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 and be replaced connective tissue, which is similar to scar tissue. In this condition, the functioning of the capillaries supplying the nerve stops.

How is the disease classified?

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

ascending - the layer of nerve fibers located on the retina of the eye 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 disc 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 widespread, but vision is not completely lost;
complete - the optic nerve dies, leading to complete loss visual function.

With a unilateral disease, one nerve is damaged, as a result of which one eye begins to see poorly. When the nerves of both eyes are damaged, they speak of bilateral atrophy. According to the stability of visual function, the pathology can be stationary, in which visual acuity falls and then remains 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 systemic and ophthalmological nature. Nerve death can occur due to:

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

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

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

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

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

What clinical picture does the disease have?

Symptoms of optic atrophy depend on the form of the disease. If this disease occurs, vision cannot be corrected with glasses. The most basic symptom is decreased visual acuity. The second symptom is a change in the fields of visual function. By this sign, the doctor can understand how deep the lesion has occurred.

The patient develops “tunnel vision,” that is, the person sees as he would see if he put a tube to his eye. Peripheral (side) 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, color vision disorder begins; the patient first ceases to distinguish between green and then red.

When nerve fibers concentrated as close as possible to the retina or directly in it are damaged, dark spots appear in the center of the visible image. With a deeper lesion, half the image on the side of the nose or temple may disappear, depending on which side the lesion occurred on. With secondary atrophy caused by any ophthalmological disease, the following symptoms occur:

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

Important! If even slight clouding appears in the eye (or both eyes), you should visit an ophthalmologist as soon as possible. Only by detecting the disease in time can it be stopped at the stage partial atrophy and restore vision without allowing complete atrophy.

What are the features of pathology in children

With the congenital form of the disease, it can be determined that the baby’s pupils do not react well to light. As the child grows up, parents may notice that he does not respond to an object brought to him from a certain direction.

Important! A child under two or three years old cannot report that he sees poorly, and older children, whose problem is congenital, may not realize that they can see differently. That is why it is necessary for the child to be examined annually by an ophthalmologist, even if there are no symptoms visible to the parent.

Parents should take their child to the doctor if he rubs his eyes or unconsciously tilts his head to one side while trying to look at something. The forced tilt of the head to some extent compensates for the function of the affected nerve and slightly sharpens vision. Main clinical picture with 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 intrauterine development, the prognosis for restoration of the optic nerve in children is more favorable than in adult patients.

How is the disease diagnosed?

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

X-ray of the skull;
Magnetic resonance imaging;
angiography of eye vessels;
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 occurred. You may also need to consult related specialists.

How is optic atrophy treated?

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

Treatment with medications

By using medicines You can increase blood circulation and nerve trophism, as well as stimulate the vital activity of healthy nerve fibers. Drug treatment includes taking:

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, spruce atrophy has an infectious bacterial pathogenesis.

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

Microsurgical treatment is aimed at eliminating compression of the nerve, as well as increasing the diameter of the vessels that feed it. Conditions can also be created in which new blood 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 nerve atrophy with folk remedies 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 wooliflora;
small periwinkle;
hawthorn (flowers and fruits);
chokeberry;
Baikal skullcap (root);
Daurian black cohosh;
grandiflora magnolia (leaves);
swampy dryweed.

Blueberries are beneficial for vision; they contain many vitamins, as well as an anthocyanoside, which has positive influence on visual apparatus. For treatment, you need to mix one kilogram of fresh berries with one and a half kilograms of sugar and put it in the refrigerator. This mixture is taken in half a glass for a month. The course must be repeated twice a year, which will be beneficial even with good vision.

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

Chinese lemongrass leaves;
zamanika roots;
Leuzea;
ginseng;
Eleutherococcus;
sea buckthorn (fruits and pollen).

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

orange;
cherry;
hawthorn;
cabbage;
corn;
seaweed;
dandelion;
chokeberry;
garlic and onion.

Carrots (contain a lot of carotene) and beets (rich in zinc) have beneficial properties.

What is the prognosis for optic nerve atrophy and its prevention?

Upon diagnosis and initiation of therapy early stage development, you can 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, it leads to disability due to complete blindness.

In order to prevent the necrosis of nerve fibers, ophthalmological diseases, as well as endocrine, neurological, infectious and rheumatological diseases should be treated in a timely manner. Very important in prevention is the prevention of intoxication damage to the body.

Optic nerve atrophy is usually called the process of partial (PAN), and in some cases, complete destruction of the fibers included in the optic nerve with their replacement by connective tissue.

Causes

According to experts, partial atrophy of the optic nerve is very often caused by: heredity and congenital pathologies, some diseases of the organ of vision, pathologies in the optic nerve itself or in (including inflammation, trauma, swelling, congestion, toxic damage, dystrophy, circulatory disorders and compression of the optic nerve). nerve), disease nervous system, general diseases.

Lesions of the central nervous system are considered to be the main “culprits” for the development of atrophy, these include: tumors, syphilitic lesions, meningitis, brain abscesses, encephalitis, skull injuries, multiple. In addition, the reasons for the development of such an anomaly can be atherosclerosis, hypertension, quinine poisoning, profuse bleeding, and vitamin deficiencies.

Starvation of the tissues of the internal structures of the eye due to obstruction of the central or peripheral arteries can also cause nerve atrophy. In addition, such atrophy is considered the main symptom.

