Optic nerve atrophy: causes of pathology and treatment. Optic nerve atrophy - treatment and prognosis How optic nerve atrophy is treated
Update: December 2018
The quality of life is primarily affected by our health. Free breathing, clear hearing, freedom of movement - all this is very important for a person. Disruption of even one organ can lead to a change in the usual way of life in a negative direction. For example, forced refusal of active physical activity (running in the morning, going to the gym), eating tasty (and fatty) foods, intimate relationships, etc. This manifests itself most clearly when the organ of vision is damaged.
Most eye diseases have a fairly favorable course for humans, since modern medicine can cure them or reduce their negative effects to nothing (correct vision, improve color perception). Complete and even partial atrophy of the optic nerve does not belong to this “majority”. With this pathology, as a rule, the functions of the eye are significantly and irreversibly impaired. Often patients lose the ability to perform even daily activities and become disabled.
Can this be prevented? Yes, you can. But only with timely detection of the cause of the disease and adequate treatment.
What is optic atrophy
This is a condition in which the nervous tissue experiences an acute lack of nutrients, due to which it ceases to perform its functions. If the process continues long enough, the neurons begin to gradually die. Over time, it affects an increasing number of cells, and in severe cases, the entire nerve trunk. It will be almost impossible to restore eye function in such patients.
To understand how this disease manifests itself, it is necessary to imagine the course of impulses to brain structures. They are conventionally divided into two portions – lateral and medial. The first contains a “picture” of the surrounding world, which is seen by the inner side of the eye (closer to the nose). The second is responsible for the perception of the outer part of the image (closer to the crown).
Both parts are formed on the back wall of the eye, from a group of special (ganglion) cells, after which they are sent to various structures of the brain. This path is quite difficult, but there is one fundamental point - almost immediately after leaving the orbit, a cross occurs in internal portions. What does this lead to?
- The left tract perceives the image of the world from the left side of the eyes;
- The right one transfers the “picture” from the right halves to the brain.
Therefore, damage to one of the nerves after it has left the orbit will result in changes in the function of both eyes.
Causes
In the vast majority of cases, this pathology does not occur independently, but is a consequence of another eye disease. It is very important to consider the cause of optic nerve atrophy, or rather the location of its occurrence. It is this factor that will determine the nature of the patient’s symptoms and the specifics of therapy.
There may be two options:
- Ascending type - the disease occurs from that part of the nerve trunk that is closer to the eye (before the chiasm);
- Descending form - the nervous tissue begins to atrophy from top to bottom (above the chiasm, but before entering the brain).
The most common causes of these conditions are presented in the table below.
| Characteristic reasons | a brief description of |
Ascending type |
|
| Glaucoma | This word hides a number of disorders that are united by one feature - increased intraocular pressure. Normally, it is necessary to maintain the correct shape of the eye. But with glaucoma, pressure impedes the flow of nutrients to the nerve tissue and makes them atrophic. |
| Intrabulbar neuritis | An infectious process that affects neurons in the cavity of the eyeball (intrabulbar form) or behind it (retrobulbar type). |
| Retrobulbar neuritis | |
| Toxic nerve damage | Exposure to toxic substances in the body leads to the breakdown of nerve cells. The following have a damaging effect on the analyzer:
|
| Ischemic disorders | Ischemia is a lack of blood flow. May occur when:
|
| Stagnant disk | By its nature, this is swelling of the initial part of the nerve trunk. It can occur in any condition associated with increased intracranial pressure:
|
| Tumors of the nerve or surrounding tissues located before the chiasm | Pathological tissue proliferation can lead to compression of neurons. |
Descending type |
|
| Toxic lesions (less common) | In some cases, the toxic substances described above can damage neurocytes after crossing. |
| Tumors of the nerve or surrounding tissues located after the chiasm | Oncological processes are the most common and most dangerous cause of the descending form of the disease. They are not classified as benign, since the difficulties of treatment make it possible to call all brain tumors malignant. |
| Specific lesions of nervous tissue | As a result of some chronic infections that occur with the destruction of neurocytes throughout the body, the optic nerve trunk may partially/completely atrophy. These specific lesions include:
|
| Abscesses in the cranial cavity | After neuroinfections (meningitis, encephalitis and others), cavities limited by connective tissue walls - abscesses - may appear. If they are located next to the optic tract, there is a possibility of pathology. |
Treatment of optic atrophy is closely related to identifying the cause. Therefore, close attention should be paid to clarifying it. Symptoms of the disease, which allow one to distinguish the ascending form from the descending one, can help in diagnosis.
Symptoms
Regardless of the level of damage (above or below the chiasm), there are two reliable signs of optic nerve atrophy - loss of visual fields (“anopsia”) and decreased visual acuity (amblyopia). How pronounced they will be in a particular patient depends on the severity of the process and the activity of the cause that caused the disease. Let's take a closer look at these symptoms.
Loss of visual fields (anopsia)
What does the term "field of view" mean? Essentially, this is just an area that a person sees. To imagine it, you can close half of your eye on either side. In this case, you see only half of the picture, since the analyzer cannot perceive the second part. We can say that you have “lost” one (right or left) zone. This is exactly what anopsia is - the disappearance of the field of vision.
Neurologists divide it into:
- temporal (half of the image located closer to the temple) and nasal (the other half from the side of the nose);
- right and left, depending on which side the zone falls on.
