Causes and treatment of optic nerve atrophy. Optic nerve atrophy: treatment, symptoms, causes of complete or partial damage Why optic nerve atrophy occurs

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

Atrophy, which is the death of nerve fibers, leads to loss of vision. This occurs due to the fact that the cells lose the ability to conduct nerve impulses responsible for transmitting images. Timely consultation with a doctor will help stop the development of the disease and avoid blindness.

Classification of optic nerve atrophy

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

Primary atrophy. It occurs due to failures in the nutrition of nerve fibers and circulatory disorders. The disease has an independent nature.
Secondary atrophy. A mandatory factor for the existence of a disease is the presence of other diseases. In particular, these are deviations associated with the optic nerve head.
Congenital atrophy. The body's tendency to develop disease is observed from birth.
Glaucomatous atrophy. Vision remains at a stable level over time. The cause of the disease is vascular insufficiency of the cribriform plate as a result of increased intraocular pressure.
Partial atrophy. Part of the optic nerve is affected, which is where the spread of the disease ends. Vision deteriorates.
Complete atrophy. The optic nerve is completely affected. If the progression of the disease is not stopped, blindness may occur.
Complete atrophy. The deviation has already formed. The spread of the disease stopped at a certain stage.
Progressive atrophy. The rapid development of the atrophic process, which can lead to complete blindness.
Descending atrophy. Irreversible changes in the optic nerves develop slowly.

We see an explanation of how partial atrophy differs from complete atrophy here:

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

Optic nerve atrophy code according to ICD-10

H47.2 Optic atrophy
Pallor of the temporal half of the optic disc

Causes of atrophy

Despite the fact that there are many causes of optic nerve atrophy, in 20% of cases the exact factor as a result of which the disease develops cannot be determined. The most influential causes of atrophy include:

Dystrophy of the retina pigment type.
Inflammation of nerve tissue.
Defects of blood vessels located in the retina.
Increased intraocular pressure.
Spasmodic manifestations related to blood vessels.
Purulent inflammation of brain tissue.
Inflammation of the spinal cord.
Multiple sclerosis.
Infectious diseases (from simple ARVI to more serious diseases).
Malignant or benign tumors.
Various injuries.

Primary descending atrophy can be caused by hypertension, atherosclerosis, or abnormalities in the development of the spine. The causes of the secondary type of disease are poisoning, inflammatory processes and injuries.

Why does atrophy occur in children?

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

Genetic deviation.
Intrauterine and other types of poisoning.
Incorrect course of pregnancy.
Hydrocephalus of the brain.
Deviations in the development of the central nervous system.
Diseases affecting the apple of the eye.
A cranium deformed from birth.
Inflammatory processes in the brain.
Tumor formation.

As we see, the main causes of damage to the nerve cells of the visual organs in children are genetic abnormalities and the mother’s poor lifestyle during pregnancy.

One case of childhood atrophy is presented in this commentary:

Symptoms of the disease

Let's consider the clinical picture for each type of atrophy. The primary form of this disease is characterized by the separation of the boundaries of the nerves of the eye disc, which have acquired a deepened appearance. The arteries inside the eye narrow. In case of a secondary type of disease, the reverse process is noticeable. Nerve boundaries blur and blood vessels dilate.

Congenital atrophy is accompanied by an inflammatory process behind the eyeball. In this case, it is impossible to focus vision without causing discomfort. The resulting image loses the clarity of its lines and looks blurry.

A partial type of disease reaches a certain stage of its development and stops developing. Its symptoms depend on the stage the disease has reached. This form of atrophy may be indicated by partial loss of vision, light flashes before the eyes, images similar to hallucinations, the spread of blind spots and other deviations from the norm.

The following manifestations are considered common signs for all types of optic nerve atrophy::

Limitation of eye functionality.
External changes in the optic disc.
If the capillaries in the macula are damaged, the disease affects central vision, which is reflected in the appearance of seals.
The field of view narrows.
The perception of color spectrums changes. First of all, this problem is associated with green shades, and then with red ones.
If peripheral nerve tissue is affected, the eyes do not adapt well to changes in distance and lighting.