Manifestations of the disease

In ophthalmology, it is customary to divide optic nerve atrophy into primary and secondary, partial and complete, complete and progressive, as well as unilateral and bilateral.

A characteristic symptom of this pathology is uncorrectable vision loss. This symptom can appear different ways, depending on the type of atrophy. The progression of the disease leads to a continuous decrease in vision due to the death of the optic nerve, which ultimately leads to complete blindness. This process, as a rule, occurs either rapidly - in a few days, or gradually - over the course of months.

Partial atrophy of the optic nerve in its course always stops the process of vision deterioration at some stage, after which vision stabilizes. This makes it possible to distinguish between progressive and complete atrophy.

Visual impairments during the course of the disease are of a very diverse nature, including changes in visual fields (usually narrowing with loss of “lateral vision”), up to “tunnel vision”, when a person sees as if through a tube, i.e. only those objects that are directly in front of it. This condition is associated with the appearance of - dark spots There is any color vision disorder in any part of the visual field.

With CHAZN, changes in visual fields are not only “tunnel”, which is due to the localization of the pathological process. Thus, the development of scotomas before the eyes may indicate a change in the nerve fibers of the central part of the retina or the area immediately adjacent to it. When the nerve fibers of the periphery are affected, a narrowing of the visual fields develops, and when the lesions are deep enough, the disappearance of half the visual field is observed. These changes can develop in either one or both eyes.

Diagnosis of CHAZN

It is unacceptable to engage in self-diagnosis, and even more so self-medication for optic nerve atrophy, since similar symptoms are also observed in peripheral vision, in which, initially, lateral vision undergoes a change, with the involvement of the central parts at later stages. It must be remembered that optic nerve atrophy is not always an independent disease. Often, this is a manifestation of a serious disease of the nervous system. Therefore, establishing its causes in the early stages seems especially important.

The symptoms described above are a reason for immediate contact with specialists (including an ophthalmologist and a neurologist).

Diagnosis of optic atrophy is usually not difficult. To identify it, an examination is prescribed, including: determination of visual acuity, its fields, as well as tests for color perception. At the same time, it is necessary to carry out a test, which can reveal the characteristic pallor of the optic nerve head and some narrowing of the fundus. Intraocular pressure is measured.

Often, to clarify the diagnosis, an X-ray examination (craniography with an image of the sella turcica), magnetic resonance or computed tomography brain, fluorescein angiographic or electrophysiological research methods, using contrast, when inspecting the patency of retinal vessels.

Laboratory tests are also necessary - general analysis blood, its biochemistry, test for borelliosis, as well as syphilis.

Video about the latest developments in the treatment of CHAZN

Optic nerve atrophy, including partial, is almost impossible to cure, because the affected nerve fibers cannot be restored. There is little hope that there will be an effect from therapy for those fibers that are not yet completely destroyed and partially retain their vital functions. True, if this moment has already been missed, vision is lost forever.

It is worth remembering that often partial atrophy of the optic nerve is not a separate disease, but develops due to certain pathological processes developing in the departments visual pathway. Therefore, its treatment, as a rule, begins with eliminating the causes of the pathology. If by this time the atrophy has not yet developed sufficiently, then over some time (sometimes up to two months) the picture will most likely normalize, with restoration visual functions.

Drug treatment for this disease is aimed at the timely elimination of swelling and inflammation, improving the trophism of the optic nerve and its blood circulation, and restoring the conductivity of nerve fibers.

It should be noted that this process is long, with little pronounced effect, which is completely absent in advanced cases. Therefore, the success of treatment certainly depends on how quickly atrophy is diagnosed.

As noted above, the main thing is the treatment of the disease that caused atrophy, therefore it is prescribed complex therapy with various forms of drugs: eye drops, injections (general and local), tablets, physiotherapy. Such treatment aims to:
Improving blood circulation and vessels supplying the nerve. For this purpose, vasodilators are used (complamin, no-shpu, nicotinic acid, papaverine, dibazol, halidor, aminophylline, sermion, trental), as well as anticoagulants (heparin or ticlid);
Improving tissue metabolic processes and activating the regeneration of affected tissues. For this, biogenic stimulants (aloe extract, peat, etc.), tamines (B1, B2, B6, ascorutin), enzymatic agents (fibrinolysin, lidase), essential amino acids (glutamic acid), as well as immunostimulants (ginseng, eleuthorococcus);
Cupping inflammatory processes through hormonal drugs (dexamethasone,);
Improving the functions of the central nervous system (Cerebrolysin, nootropil, Fezam, emoxipin, Cavinton).

Any medications must be taken strictly according to the regimen prescribed by the attending physician after diagnosis. Since only a specialist can choose optimal treatment, taking into account concomitant diseases.

At the same time, physiotherapeutic procedures and acupuncture may be prescribed; sessions of laser, magnetic, and electrical stimulation of optic nerve tissue.

Such treatment must be repeated in courses several times a year.

If there is an obvious decrease in vision, a disability group may be assigned.

Those who are blind due to disease and visually impaired are prescribed rehabilitation courses, which are aimed at eliminating or compensating for the limitations in life that have arisen due to loss of vision.

Remember that this disease cannot be treated with folk remedies; do not waste precious time on it when there is still a chance to cure atrophy and preserve vision.