With partial atrophy of the optic nerve, there may be no symptoms, since the remaining neurons transmit information from the eye to the brain. However, if a lesion occurs through the entire thickness of the trunk, this sign will certainly appear in the patient.
Which areas will be missing from the patient’s perception? This depends on the level at which the pathological process is located and on the degree of cell damage. There are several options:
| Type of atrophy | Damage level | What does the patient feel? |
| Complete – the entire diameter of the nerve trunk is damaged (the signal is interrupted and is not transmitted to the brain) | The organ of vision on the affected side completely ceases to see | |
| Loss of right or left visual fields in both eyes | ||
| Incomplete - only part of the neurocytes do not perform their function. Most of the image is perceived by the patient | Before the cross (with an ascending form) | There may be no symptoms or the field of vision in one eye may be lost. Which one depends on the location of the atrophy process. |
| After crossing (with descending type) |
This neurological symptom seems difficult to perceive, but thanks to it, an experienced specialist can identify the location of the lesion without any additional methods. Therefore, it is very important that the patient speaks openly to their doctor about any signs of visual field loss.
Decreased visual acuity (amblyopia)
This is the second sign that is observed in all patients without exception. Only the degree of its severity varies:
- Mild – characteristic of the initial manifestations of the process. The patient does not feel a decrease in vision, the symptom appears only when carefully examining distant objects;
- Medium – occurs when a significant portion of neurons are damaged. Distant objects are practically invisible; at a short distance the patient does not experience any difficulties;
- Severe – indicates the activity of the pathology. The sharpness is reduced so much that even objects located nearby become difficult to distinguish;
- Blindness (synonymous with amorosis) is a sign of complete atrophy of the optic nerve.
As a rule, amblyopia occurs suddenly and gradually increases, without adequate treatment. If the pathological process is aggressive or the patient does not seek help in a timely manner, there is a possibility of developing irreversible blindness.
Diagnostics
As a rule, problems with detecting this pathology rarely arise. The main thing is that the patient seeks medical help in a timely manner. To confirm the diagnosis, he is referred to an ophthalmologist for a fundus examination. This is a special technique with which you can examine the initial part of the nerve trunk.
How is ophthalmoscopy performed?. In the classic version, the fundus is examined by a doctor in a dark room, using a special mirror device (ophthalmoscope) and a light source. The use of modern equipment (electronic ophthalmoscope) allows this study to be carried out with greater accuracy. The patient is not required to have any preparation for the procedure or special actions during the examination.
Unfortunately, ophthalmoscopy does not always detect changes, since symptoms of damage occur earlier than tissue changes. Laboratory tests (blood, urine, cerebrospinal fluid tests) are nonspecific and have only auxiliary diagnostic value.
How to proceed in this case? In modern multidisciplinary hospitals, to detect the cause of the disease and changes in nervous tissue, the following methods exist:
| Research method | Principle of the method | Changes in atrophy |
| Fluorescein angiography (FA) | The patient is injected with a dye through a vein, which enters the blood vessels of the eyes. Using a special device that emits light of different frequencies, the fundus of the eye is “illuminated” and its condition is assessed. | Signs of insufficient blood supply and tissue damage |
| Laser eye disc tomography (HRTIII) | Non-invasive (remote) way to study the anatomy of the fundus. | Changes in the initial part of the nerve trunk according to the type of atrophy. |
| Optical coherence tomography (OCT) of the optic disc | Using high-precision infrared radiation, the condition of tissues is assessed. | |
| CT/MRI of the brain | Non-invasive methods for studying the tissues of our body. Allows you to obtain an image at any level, with an accuracy of cm. | Used to determine the possible cause of a disease. Typically, the purpose of this study is to look for a tumor or other mass formation (abscesses, cysts, etc.). |
Treatment of the disease begins from the moment the patient contacts, since it is irrational to wait for diagnostic results. During this time, the pathology may continue to progress, and changes in tissues will become irreversible. After clarifying the cause, the doctor adjusts his tactics to achieve the optimal effect.
Treatment
There is a widespread belief in society that “nerve cells do not recover.” This is not entirely correct. Neurocytes can grow, increase the number of connections with other tissues and take on the functions of dead “comrades”. However, they do not have one property that is very important for complete regeneration - the ability to reproduce.
Can optic nerve atrophy be cured? Definitely not. If the trunk is partially damaged, medications can improve visual acuity and fields. In rare cases, even virtually restore the patient's ability to see to normal levels. If the pathological process completely disrupts the transmission of impulses from the eye to the brain, only surgery can help.
To successfully treat this disease, it is necessary, first of all, to eliminate the cause of its occurrence. This will prevent/reduce cell damage and stabilize the course of pathology. Since there are a large number of factors that cause atrophy, doctors' tactics can vary significantly for different conditions. If it is not possible to cure the cause (malignant tumor, hard-to-reach abscess, etc.), you should immediately begin to restore the functionality of the eye.
Modern methods of nerve restoration
Just 10-15 years ago, the main role in the treatment of optic nerve atrophy was given to vitamins and angioprotectors. At present, they have only additional meaning. Medicines that restore metabolism in neurons (antihypoxants) and increase blood flow to them (nootropics, antiplatelet agents and others) come to the fore.