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

Hereditary atrophy. Types and symptoms

Hereditary optic atrophy has several forms of manifestation:

Infantile. Full vision loss occurs between 0 and 3 years of age. The disease is recessive in nature.
Juvenile blindness. The optic disc becomes pale. Vision decreases to 0.1-0.2. The disease develops between 2 and 7 years of age. She is dominant.
Optical-oto-diabetic syndrome. It is detected in the age range from 2 to 20 years. Concomitant diseases - various types of diabetes, deafness, problems with urination, cataracts, pigmented retinal dystrophy.
Beer's syndrome. A serious disease, which is characterized by a decrease in vision in the first year of life to 0.1-0.05. Associated abnormalities include strabismus, symptoms of neurological disorders and mental retardation, damage to the pelvic organs.
Gender-dependent atrophy. In most cases, the disease develops in male children. It begins to manifest itself in early childhood and gradually worsens.
Lester's disease. The age from 13 to 30 years is the period in which the disease occurs in 90% of cases.

Symptoms

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

Diagnosis of optic nerve atrophy

Such studies help to identify the presence of atrophy:

Spheroperimetry – determination of the visual field.
Determination of the degree of visual acuity.
Fundus examination using a slit lamp.
Measuring intraocular pressure.
Computer perimetry helps determine the damaged area of tissue.
Dopplerography using laser equipment shows the characteristics of blood vessels.

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

Treatment of optic atrophy

The goal of treatment is to maintain the ability to see at the level that was noted at the time the disease was diagnosed. It is impossible to improve vision with atrophy of the optic nerves, since tissues that die as a result of damage are not restored. Most often, ophthalmologists choose this treatment regimen:

Stimulant medications.
Drugs that dilate blood vessels. Among them are Papaverine and Noshpa.
Tissue therapy. For these purposes, the use of vitamin B and intravenous administration of nicotinic acid are prescribed.
Medicines against atherosclerosis.
Drugs that regulate blood clotting. This may be Heparin or subcutaneous injections of ATP.
Ultrasonic exposure.
Reflex therapy in the form of acupuncture.
Use of trypsin enzymes.
Intramuscular administration of Pyrogenal.
The procedure for vagosympathetic blockade according to Vishnevsky. It is the introduction of a 0.5% Novocaine solution into the area of the carotid artery in order to dilate blood vessels and block sympathetic innervation.

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

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

Here is a possible clinical picture of atrophy and its treatment regimen:

A set of medications and physiotherapeutic measures helps speed up the healing process. Treatment is aimed at improving metabolism and blood circulation. Spasms and blood clots that disrupt these processes are eliminated.

Some cases of the disease require the possibility of surgical intervention. A medical drug, the patient’s own tissue or donor materials are placed in the retrobulbar space, which promotes the restoration of damaged areas and the growth of new blood vessels. Surgical installation of an electrical stimulator is also possible. It remains in the orbit of the eye for several years. In most cases of treatment of a disease detected in time, vision can be preserved.

Disease prevention

Measures that will reduce the risk of atrophy to a minimum are a standard list:

Treat infectious diseases in a timely manner.
Eliminate the possibility of injury to the brain and visual organs.
Visit your oncologist regularly to detect cancer early.
Avoid excessive consumption of alcoholic beverages.
Monitor your blood pressure status.

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

Optic nerve atrophy is the development of a pathology in which the optic nerve is partially or completely destroyed within its own fibers, after which these fibers are replaced by connective tissue. Optic nerve atrophy, the symptoms of which are a decrease in visual function in combination with a general blanching of the nerve disc, can be congenital or acquired in the nature of its occurrence.

general description

In ophthalmology, diseases of the optic nerve of one type or another are diagnosed on average in 1-1.5% of cases, while in approximately 26% of them the optic nerve is subject to complete atrophy, which, in turn, causes blindness that cannot be treated. cure. In general, with atrophy, as is clear from the description of the consequences to which it leads, there is a gradual death of its fibers in the optic nerve, followed by their gradual replacement, ensured by connective tissue. This is also accompanied by the conversion of the light signal received by the retina into an electrical signal during its further transmission to the posterior lobes of the brain. Against this background, various types of disorders develop, with a narrowing of the visual fields and a decrease in visual acuity preceding blindness.

Optic nerve atrophy: causes

Congenital or hereditary pathologies directly related to vision that are relevant to the patient can be considered as reasons that provoke the development of the disease we are considering. Optic nerve atrophy can also develop as a result of suffering from any eye diseases or a certain type of pathological process that affects the retina and the optic nerve itself. Examples of the latter factors include eye injury, inflammation, dystrophy, congestion, edema, damage caused by toxic effects, compression of the optic nerve, circulatory disorders of one scale or another. In addition, current pathologies affecting the nervous system, as well as the general type of the disease, also play an important role in the causes.