Where to treat?

Choice medical institution for the treatment of optic nerve atrophy is a very important issue, since the result of treatment, including the prognosis for recovery, completely depends on the thoroughness of the examination and the professionalism of the doctor. Be sure to pay attention to the level of equipment of the clinic, as well as the qualifications of its specialists, because only the attention and experience of the medical staff allows you to achieve best effect in the treatment of eye diseases.

19-12-2012, 14:49

Description

is not an independent disease. This is a consequence of various pathological processes affecting various areas visual path. It is characterized by decreased visual function and blanching of the optic nerve head.

Etiology

Development of optic nerve atrophy cause various pathological processes in the optic nerve and retina(inflammation, dystrophy, edema, circulatory disorders, the effects of toxins, compression and damage to the optic nerve), diseases of the central nervous system, general diseases of the body, hereditary causes.

Lead to optic nerve atrophy general diseases. This happens with poisoning with ethyl and methyl alcohols, tobacco, quinine, chlorophos, sulfonamides, lead, carbon disulfide and other substances, with botulism. Vascular diseases can cause acute or chronic circulatory disorders in the vessels of the optic nerve with the development of ischemic foci and foci of softening (colliquation necrosis). Essential and symptomatic hypertension, atherosclerosis, diabetes mellitus, internal profuse bleeding, anemia, diseases of cardio-vascular system, fasting, vitamin deficiencies can lead to optic nerve atrophy.

In the etiology of optic nerve atrophy, the following are also important: diseases of the eyeball. These are lesions of the retina of vascular origin (with hypertensive angiosclerosis, atherosclerosis, involutional changes), retinal vessels (inflammatory and allergic vasculitis, obstruction of the central artery and central vein retina), dystrophic diseases of the retina (including pigmentary dystrophy retina), complications of uveitis (papillitis, chorioretinitis), retinal detachment, primary and secondary glaucoma (inflammatory and post-inflammatory, flicogenic, vascular, dystrophic, traumatic, postoperative, neoplastic). Prolonged hypotension of the eyeball after surgery, inflammatory degenerative diseases of the ciliary body, penetrating wounds of the eyeball with the formation of a fistula lead to swelling of the optic disc (congestive papilla), after which atrophy of the optic disc develops.

In addition to Leber's hereditary atrophy and hereditary infantile optic nerve atrophy, hereditary causes are important in the occurrence of atrophy in drusen of the optic nerve head. Diseases and deformations of the skull bones (tower-shaped skull, Crouzon's disease) also lead to atrophy of the optic nerves.

It should be noted that in practice the etiology of optic nerve atrophy is not always easy to establish. According to E. Zh. Tron, in 20.4% of patients with optic nerve atrophy, its etiology was not established.

Pathogenesis

Nerve fibers of the peripheral neuron of the optic pathway can be subject to various influences. This is inflammation, non-inflammatory edema, dystrophy, circulatory disorders, the action of toxins, damage, compression (tumor, adhesions, hematomas, cysts, sclerotic vessels, aneurysms), which leads to the destruction of nerve fibers and their replacement with glial and connective tissue, obliteration of the capillaries that feed them .

Moreover, when increasing intraocular pressure develops collapse of the glial cribriform membrane of the optic disc, which leads to degeneration of nerve fibers in vulnerable areas of the disc, and then to disc atrophy with excavation resulting from direct compression of the disc and secondary disruption of microcirculation.

Classification

According to the ophthalmoscopic picture, they distinguish primary (simple) and secondary optic nerve atrophy. Primary atrophy occurs on a previously unchanged disc. With simple atrophy, nerve fibers are promptly replaced by proliferating elements of glia and connective tissue that take their places. The boundaries of the disc remain distinct. Secondary optic disc atrophy occurs on the altered disc due to its swelling (congestive nipple, anterior ischemic neuropathy) or inflammation. In place of dead nerve fibers, as in primary atrophy, glial elements penetrate, but this occurs more rapidly and in large sizes, resulting in the formation of rough scars. The boundaries of the optic disc are not distinct, blurred, and its diameter may be increased. The division of atrophy into primary and secondary is arbitrary. With secondary atrophy, the boundaries of the disc are only unclear at first; over time, the swelling disappears and the boundaries of the disc become clear. Such atrophy is no longer different from simple atrophy. Sometimes glaucomatous (marginal, cavernous, cauldron) atrophy of the optic disc is classified as a separate form. With it, there is practically no proliferation of glia and connective tissue, and as a result of the direct mechanical effect of increased intraocular pressure, depression (excavation) of the optic nerve disc occurs as a result of the collapse of its glial-cribriform membrane.

Optic disc atrophy, depending on the degree of color loss detected during ophthalmoscopy, is divided into initial, partial, incomplete and complete. With initial atrophy, a slight blanching appears against the background of the pink color of the disc, which later becomes more intense. When not the entire diameter of the optic nerve is affected, but only part of it, partial atrophy of the optic nerve head develops. Thus, when the papillomacular bundle is damaged, blanching of the temporal half of the optic nerve occurs. With further spread of the process, partial atrophy can spread to the entire nipple. With diffuse spread of the atrophic process, uniform blanching of the entire disc is noted. If visual functions are still preserved, then they speak of incomplete atrophy. With complete atrophy of the optic nerve, the disc becomes completely blanched and the visual functions of the affected eye are completely lost (amaurosis). Not only visual but also reflex nerve fibers pass through the optic nerve, therefore, with complete atrophy of the optic nerve, the direct reaction of the pupil to light is lost on the affected side, and the friendly one on the other eye.