A modern scheme for restoring eye functions includes:
- Antioxidant and antihypoxant (Mexidol, Trimetazidine, Trimectal and others) - this group is aimed at tissue restoration, reducing the activity of damaging processes, and eliminating “oxygen starvation” of the nerve. In a hospital setting, they are administered intravenously; during outpatient treatment, antioxidants are taken in the form of tablets;
- Microcirculation correctors (Actovegin, Trental) - improve metabolic processes in nerve cells and increase their blood supply. These drugs are one of the most important components of treatment. Also available in the form of solutions for intravenous infusions and tablets;
- Nootropics (Piracetam, Cerebrolysin, Glutamic acid) are stimulators of blood flow to neurocytes. Accelerate their recovery;
- Drugs that reduce vascular permeability (Emoxipin) - protects the optic nerve from further damage. It was introduced into the treatment of eye diseases not so long ago and is used only in large ophthalmological centers. It is administered parabulbarly (a thin needle is passed along the wall of the orbit into the tissue surrounding the eye);
- Vitamins C, PP, B 6, B 12 are an additional component of therapy. These substances are believed to improve metabolism in neurons.
The above is a classic treatment for atrophy, but in 2010, ophthalmologists proposed fundamentally new methods for restoring eye function using peptide bioregulators. At the moment, only two drugs are widely used in specialized centers - Cortexin and Retinalamin. Studies have shown that they improve vision almost twice.
Their effect is realized through two mechanisms - these bioregulators stimulate the restoration of neurocytes and limit damaging processes. The method of their application is quite specific:
- Cortexin - used as injections into the skin of the temples or intramuscularly. The first method is preferable, since it creates a higher concentration of the substance;
- Retinalamin - the medicine is injected into the parabulbar tissue.
The combination of classical and peptide therapy is quite effective for nerve regeneration, but even this does not always achieve the desired result. You can additionally stimulate recovery processes with the help of targeted physiotherapy.
Physiotherapy for optic atrophy
There are two physiotherapeutic techniques, whose positive effects are confirmed by scientific research:
- Pulsed magnetic therapy (MPT) - this method is not aimed at restoring cells, but at improving their functioning. Thanks to the directed influence of magnetic fields, the contents of neurons are “condensed”, which is why the generation and transmission of impulses to the brain is faster;
- Bioresonance therapy (BT) - its mechanism of action is associated with improving metabolic processes in damaged tissues and normalizing blood flow through microscopic vessels (capillaries).
They are very specific and are used only in large regional or private ophthalmology centers, due to the need for expensive equipment. As a rule, for most patients these technologies are paid, so BMI and BT are used quite rarely.
Surgical treatment of atrophy
In ophthalmology, there are special operations that improve visual function in patients with atrophy. They can be divided into two main types:
- Redistributing blood flow in the eye area - in order to increase the flow of nutrients to one place, it is necessary to reduce it in other tissues. For this purpose, some of the vessels on the face are ligated, which is why most of the blood is forced to flow through the ophthalmic artery. This type of intervention is performed quite rarely, as it can lead to complications in the postoperative period;
- Transplantation of revascularizing tissues - the principle of this operation is to transplant tissues with an abundant blood supply (parts of muscle, conjunctiva) into an atrophic area. New vessels will grow through the graft, ensuring adequate blood flow to the neurons. Such an intervention is much more widespread, since it practically does not affect other tissues of the body.
Several years ago, stem cell treatment methods were actively developed in the Russian Federation. However, an amendment to the country's legislation made these studies and the use of their results on people illegal. Therefore, at present, technologies of this level can only be found abroad (Israel, Germany).
Forecast
The degree of vision loss in a patient depends on two factors - the severity of damage to the nerve trunk and the time of initiation of treatment. If the pathological process has affected only a part of the neurocytes, in some cases it is possible to almost completely restore the functions of the eye, with adequate therapy.
Unfortunately, with the atrophy of all nerve cells and the cessation of impulse transmission, there is a high probability of the patient developing blindness. The solution in this case may be surgical restoration of tissue nutrition, but such treatment does not guarantee the restoration of vision.
FAQ
Question:
Could this disease be congenital?
Yes, but very rarely. In this case, all the symptoms of the disease described above appear. As a rule, the first signs are detected before the age of one year (6-8 months). It is important to consult an ophthalmologist in a timely manner, since the greatest effect of treatment is observed in children under 5 years of age.
Question:
Where can optic nerve atrophy be treated?
It should be emphasized once again that it is impossible to completely get rid of this pathology. With the help of therapy, it is possible to control the disease and partially restore visual functions, but it cannot be cured.
Question:
How often does pathology develop in children?
No, these are quite rare cases. If a child is diagnosed and confirmed, it is necessary to clarify whether it is congenital.
Question:
What treatment with folk remedies is most effective?
Atrophy is difficult to treat even with highly active drugs and specialized physiotherapy. Traditional methods will not have a significant impact on this process.
Question:
Do they provide disability groups for atrophy?
This depends on the degree of vision loss. Blindness is the indication for the first group, acuity from 0.3 to 0.1 for the second.
All therapy is accepted by the patient for life. Short-term treatment is not enough to control this disease.
Hello, dear readers! Our conversation today will touch on a topic that not only medical workers, but literally each of us needs to know. We will talk about a dangerous pathology of the organs of vision.
Negligence towards eye health, untreated eye infections, even such a familiar, seemingly banal herpes virus on the face - all this can become an impetus for the development of a disease that is difficult to cope with. So, optic atrophy: what is it?
How does the disease manifest?
The fibers of the optic nerve carry impulses from the retina to the brain. Their pathological changes lead to a partial or complete inability to perform this function. As a result, the person experiences worsening vision. This happens quickly or gradually. The second option is more common.