Topically isolated ascending and descending optic atrophy. Retinal ascending atrophy (waxy, valerian) occurs during inflammatory and dystrophic processes in the retina due to primary damage to the visual ganglion neurocytes of the ganglion layer of the retina. The optic disc becomes grayish-yellow, the vessels of the disc narrow, and their number decreases. Ascending atrophy does not develop when only the neuroepithelial layer of the retina (rods and cones) is affected. Descending optic atrophy occurs when a peripheral neuron of the optic pathway is damaged and slowly descends to the optic disc. Having reached the optic nerve head, the atrophic process changes it according to the type of primary atrophy. Descending atrophy spreads more slowly than ascending atrophy. The closer the process is to the eyeball, the faster optic disc atrophy appears in the fundus. Thus, damage to the optic nerve at the site where the central retinal artery enters it (10-12 mm behind the eyeball) causes atrophy of the optic nerve head in 7-10 days. Damage to the intraorbital segment of the optic nerve before the entrance of the central retinal artery leads to the development of optic disc atrophy after 2-3 weeks. With retrobulbar neuritis, atrophy descends to the fundus within 1-2 months. With chiasm injuries, descending atrophy descends to the fundus 4-8 weeks after the injury, and with slow compression of the chiasm by pituitary tumors, optic disc atrophy develops only after 5-8 months. Thus, the rate of spread of descending atrophy is also associated with the type and intensity of the pathological process affecting the peripheral neuron of the visual pathway. They also matter blood supply conditions: the atrophic process develops faster when the blood supply to nerve fibers deteriorates. Atrophy of the optic discs with damage to the optic tract occurs approximately a year after the onset of the disease (slightly faster with injuries to the optic tract).

Optic nerve atrophy may be stationary and progressive, which is assessed during a dynamic study of the fundus and visual functions.

If one eye is affected, it is said unilateral, if both eyes are affected - o bilateral optic atrophy. Atrophy of the optic nerves during intracranial processes is often bilateral, but the degree of its severity varies. Unilateral optic nerve atrophy also occurs in intracranial processes, which is especially common when the pathological focus is localized in the anterior cranial fossa. Unilateral atrophy during intracranial processes can be the initial stage of bilateral atrophy. In case of impaired blood circulation in the vessels of the optic nerve or intoxication, the process is usually bilateral. Unilateral atrophy occurs with damage to the optic nerve, pathological processes in the orbit, or is caused by unilateral pathology of the eyeball.

Ophthalmoscopic picture

With optic nerve atrophy there is always optic disc pallor A. There is often, but not always, vasoconstriction of the optic disc.

With primary (simple) atrophy The boundaries of the disc are clear, its color is white or grayish-white, bluish or slightly greenish. In red-free light, the contours of the disc remain clear or become sharper, while the contours of a normal disc are veiled. In red (purple) light, the atrophic disc appears blue. The cribriform plate (lamina cribrosa), through which the optic nerve passes as it enters the eyeball, very little shines through. Translucency of the cribriform plate is due to a decrease in blood supply to the atrophied disc and less proliferation of glial tissue than with secondary atrophy. Disc blanching can vary in intensity and distribution. With initial atrophy, a slight but distinct blanching appears against the background of the pink color of the disc, then it becomes more intense while the pink tint weakens, which then completely disappears. With advanced atrophy, the disc is white. At this stage of atrophy, vasoconstriction is almost always observed, and the arteries are narrowed more sharply than the veins. The number of vessels on the disc also decreases. Normally, about 10 small vessels. With atrophy, their number decreases to 7-6, and sometimes to three (Kestenbaum's symptom). Sometimes, with primary atrophy, a slight excavation of the optic nerve head is possible.

With secondary atrophy The boundaries of the disc are unclear and blurred. Its color is gray or dirty gray. The vascular infundibulum or physiological excavation is filled with connective or glial tissue; the lamina cribrosa is not visible. These changes are usually more pronounced with atrophy after a congestive nipple than with atrophy after optic neuritis or anterior ischemic neuropathy.

Retinal waxy optic disc atrophy It is distinguished by its yellow waxy color.

For glaucoma Increased intraocular pressure causes the appearance of glaucomatous excavation of the optic disc. In this case, first the vascular bundle of the disc shifts to the nasal side, then the excavation of the nipple gradually develops, which gradually increases. The color of the disc becomes whitish and pale. A cauldron-shaped excavation covers almost the entire disc to its edges (cauldron-shaped, marginal excavation), which distinguishes it from physiological excavation, which has the shape of a funnel that does not reach the edges of the disc and does not displace the vascular bundle to the nasal side. The vessels at the edge of the disc bend over the edge of the depression. In advanced stages of glaucoma, the excavation involves the entire disc, which becomes completely white, and the vessels on it are greatly narrowed.

Cavernous atrophy occurs when the optic nerve vessels are damaged. The atrophic optic disc begins to gouge under the influence of normal intraocular pressure with the appearance of excavation, whereas excavation of a normal disc requires increased intraocular pressure. Excavation of the disc in cavernous atrophy is facilitated by the fact that the proliferation of glia is small, and therefore no additional resistance is created that prevents excavation.

Visual functions

Visual acuity of patients with optic atrophy depends on the location and intensity of the atrophic process. If the papillomacular bundle is affected, then visual acuity is noticeably reduced. If the papillomacular bundle is slightly affected, and the peripheral fibers of the optic nerve are more affected, then visual acuity does not decrease much. If there is no damage to the papillomacular bundle, and only the peripheral fibers of the optic nerve are affected, then visual acuity does not change.

Changes in field of view with optic nerve atrophy, they are important in topical diagnosis. They depend to a greater extent on the localization of the pathological process and to a lesser extent on its intensity. If the papillomacular bundle is affected, a central scotoma occurs. If the peripheral fibers of the optic nerve are affected, narrowing develops peripheral boundaries field of view (uniform along all meridians, uneven, sector-shaped). If optic nerve atrophy is associated with damage to the chiasm or optic tract, hemianopsia (homonymous and heteronymous) occurs. Hemianopsia in one eye occurs when the intracranial part of the optic nerve is damaged.

Color vision disorders more often occur and are clearly expressed with atrophy of the optic nerve head, occurring after neuritis, and rarely with atrophy after edema. First of all, the color perception of green and red colors suffers.

Often with optic nerve atrophy changes in the fundus correspond to changes in visual functions, but this does not always happen. Thus, with descending atrophy of the optic nerve, visual functions can be greatly changed, and the fundus for a long time remains normal until the atrophic process descends to the optic nerve head. Severe pallor of the optic disc in combination with a slight change in visual functions is also possible. This can happen in multiple sclerosis, when the death of myelin sheaths in the area of plaques occurs while the axial cylinders of the nerve fibers are preserved. Severe disc pallor while maintaining visual functions may also be associated with the peculiarity of the blood supply in the area of the lamina cribrosa of the sclera. This area is supplied with blood from the posterior short ciliary arteries; deterioration of blood flow through them causes intense blanching of the disc. The rest (orbital) part of the optic nerve is supplied with blood from the anterior and posterior arteries optic nerve, that is, from other vessels.

With blanching of the optic nerve head, combined with a normal state of visual functions, it is necessary to study the visual field using campimetry to identify small defects. In addition, you need to collect an anamnesis about the initial visual acuity, since sometimes visual acuity can be above one, and in these cases its decrease to one may indicate the influence of the atrophic process.

With unilateral atrophy a thorough examination of the functions of the second eye is necessary, since unilateral atrophy can only be the beginning of bilateral atrophy, which often happens with intracranial processes. Changes in the visual field of the other eye indicate a bilateral process and acquire important topical and diagnostic significance.

Diagnostics

In severe cases, diagnosis is not difficult. If the pallor of the optic disc is insignificant (especially temporal, since the temporal half of the disc is normally somewhat paler than the nasal half), then a long-term study of visual functions over time helps establish the diagnosis. In this case it is necessary pay special attention to the study of the visual field on White color and colored objects. Electrophysiological, radiological and fluorescein angiographic studies facilitate diagnosis. Characteristic changes visual fields and an increase in the threshold of electrical sensitivity (up to 400 μA when the norm is 40 μA) indicate optic nerve atrophy. The presence of marginal excavation of the optic nerve head and increased intraocular pressure indicate glaucomatous atrophy.

Sometimes it is difficult to determine the type of damage to the optic nerve or the nature of the underlying disease just by the presence of disc atrophy in the fundus. Blurring of the disc boundaries during atrophy indicates that it was the result of edema or inflammation of the disc. It is necessary to study the anamnesis in more detail: the presence of symptoms of intracranial hypertension indicates the post-congestive nature of atrophy. The presence of simple atrophy with clear boundaries does not exclude its inflammatory origin. So, descending atrophy due to retrobulbar neuritis and inflammatory processes of the brain and its membranes, it causes changes in the disc in the fundus similar to simple atrophy. Nature of atrophy(simple or secondary) is of great importance in diagnosis, since certain diseases lead to certain, “favorite” types of damage to the optic nerves. For example, compression of the optic nerve or chiasm by a tumor leads to the development of simple atrophy of the optic nerves, tumors of the ventricles of the brain - to the development of congestive nipples and further to secondary atrophy. However, diagnosis is complicated by the fact that some diseases, for example meningitis, arachnoiditis, neurosyphilis, can be accompanied by both simple and secondary atrophy of the optic discs. In this case, accompanying eye symptoms are important: changes in the vessels of the retina, the retina itself, choroid, as well as a combination of optic nerve atrophy with disorder of pupillary reactions.

When assessing the degree of color loss and pallor of the optic nerve head it is necessary to take into account the general background of the fundus. Against the parquet background of the fundus of brunettes, even a normal or slightly atrophied disc appears paler and whiter. Against a light background of the fundus, the atrophic nipple may not look so pale and white. In severe anemia, the optic discs are completely white, but more often a faint pink tint remains. In hypermetropes, the optic discs are in in good condition more hyperemic, and with high degree hyperopia may be a picture of false neuritis (severe hyperemia of the nipples). With myopia, the optic discs are paler than those of emmetropes. The temporal half of the optic nerve head is normally somewhat paler than the nasal half.