Attention! Be sure to see your doctor as soon as possible if you experience any of the following symptoms:
- difficulties when trying to see distant objects;
- the appearance of spots before the eyes;
- impaired color vision;
- changes in visual fields (the ability to see areas located on the sides disappears (“tunnel” syndrome).
All these phenomena can be observed after inflammatory eye diseases or independently of them. The results of advanced nerve atrophy are sad: complete loss of vision is possible (develops in 26% of patients). The rest are more “lucky”; the deformation process stops at some stage, and vision is partially preserved. But it is no longer possible to completely restore it.
Reasons for the development of the disease
In order to “catch” the disease in time and stop its progression, you need to be attentive to yourself if you have the following diseases:
- any eye infections;
- retinal lesions;
- glaucoma;
- cerebrovascular diseases;
- hypertension;
- any brain tumors, including benign ones (for example, a common pituitary tumor).
The diseases cause chronic irritation of the optic nerve, resulting in deformation in certain areas.
Often optic nerve atrophy is combined with multiple sclerosis and other systemic diseases.
Diagnostics
During the examination, the ophthalmologist will interview the patient, finding out when he noticed suspicious signs, whether close relatives had a similar problem, and whether he has recently suffered from viral or infectious diseases. The doctor needs to be told about the presence of chronic diseases (if any).
Then the doctor will conduct a study of the degree of mobility of the eyeball, measure the level of intraocular pressure, check the reaction to light, and determine whether there are disturbances in color perception.
Visual acuity must be checked and compared with the results of the previous examination.
A decrease in lability, as well as an increase in the sensitivity thresholds of the optic nerve, revealed during the examination, confirms the diagnosis of atrophy.
An increase in intraocular pressure is often detected.
The patient may be referred for an MRI to rule out the presence of brain tumors and various serious vascular damage. A neurosurgeon is involved in the diagnostic process.
Treatment
Before deciding how to treat the atrophy, your doctor will order additional tests to look for a disease that could be causing problems with the optic nerve. If it is possible to determine the causes that served as the trigger for the onset of the pathological process, first of all they try to eliminate them. Unfortunately, this is not always possible - in some cases the reason remains unclear.
In order to improve blood supply to the optic nerve, the patient is prescribed vasodilators. Anti-sclerotic drugs play an important role in treatment, helping to increase the elasticity of the walls of blood vessels.
Since atrophic processes are preceded by long-term inflammation, which is accompanied by swelling of the affected area, drugs are prescribed that eliminate swelling and eliminate signs of inflammation. This:
- a nicotinic acid;
- no-shpa;
- papaverine;
- Dibazol.
All of them help to dilate blood vessels and relieve symptoms of inflammation.
Sometimes injections of dexamethasone are required (if the inflammation is severe).
Thanks to the infusion of solutions of calcium chloride and glucose, tissue nutrition is improved.
To restore the functioning of the optic nerve, injections of xanthinol nicotinate and atropine are prescribed. Medicines improve trophism and help restore vascular patency.
A decrease in blood viscosity is achieved by taking anticoagulants; with the help of these drugs, blood microcirculation is enhanced. A decrease in intraocular pressure is achieved with the help of pilocarpine.
Vitamins B2 and B6 help speed up metabolism and remove waste products from pathogenic microorganisms. Most often they are prescribed in the form of injections.
When the intensity of the inflammatory process decreases, the patient is offered to undergo a course of physical therapy. They give a good effect:
- acupuncture;
- electrophoresis;
- magnetotherapy.
The diagnosis of optic nerve atrophy is disappointing. There are no drugs yet that can achieve complete regeneration of damaged tissue, so treatment is aimed at preserving healthy tissue - so that as little as possible of the nerve is involved in the pathological process.
If the damage is minor, visual acuity may suffer slightly. If treatment is started late, there is a danger of decreased vision, even to the point of blindness.
This is brief information about optic nerve atrophy, which is useful to know for every person who wants to maintain eye health. If the article, in your opinion, contains important information that allows you to take timely measures to prevent the onset of the disease, share it with your friends and acquaintances on social networks.
With this we say goodbye, until we meet again. Take care of your eyes, because regaining lost vision can be difficult and sometimes impossible.
Optic nerve atrophy is characterized by the development of the process of complete or partial death of nerve fibers, accompanied by the replacement of healthy connective tissue.
Types of disease
Optic disc atrophy is divided into several types depending on its etiology. These include:
- Primary form (ascending and descending optic nerve atrophy). This pathological process develops as an independent disease. The descending type is diagnosed much more often than the ascending type. This disease is usually observed in males, since it is linked only to the X chromosome. The first manifestations of the disease occur at approximately 15-25 years of age. In this case, damage directly to the nerve fibers occurs.
- Secondary atrophy of the optic nerve. In this case, the pathological process develops against the background of other diseases. In addition, the disorder may be caused by a failure in the flow of blood to the nerve. A disease of this nature can occur in any person, regardless of his age and gender.
Based on the nature of the course, the following types of this disease are distinguished:
- Partial atrophy of the optic nerve (initial). The main difference between this type is the partial preservation of visual ability, which is most important in case of deteriorated vision (due to which wearing glasses or contact lenses cannot improve the quality of vision). Despite the fact that residual visual ability can usually be preserved, disruptions in color perception often occur. Those areas of the field of view that were saved will continue to be accessible.