Optic nerve atrophy in some diseases

Brain tumors . Secondary atrophy of the optic nerve in brain tumors is a consequence of congestive nipples. It occurs more often with tumors cerebellopontine angle, hemispheres and ventricles of the brain. With subtentorial tumors, secondary atrophy occurs less frequently than with supratentorial ones. The incidence of secondary atrophy is influenced not only by the location, but also by the nature of the tumor. It occurs more often with benign tumors. It develops especially rarely with metastases of malignant tumors in the brain, since death occurs before stagnant nipples turn into secondary atrophy.

Primary (simple) optic nerve atrophy occurs when compression of the peripheral neuron of the optic pathway. Most often, the chiasm is affected, less often the intracranial part of the optic nerve, and even less often the optic tract. Simple atrophy of the optic nerve is characteristic of supratentorial brain tumors; it is especially often caused by tumors of the chiasmal-sellar region. Rarely, primary atrophy of the optic nerves occurs with subtentorial tumors as a symptom at a distance: compression of the peripheral neuron of the optic pathway occurs through the dilated ventricular system or by brain dislocation. Primary optic atrophy rarely occurs with tumors of the ventricles of the cerebral hemispheres, cerebellum and cerebellopontine angle, and secondary atrophy with tumors of this localization is common. Rarely, simple atrophy of the optic nerves develops with malignant tumors and often with benign ones. Primary optic atrophy is usually caused by benign tumors sella turcica (pituitary adenomas, craniopharyngiomas) and meningiomas of the lesser wing of the sphenoid bone and olfactory fossa. Optic nerve atrophy develops in Foster Kennedy syndrome: simple atrophy in one eye and a congestive nipple with possible progression to secondary atrophy in the other eye.

Brain abscesses . Congestive discs often develop, but they rarely progress to secondary optic atrophy, as increased intracranial pressure does not last so long, since intracranial hypertension either decreases after surgery, or patients do not live to see the transition of stagnant nipples to secondary atrophy. Foster Kennedy syndrome is rare.

Optochiasmal arachnoiditis . More often, primary atrophy of the optic discs occurs in the form of blanching of the entire nipple or its temporal half (partial atrophy). In isolated cases, the upper or lower half of the disc may become pale.

Secondary atrophy of the optic discs in optochiasmal arachnoiditis can be postneuritic (transition of inflammation from meninges on the optic nerve) or post-congestive (occurs after congestive nipples).

Arachnoiditis of the posterior cranial fossa . Often lead to the development of pronounced congestive nipples, which then develop into secondary atrophy of the optic discs.

Aneurysms of the vessels of the base of the brain . Aneurysms anterior section The circle of Willis often puts pressure on the intracranial part of the optic nerve and the chiasm, which leads to the development of simple atrophy of the optic nerve. Simple atrophy due to compression of the optic nerve is unilateral, always located on the side of the aneurysm. When pressure is applied to the chiasm, bilateral simple atrophy occurs, which may first occur in one eye and then appear in the other. Unilateral simple atrophy of the optic nerve most often occurs with aneurysms of the internal carotid artery, less often with aneurysms of the anterior cerebral artery. Aneurysms of the vessels of the base of the brain most often manifest as unilateral paralysis and paresis of the nerves of the oculomotor system.

Thrombosis of the internal carotid artery . The presence of alternating optic-pyramidal syndrome is characteristic: blindness of the eye with simple atrophy of the optic disc on the side of thrombosis in combination with hemiplegia on the other side.

Tabes dorsalis and progressive paralysis . With tabes and progressive paralysis, atrophy of the optic nerves is usually bilateral and has the character of simple atrophy. Optic nerve atrophy is more common with tabes than with progressive paralysis. The atrophic process begins with the peripheral fibers and then slowly goes deep into the optic nerve, so there is a gradual decrease in visual functions. Visual acuity gradually decreases with varying degrees of severity in both eyes, up to bilateral blindness. Visual fields gradually narrow, especially to colors, in the absence of scotomas. Optic nerve atrophy with tabes usually develops in early period diseases when others neurological symptoms(ataxia, paralysis) are not expressed or absent. Tabes is characterized by a combination of simple optic atrophy with Argil Robertson's sign. Reflex immobility of the pupils during tabesa is often combined with miosis, anisocoria and pupillary deformation. Argil Robertson's symptom also occurs with syphilis of the brain, but much less frequently. Secondary atrophy of the optic discs (post-congestive and post-neuritic) speaks against tabes and often occurs with syphilis of the brain.

Atherosclerosis . Optic nerve atrophy in atherosclerosis occurs as a result of direct compression of the optic nerve by sclerotic carotid artery or due to damage to the vessels supplying the optic nerve. Primary optic nerve atrophy develops more often, and secondary atrophy develops much less often (after disc edema due to anterior ischemic neuropathy). There are often sclerotic changes in the retinal vessels, but these changes are also characteristic of syphilis, hypertension and kidney disease.

Hypertonic disease . Optic nerve atrophy may be a consequence of neuroretinopathy. This is secondary disc atrophy with associated symptoms, characteristic of hypertensive angioretinopathy.

In hypertension, optic nerve atrophy may occur as an independent process not associated with changes in the retina and retinal vessels. In this case, atrophy develops due to damage to the peripheral neuron of the visual pathway (nerve, chiasm, tract) and has the character of primary atrophy.