- Complete atrophy of the optic nerve. In this case, the symptoms of the disease have some similarities with such eye pathologies as cataracts and amblyopia. In addition, this type of disease can manifest itself in a non-progressive form, which does not have specific symptoms. This fact indicates that the state of the necessary visual functions remains stable. However, most often there is a progressive form of pathology, during which rapid loss of vision occurs, which, as a rule, cannot be restored. This greatly complicates the diagnostic process.
Symptoms
If optic atrophy develops, symptoms manifest themselves mainly in the form of deterioration in the quality of vision in both eyes at the same time or in just one. Restoring visual ability in this case is impossible. Depending on the type of pathology, this symptom may have different manifestations.
As the disease progresses, vision gradually deteriorates. In the most severe cases, complete atrophy of the optic nerve occurs, which provokes a complete loss of the ability to see. This process can last for many weeks, or can develop in a couple of days.
If partial atrophy of the optic nerve is observed, there is a gradual slowdown in progression, after which it completely stops at a certain stage. At the same time, visual activity stops decreasing.
Signs of optic nerve atrophy often appear as: Usually they narrow, which is characterized by loss of lateral vision. This symptom can be almost invisible, but sometimes tunnel vision occurs, that is, when the patient is able to see only those objects that are located directly in the direction of his gaze, as if through a thin tube. Very often, with atrophy, dark, light or colored spots appear before the eyes, and it becomes difficult for a person to distinguish colors.
The appearance of dark or white spots in front of the eyes (both closed and open) indicates that the destruction process is affecting nerve fibers that are located in the central part of the retina or very close to it. Narrowing of the visual fields begins if peripheral nerve tissues have been affected.
With a more extensive spread of the pathological process, a large part of the visual field may disappear. This type of disease can spread to only one eye or affect both.
Causes
The causes of optic nerve atrophy can be different. Both acquired and congenital diseases, which are directly related to the visual organs, act as a provoking factor.
The appearance of atrophy can be triggered by the development of diseases that directly affect the nerve fibers or the retina of the eye. The following pathological processes can be cited as examples:
- mechanical damage (burn or injury) to the retina;
- inflammatory processes;
- congenital optic nerve dystrophy (OND);
- fluid stagnation and swelling;
- toxic effects of certain chemicals;
- impaired access of blood to nerve tissues;
- compression of certain areas of the nerve.
In addition, diseases of the nervous and other body systems play an important role in the development of this pathological process.
Quite often, the onset of this pathological condition is caused by the development of diseases that directly affect the human central nervous system. It can be;
- syphilitic brain damage;
- development of abscesses;
- neoplasms of various types in the brain;
- meningitis;
- encephalitis;
- mechanical damage to the skull;
- development of multiple sclerosis.
More rare causes are alcohol poisoning of the body and intoxication with other chemicals.
Sometimes this pathology develops against the background of hypertension or atherosclerosis, as well as other cardiovascular diseases. In rare cases, the cause may be a lack of vitamins and macroelements in the human body.
In addition to the listed reasons, the development of an atrophic disorder can be affected by obstruction of the central or peripheral retinal arteries. This is explained by the fact that these arteries provide nutrients to the organ. As a result of their blockage, metabolism is disrupted, which provokes a deterioration in the general condition. Quite often, obstruction is a consequence of the development of glaucoma.
Diagnostics
During the examination of the patient, the doctor must identify the presence of concomitant diseases, the use of certain medications and contact with caustic substances, the presence of bad habits and symptoms indicating the development of intracranial disorders.
In most cases, diagnosing diseases of this nature does not cause great difficulties. In order to determine an accurate diagnosis, it is necessary first of all to check the quality of visual function, namely, determine visual acuity and fields and conduct color vision tests. After this, ophthalmoscopy is performed. This procedure allows us to identify the pallor of the optic disc and a decrease in the lumen of the fundus vessels, characteristic of this disease. Another mandatory procedure is.
Very often, diagnosis involves the use of the following instrumental methods:
- X-ray examination;
- magnetic resonance imaging (MRI);
- computed tomography of the brain;
- electrophysiological diagnostics;
- contrast methods (used to determine the patency of retinal vessels).
Laboratory diagnostic methods are mandatory, in particular general and biochemical blood tests.
Treatment options
Treatment for optic nerve atrophy should be carried out immediately after diagnosis. It should be remembered that it is impossible to completely get rid of the disease, but it is quite possible to slow down its progression and even stop it.
During therapy, it is necessary to take into account the fact that this pathological process is not an independent disease, but the result of diseases affecting one or another part of the visual organ. Therefore, in order to cure optic nerve atrophy, it is necessary to first eliminate the provoking factor.
In most cases, complex therapy is used, including the use of drugs and optical surgery. Treatment can be carried out with the following medications:
- vasodilators (Papaverine, Dibazol, Sermion);
- anticoagulants (Heparin);
- drugs that improve metabolism (aloe extract);
- vitamin complexes;
- enzyme preparations (Lidase, Fibrinolysin);
- agents that enhance immunity (Eleutherococcus extract);
- hormonal anti-inflammatory drugs (Dexamethasone);
- drugs that improve the functioning of the central nervous system (Nootropil, Emoxipin).
The listed medications can be used in the form of tablets, solutions, eye drops and injections. In the most severe cases, surgery is required. Many people are interested in whether this disease can be cured only by conservative methods. Sometimes this is possible, but only a specialist can answer the question of how to treat atrophy in a particular case.
Any medicine should be taken only after prescription by the attending physician, observing the prescribed dosage. It is strictly prohibited to choose medications on your own.
Quite often, physiotherapeutic procedures are performed during the treatment of optic nerve atrophy. Acupuncture or laser and magnetic stimulation of the optic nerve are especially effective.
In some cases, treatment with folk remedies may be used. To restore the optic nerve, various infusions and decoctions of medicinal plants are used. However, this method can only be used as an additional therapy in combination with traditional medicine and only after consultation with your doctor.
Surgery is usually prescribed in the presence of neoplasms of various types and hereditary atrophy of the optic nerve. Surgery is required if there are congenital abnormalities of the visual organ, such as Leber optic atrophy.
Currently, the following surgical methods are used for Leber optic nerve atrophy and other congenital disorders:
- extrascleral methods (the most common type of surgery for eye pathologies);
- vasoconstructive therapy;
- decompression methods (used very rarely).
With this pathology, symptoms and treatment are interrelated, since the doctor prescribes therapy depending on the symptoms and type of disease.
In order not to risk your vision, self-medication is strictly prohibited. At the first symptoms of a disorder, it is recommended to seek help from a doctor. In this case, you should find a suitable clinic where the disease can be treated most effectively.
Prognosis and prevention
Timely detection of complete or partial atrophy of the optic nerve and its treatment make it possible to prevent the development of destructive disorders in the tissues. Correctly prescribed therapy will help maintain the quality of visual function, and sometimes even improve it. However, it is impossible to achieve complete restoration of vision due to severe damage and death of nerve fibers.
Lack of timely treatment can provoke very serious complications that lead not only to decreased vision, but also to its complete loss. In this case, the prognosis is disappointing, since it will no longer be possible to restore visual ability.
In order to prevent the development of this pathological process, the following rules must be observed:
- engage in the prevention and timely treatment of any infectious and inflammatory diseases of the body;
- prevent mechanical damage to the eye tissue and brain injuries;
- periodically undergo examination by a doctor and carry out all necessary diagnostic measures for early detection of diseases;
- stop smoking;
- remove alcohol from your life;
- regularly measure blood pressure;
- adhere to proper nutrition;
- to live an active lifestyle;
- take regular walks in the fresh air.
A disease of this nature is very serious, therefore, at the first symptoms, it is imperative to consult a specialist and in no case self-medicate.
Video
(optic neuropathy) - partial or complete destruction of the nerve fibers that transmit visual stimuli from the retina to the brain. Optic nerve atrophy leads to decreased or complete loss of vision, narrowing of visual fields, impaired color vision, and pallor of the optic disc. The diagnosis of optic nerve atrophy is made by identifying characteristic signs of the disease using ophthalmoscopy, perimetry, color testing, determination of visual acuity, craniography, CT and MRI of the brain, B-scanning ultrasound of the eye, angiography of retinal vessels, studies of visual VP, etc. With optic atrophy nerve treatment is aimed at eliminating the pathology that led to this complication.
ICD-10
H47.2
General information
Various diseases of the optic nerve in ophthalmology occur in 1-1.5% of cases; of these, 19 to 26% lead to complete atrophy of the optic nerve and incurable blindness. Pathomorphological changes in optic nerve atrophy are characterized by destruction of axons of retinal ganglion cells with their glial-connective tissue transformation, obliteration of the capillary network of the optic nerve and its thinning. Optic nerve atrophy can be a consequence of a large number of diseases that occur with inflammation, compression, swelling, damage to nerve fibers or damage to the blood vessels of the eye.
Causes of optic nerve atrophy
Factors leading to optic nerve atrophy may include eye diseases, central nervous system lesions, mechanical damage, intoxication, general, infectious, autoimmune diseases, etc.
The causes of damage and subsequent atrophy of the optic nerve are often various ophthalmopathologies: glaucoma, pigmentary degeneration of the retina, occlusion of the central retinal artery, myopia, uveitis, retinitis, optic neuritis, etc. The danger of damage to the optic nerve may be associated with tumors and diseases of the orbit: meningioma and optic nerve glioma, neuroma, neurofibroma, primary orbital cancer, osteosarcoma, local orbital vasculitis, sarcoidosis, etc.
Among diseases of the central nervous system, the leading role is played by tumors of the pituitary gland and posterior cranial fossa, compression of the area of the optic chiasm (chiasm), purulent-inflammatory diseases (brain abscess, encephalitis, meningitis), multiple sclerosis, traumatic brain injuries and damage to the facial skeleton accompanied by injury optic nerve.
Often optic nerve atrophy is preceded by hypertension, atherosclerosis, fasting, vitamin deficiency, intoxication (poisoning with alcohol substitutes, nicotine, chlorophos, drugs), large simultaneous blood loss (usually with uterine and gastrointestinal bleeding), diabetes mellitus, anemia. Degenerative processes in the optic nerve can develop with antiphospholipid syndrome, systemic lupus erythematosus, Wegener's granulomatosis, Behcet's disease, Horton's disease.
Congenital atrophies of the optic nerve occur with acrocephaly (tower-shaped skull), micro- and macrocephaly, craniofacial dysostosis (Crouzon's disease), and hereditary syndromes. In 20% of cases, the etiology of optic nerve atrophy remains unclear.