Profuse bleeding . After profuse bleeding (gastrointestinal, uterine), after a more or less long time, from several hours to 3-10 days, anterior ischemic neuropathy may develop, after which secondary atrophy of the optic discs develops. The lesion is usually bilateral.

Leberian optic atrophy . Familial hereditary optic atrophy (Leber's disease) is observed in men 16-22 years old in several generations and is transmitted through the female line. The disease proceeds as bilateral retrobulbar neuritis, starting with a sharp decrease in vision. After a few months, simple atrophy of the optic discs develops. Sometimes the entire nipple turns pale, sometimes only the temporal halves. Complete blindness usually does not occur. Some authors believe that Leber's atrophy is a consequence of optochiasmal arachnoiditis. The type of inheritance is recessive, linked to the X chromosome.

Hereditary infantile optic atrophy . Children aged 2-14 years are affected. Gradually, simple atrophy of the optic nerves develops with temporal blanching of the disc, most rarely the nipple. High visual acuity is often maintained, and blindness in both eyes never occurs. Central scotomas often occur in the field of vision of both eyes. Color perception is usually impaired, more towards blue than red and green colors. The type of inheritance is dominant, that is, the disease is transmitted from sick fathers and sick mothers to both sons and daughters.

Diseases and deformations of the skull bones . In the early childhood with a tower-shaped skull and Crouzon's disease (craniofacial dysostosis), congestive nipples may develop, after which secondary atrophy of the optic discs of both eyes develops.

Principles of treatment

Treatment of patients with optic nerve atrophy is carried out taking into account its etiology. Patients with optic nerve atrophy, which has developed due to compression of the peripheral neuron of the optic pathway by the intracranial process, require neurosurgical treatment.

To improve blood supply to the optic nerve use vasodilators, vitamin preparations, biogenic stimulants, neuroprotectors, infusion hypertonic solutions. It is possible to use oxygen therapy, blood transfusions, and the use of heparin. In the absence of contraindications, physiotherapy is used: ultrasound on open eye and endonasal drug electrophoresis vasodilators, vitamin preparations, lecozyme (papain), lidase; electrical and magnetic stimulation of the optic nerves is used.

Forecast

Prognosis of optic nerve atrophy always serious. In some cases, you can expect to preserve your vision. If atrophy develops, the prognosis is unfavorable. Treatment of patients with optic atrophy, whose visual acuity has been less than 0.01 for several years, is ineffective.

Article from the book: .

A rapid decrease in vision may indicate various eye diseases. But rarely does anyone think that it can be caused by such dangerous disease as optic nerve atrophy. The optic nerve is an important component in the perception of light information. Therefore, it is worth taking a closer look at this disease so that it is possible to identify the symptoms in the early stages.

What it is?

The optic nerve is a nerve fiber responsible for processing and transmitting light information. The main function of the optic nerve is to deliver nerve impulses to the brain area.

The optic nerve is attached to retinal ganglion neurocytes, which make up the optic disc. Light rays, converted into a nerve impulse, are transmitted along the optic nerve from the retinal cells to the chiasma (the segment where the optic nerves of both eyes intersect).

Where is the optic nerve located?

Its integrity ensures high. However, even the smallest injuries to the optic nerve can lead to severe consequences. The most common disease of the optic nerve is its atrophy.

Optic atrophy is an eye disease in which the optic nerve deteriorates, resulting in decreased vision. With this disease, the fibers of the optic nerve completely or partially die and are replaced by connective tissue. As a result, light rays falling on the retina of the eye are converted into an electrical signal with distortions, which narrows the field of view and reduces its quality.

Depending on the degree of damage, optic nerve atrophy can be partial or complete. Partial atrophy of the optic nerve differs from complete atrophy by a less pronounced manifestation of the disease and preservation of vision at a certain level.

Vision correction traditional methods ( , contact lenses) are absolutely ineffective for this disease, since they are aimed at correcting the refraction of the eye and have nothing to do with the optic nerve.

Causes

Optic nerve atrophy is not an independent disease, but is a consequence of some pathological process in the patient’s body.

Optic atrophy

The main causes of the disease include:

Eye diseases (diseases of the retina, eyeball, eye structures).
Pathologies of the central nervous system (brain damage due to syphilis, brain abscess, skull injury, brain tumors, multiple sclerosis, encephalitis, meningitis, arachnoiditis).
Diseases of the cardiovascular system (cerebral atherosclerosis, arterial hypertension, vascular spasm).
Long-term toxic effects of alcohol, nicotine and drugs. Alcohol poisoning methyl alcohol.
Hereditary factor.

Optic nerve atrophy can be congenital or acquired.

Congenital optic atrophy occurs as a result of genetic diseases(in most cases of Leber's disease). In this case, the patient has low quality of vision from birth.

Acquired optic atrophy appears as a result of certain diseases in older age.

Symptoms

The main symptoms of partial visual atrophy may be:

Deterioration in the quality of vision and the inability to correct it with traditional correction methods.
Pain when moving the eyeballs.
Change in color perception.
Narrowing of visual fields (up to the manifestation of tunnel syndrome, in which the ability to peripherally view is completely lost).
The appearance of blind spots in the field of vision (scotomas).

Methods laser correction view can be seen in .