Classification
Optic nerve atrophy can be hereditary or non-hereditary (acquired). Hereditary forms of optic atrophy include autosomal dominant, autosomal recessive and mitochondrial. The autosomal dominant form can have a severe or mild course, and is sometimes combined with congenital deafness. An autosomal recessive form of optic nerve atrophy occurs in patients with Wehr, Wolfram, Bourneville, Jensen, Rosenberg-Chattorian, and Kenny-Coffey syndromes. The mitochondrial form is observed when there is a mutation in mitochondrial DNA and accompanies Leber's disease.
Acquired atrophy of the optic nerve, depending on the etiological factors, can be primary, secondary and glaucomatous in nature. The mechanism of development of primary atrophy is associated with compression of peripheral neurons of the visual pathway; The optic disc is not changed, its boundaries remain clear. In the pathogenesis of secondary atrophy, swelling of the optic disc occurs, caused by a pathological process in the retina or the optic nerve itself. The replacement of nerve fibers by neuroglia is more pronounced; The optic disc increases in diameter and loses its clear boundaries. The development of glaucomatous optic atrophy is caused by the collapse of the lamina cribrosa of the sclera against the background of increased intraocular pressure.
Based on the degree of color change of the optic nerve head, initial, partial (incomplete) and complete atrophy are distinguished. The initial degree of atrophy is characterized by slight blanching of the optic disc while maintaining the normal color of the optic nerve. With partial atrophy, disc blanching in one of the segments is noted. Complete atrophy is manifested by uniform pallor and thinning of the entire optic nerve head, and narrowing of the fundus vessels.
Based on localization, ascending (if retinal cells are damaged) and descending (if optic nerve fibers are damaged) atrophy is distinguished; by localization - one-sided and two-sided; according to the degree of progression - stationary and progressive (determined during dynamic observation by an ophthalmologist).
Symptoms of optic atrophy
The main sign of optic nerve atrophy is a decrease in visual acuity that cannot be corrected with glasses and lenses. With progressive atrophy, a decrease in visual function develops over a period of several days to several months and can result in complete blindness. In the case of incomplete atrophy of the optic nerve, pathological changes reach a certain point and do not develop further, and therefore vision is partially lost.
With optic nerve atrophy, disturbances in visual function can manifest themselves as concentric narrowing of the visual fields (disappearance of lateral vision), the development of “tunnel” vision, color vision disorder (mainly green-red, less often blue-yellow part of the spectrum), the appearance of dark spots (scotoma) on the areas of the field of view. Typically, an afferent pupillary defect is detected on the affected side - a decrease in the pupillary reaction to light while maintaining a congenial pupillary reaction. Such changes can occur in one or both eyes.
Objective signs of optic nerve atrophy are revealed during an ophthalmological examination.
Diagnostics
When examining patients with optic nerve atrophy, it is necessary to find out the presence of concomitant diseases, the fact of taking medications and contact with chemicals, the presence of bad habits, as well as complaints indicating possible intracranial lesions.
During a physical examination, the ophthalmologist determines the absence or presence of exophthalmos, examines the mobility of the eyeballs, checks the reaction of the pupils to light, and the corneal reflex. Visual acuity testing, perimetry, and color vision testing are required.
Basic information about the presence and degree of optic nerve atrophy is obtained using ophthalmoscopy. Depending on the cause and form of optic neuropathy, the ophthalmoscopic picture will differ, but there are typical characteristics found in various types of optic atrophy. These include: pallor of the optic disc of varying degrees and prevalence, changes in its contours and color (from grayish to waxy), excavation of the disc surface, a decrease in the number of small vessels on the disc (Kestenbaum’s symptom), narrowing of the caliber of the retinal arteries, changes in the veins, etc. Condition The optic disc is clarified using tomography (optical coherence, laser scanning).
To prevent optic nerve atrophy, timely treatment of eye, neurological, rheumatological, endocrine, and infectious diseases is necessary; prevention of intoxication, timely blood transfusion in case of profuse bleeding. At the first signs of visual impairment, consultation with an ophthalmologist is necessary.
Atrophy of any organ is characterized by a decrease in its size and loss of function due to lack of nutrition. Atrophic processes are irreversible and indicate a severe form of any disease. Optic atrophy is a complex pathological condition that is almost untreatable and often results in vision loss.
In this article
Functions of the optic nerve
The optic nerve is the white matter of the large brain, as if brought to the periphery and connected to the brain. This substance conducts visual images from the retina, on which light rays fall, to the cerebral cortex, where the final image is formed, which a person sees. In other words, the optic nerve acts as a supplier of messages to the brain and is the most important component of the entire process of transforming the light information received by the eyes.
Optic atrophy: general description
With atrophy of the optic nerve, its fibers are completely or partially destroyed. They are subsequently replaced by connective tissue. The death of the fibers causes the light signals received by the retina to be converted into electrical signals that are transmitted to the brain. For the brain and eyes, this process is pathological and very dangerous. Against this background, various disorders develop, including decreased visual acuity and narrowing of its fields. Optic nerve atrophy is quite rare in practice, although even the most minor eye injuries can provoke its onset. However, approximately 26% of cases of the disease end with the patient completely losing vision in one eye.
Causes of optic nerve atrophy
Optic nerve atrophy is one of the symptoms of various eye diseases or a stage in the development of any disease. There are many reasons that can lead to this pathology. Among the ophthalmological diseases that can provoke atrophic changes in the optic nerve are the following ailments:
- glaucoma;
- retinal pigmentary dystrophy;
- myopia;
- uveitis;
- retinitis;
- optic neuritis,
- damage to the central artery of the retina.