Stages of optic nerve atrophy

Diagnostics

Typically, diagnosing this disease does not cause any particular difficulties. As a rule, the patient notices a significant decrease in vision and consults an ophthalmologist, who makes the correct diagnosis. Great importance has the identification of the cause of the disease.

To identify optic nerve atrophy in a patient, a complex diagnostic methods:

(visual acuity test).
Spheroperimetry (determination of visual fields).
Ophthalmoscopy (detection of pallor of the optic nerve head and narrowing of the fundus vessels).
Tonometry (measurement of intraocular pressure).
Video-ophthalmography (study of the optic nerve relief).
(examination of areas of the affected nerve).
Computed tomography and magnetic resonance imaging (a study of the brain to detect possible reasons, causing optic nerve atrophy).

Read what computer perimetry determines in ophthalmology.

Except ophthalmological examination the patient may be prescribed an examination by a neurologist or neurosurgeon. This is necessary because the symptoms of optic nerve atrophy may be symptoms of an incipient intracranial pathological process.

Treatment

Treatment of optic nerve atrophy is quite complex. Destroyed nerve fibers cannot be restored, so first of all it is necessary to stop the process of changes in the tissues of the optic nerve. Since the nerve tissue of the optic nerve cannot be restored, visual acuity cannot be raised to the previous level. However, the disease must be treated to avoid its progression and blindness. The prognosis of the disease depends on the timing of the start of treatment, so it is advisable to immediately consult an ophthalmologist when the first symptoms of the disease are detected.

The difference between partial optic nerve atrophy and complete one is that this form of the disease is treatable and it is still possible to restore vision. The main goal in the treatment of partial optic nerve atrophy is to stop the destruction of optic nerve tissue.

The main efforts should be aimed at eliminating. Treatment of the underlying disease will stop the destruction of optic nerve tissue and restore visual function.

During the treatment of the underlying disease that caused optic nerve atrophy, complex therapy is carried out. Additionally, during treatment, medications can be used to improve blood supply and nutrition to the optic nerve, improve metabolism, eliminate swelling and inflammation. It would be a good idea to take multivitamins and biostimulants.

The main drugs used are:

Vasodilators. These drugs improve blood circulation and trophism in the tissues of the optic nerve. Among the drugs in this group one can highlight complamin, papaverine, dibazol, no-shpu, halidor, aminophylline, trental, sermion.
Drugs that stimulate the restoration of altered tissues of the optic nerve and improve metabolic processes in it. These include biogenic stimulants (peat, aloe extract), amino acids (glutamic acid), vitamins and immunostimulants (eleuthorococcus, ginseng).
Drugs that resolve pathological processes and metabolic stimulants (phosphaden, pyrogenal, preductal).

It is necessary to understand that drug therapy does not treat optic nerve atrophy, but only helps to improve the condition of the nerve fibers. To cure optic nerve atrophy, it is necessary to first cure the underlying disease.

Physiotherapeutic procedures, which are used in combination with other treatment methods, are also important. Also, methods of magnetic, laser and electrical stimulation of the optic nerve are effective. They contribute to improvement functional state optic nerve and visual functions.

As additional treatment The following procedures apply:

Magnetic stimulation. During this procedure, the optic nerve is exposed to a special device that creates an alternating magnetic field. Magnetic stimulation helps improve blood supply, saturate the tissues of the optic nerve with oxygen, and activate metabolic processes.
Electrical stimulation. This procedure is carried out using a special electrode, which is inserted behind the eyeball to the optic nerve and electrical impulses are applied to it.
Laser stimulation. The essence of this method is non-invasive stimulation of the optic nerve through the cornea or pupil using a special emitter.
Ultrasound therapy. This method effectively stimulates blood circulation and metabolic processes in the tissues of the optic nerve, improves the permeability of the blood-ophthalmic barrier and the sorption properties of eye tissues. If the cause of optic nerve atrophy is encephalitis or tuberculous meningitis, then the disease will be quite difficult to treat with ultrasound.
Electrophoresis. This procedure characterized by the effect of low-power direct current on the eye tissue and medicines. Electrophoresis promotes expansion blood vessels, improving cell metabolism and normalizing metabolism.
Oxygen therapy. This method consists of saturating the tissues of the optic nerve with oxygen, which helps improve metabolic processes in them.

During the treatment of optic nerve atrophy, it is imperative to maintain a high-quality diet rich in various vitamins and minerals. It is necessary to consume fresh vegetables and fruits, cereals, meat, and dairy products more often.

See what foods improve vision.

It is not recommended to treat the disease with folk remedies, since in this case they are ineffective. If you only hope for folk remedies, you can lose precious time when the quality of vision could still be preserved.

Complications

It must be remembered that optic nerve atrophy is serious illness and you should not treat it yourself. Incorrect self-treatment can lead to dire consequences - complications of the disease.

The most serious complication There may be complete loss of vision. Ignoring treatment leads to further development disease and a steady decrease in visual acuity, as a result of which the patient will no longer be able to lead his previous lifestyle. Very often, with optic nerve atrophy, the patient becomes disabled.

Prevention

To avoid the occurrence of optic nerve atrophy, it is necessary to treat diseases in a timely manner, consult an ophthalmologist in a timely manner if visual acuity decreases, and not expose the body to alcohol and drug intoxication. Only if you pay due attention to your health can you reduce the risk of disease.