Atrophy can also be associated with tumors and diseases of the orbit: optic glioma, neuroma, orbital cancer, meningioma, osteosarcoma and others.
All kinds of diseases of the brain and central nervous system in some cases lead to atrophic processes in the eyes, affecting primarily the optic nerves. Such diseases include:
- multiple sclerosis;
- pituitary tumors;
- meningitis;
- brain abscess;
- encephalitis;
- traumatic brain injuries;
- damage to the facial skeleton with injury to the optic nerve.
Types and forms of optic nerve atrophy
This pathological condition can be congenital or acquired. Acquired atrophy is divided into descending and ascending. In the first case, the fibers of the optic nerve are directly affected. In the second, the cells of the retina come under attack.
According to another classification, acquired atrophy can be:
- Primary. It is also called a simple form of atrophy, in which the optic disc becomes pale, but has clear boundaries. The vessels in the retina with this type of pathology narrow.
- Secondary, which develops due to inflammation of the optic nerve or its stagnation. The boundaries of the disc become unclear.
- Glaucomatous, accompanied by increased intraocular pressure.
Based on the extent of damage to the optic nerve fibers, atrophy is divided into partial and complete. The partial (initial) form manifests itself in severe deterioration of vision, which cannot be corrected with contact lenses and glasses. At this stage, the remaining visual functions can be preserved, but color perception will be severely impaired. Complete atrophy is damage to the entire optic nerve, in which a person can no longer see anything with the affected eye. Optic nerve atrophy manifests itself in a stationary form (does not develop, but remains at the same level) and progressive. With stationary atrophy, visual functions remain in a stable state. The progressive form is accompanied by a rapid decrease in visual acuity. Another classification divides atrophy into unilateral and bilateral, that is, with damage to one or both organs of vision.
Symptoms of optic atrophy
The first and main symptom that manifests itself in any form of optic nerve atrophy is blurred vision. However, it cannot be corrected. This is a sign by which the atrophic process can be distinguished from ametropia - a change in the ability of the human eye to correctly refract light rays. Vision can deteriorate gradually and rapidly. It depends on the form in which atrophic changes occur. In some cases, visual functions decrease within 3-4 months, sometimes a person becomes completely blind in one or both eyes within a few days. In addition to a general decrease in visual acuity, its fields are narrowed. 
The patient almost completely loses lateral vision, which leads to the development of the so-called “tunnel” type of perception of the surrounding reality, when a person sees everything as if through a pipe. In other words, only what is directly in front of the person is visible, and not to the side of him.
Another common sign of optic nerve atrophy is the appearance of scotomas - dark or blind areas that appear in the field of vision. By the location of the scotomas, you can determine which fibers of the nerve or retina are damaged the most. If spots appear right in front of the eyes, then the nerve fibers located closer to the central part of the retina or directly in it are affected. Color vision disorder becomes another problem that a person faces with atrophy. Most often, the perception of green and red hues is impaired, rarely - the blue-yellow spectrum.
All these symptoms are signs of the primary form, that is, its initial stage. The patient himself can notice them. Symptoms of secondary atrophy are visible only during examination.
Symptoms of secondary optic atrophy
As soon as a person consults a doctor with symptoms such as decreased visual acuity and narrowing of its fields, the doctor conducts an examination. One of the main methods is ophthalmoscopy - examination of the fundus of the eye using special instruments and devices. During ophthalmoscopy, the following signs of optic nerve atrophy are revealed: 
- vasoconstriction;
- varicose veins;
- disc blanching;
- decreased pupil reaction to light.
Diagnostics
As already described above, the first method used to identify pathology is ophthalmoscopy. However, the symptoms that can be detected with this test do not allow a definitive diagnosis. Deterioration of vision, lack of pupillary response to light, narrowing of the blood vessels in the eye are signs of many eye diseases, for example, peripheral cataracts. In this regard, many different methods are used to diagnose atrophy:
Laboratory tests are also carried out. The patient donates blood and urine for analysis. Tests are prescribed for syphilis, borreliosis and to determine other non-ophthalmological diseases.
How is optic nerve atrophy treated?
It is impossible to restore fibers that have already been destroyed. Treatment helps stop atrophy and save those fibers that are still functioning. There are three ways to combat this pathology:
- conservative;
- therapeutic;
- surgical.
With conservative treatment, the patient is prescribed vasoconstrictors and medications, the actions of which are aimed at normalizing the blood supply to the optic nerve. The doctor also prescribes anticoagulants, which inhibit blood clotting activity. 
Drugs that stimulate metabolism and medications that relieve inflammation, including hormonal ones, help stop the death of fibers.
Physiotherapeutic treatment involves prescribing:
The surgical treatment method is aimed at removing formations that put pressure on the optic nerve. During the operation, the surgeon can implant biogenic materials into the patient, which will help improve blood circulation in the eye and in the atrophied nerve, in particular. The pathology suffered in most cases leads to the fact that a person is assigned a disability. Patients who are blind or visually impaired are sent for rehabilitation.
Prevention
To prevent optic nerve atrophy, it is necessary to begin treating ophthalmological diseases in a timely manner. 
At the first signs of a decrease in visual acuity, you should immediately make an appointment with an ophthalmologist. When atrophy begins, not a minute can be lost. If at the initial stage it is still possible to preserve most of the visual functions, then as a result of further atrophic changes the person may become disabled.