In frequent cases, the development of optic nerve atrophy is caused by the influence exerted by the pathology of the central nervous system that is relevant to the patient. Such pathologies can be considered syphilitic brain damage, abscesses and brain tumors, meningitis and encephalitis, skull trauma, multiple sclerosis, etc. Alcohol poisoning caused by the use of methyl alcohol and general intoxication of the body are also among the factors affecting the central nervous system , and, ultimately, among the factors provoking optic nerve atrophy.

The development of the pathology we are considering can also be contributed to by diseases such as atherosclerosis and hypertension, as well as conditions the development of which is provoked by vitamin deficiency, quinine poisoning, profuse bleeding and fasting.

In addition to the listed factors, optic nerve atrophy can also develop against the background of obstruction of the peripheral retinal arteries and obstruction of the central artery in it. These arteries provide nutrition to the optic nerve; accordingly, if they are obstructed, its functions and general condition are disrupted. It should be noted that obstruction of these arteries is also considered as the main symptom indicating the manifestation of glaucoma.

Optic nerve atrophy: classification

Optic nerve atrophy, as we initially noted, can manifest itself both as a hereditary pathology and as a non-hereditary pathology, that is, acquired. The hereditary form of this disease can manifest itself in such basic forms as the autosomal dominant form of optic atrophy, the autosomal recessive form of optic atrophy, and the mitochondrial form.

Congenital atrophy is considered to be atrophy resulting from genetic diseases that cause visual impairment in the patient from birth. Leber's disease is identified as the most common disease in this group.

As for the acquired form of optic nerve atrophy, it is determined by the peculiarities of the influence of etiological factors, such as damage to the fibrous structure of the optic nerve (which determines such a pathology as descending atrophy) or damage to retinal cells (this, accordingly, determines such a pathology as ascending atrophy) atrophy). The acquired form of optic nerve atrophy can, again, be provoked by inflammation, glaucoma, myopia, metabolic disorders in the body and other factors that we have already discussed above. Acquired optic atrophy can be primary, secondary or glaucomatous.

At the heart of the mechanism primary form of atrophy The optic nerve is considered to be an effect in which compression of peripheral neurons within the visual pathway occurs. The primary form (which is also defined as the simple form) of atrophy is accompanied by clear disc boundaries and pallor, narrowing of the vessels in the retina and the possible development of excavation.

Secondary atrophy, developing against the background of stagnation of the optic nerve or against the background of its inflammation, is characterized by the appearance of signs inherent in the previous, primary form of atrophy, but in this case the only difference is the vagueness of the boundaries, which is relevant for the boundaries of the optic nerve head.

At the heart of the development mechanism glaucomatous form of atrophy The optic nerve, in turn, is considered to be a collapse that has arisen in the sclera from the side of its cribriform plate, which occurs due to a state of increased intraocular pressure.

In addition, the classification of forms of optic nerve atrophy also includes such variants of this pathology as already noted in the general review partial atrophy optic nerve and complete atrophy optic nerve. Here, as the reader can roughly assume, we are talking about the specific degree of scale of damage to nerve tissue.

A characteristic feature of the partial form of optic nerve atrophy (or initial atrophy, as it is also defined) is the incomplete preservation of visual function (vision itself), which is important when visual acuity is reduced (due to which the use of lenses or glasses does not improve the quality of vision). Although residual vision can be preserved in this case, there are disturbances in color perception. Preserved areas within sight remain accessible.

In addition, optic nerve atrophy can manifest itself in stationary form ( that is, in finished form or non-progressive form), which indicates a stable state of actual visual functions, as well as in the opposite, progressive form, in which a decrease in the quality of visual acuity inevitably occurs. Depending on the extent of the lesion, optic nerve atrophy manifests itself in both unilateral and bilateral forms (that is, affecting one eye or both eyes at once).

Optic nerve atrophy: symptoms

The main symptom of this disease is, as noted earlier, a decrease in visual acuity, and this pathology cannot be corrected. The manifestations of this symptom may vary depending on the specific type of atrophy. Progression of the disease can lead to a gradual decrease in vision until complete atrophy is achieved, in which vision is completely lost. The duration of this process can vary from several days to several months.

Partial atrophy is accompanied by a stop in the process at a certain stage, after which vision stops falling. According to these features, a progressive or completed form of the disease is distinguished.

With atrophy, vision can be impaired in various ways. Thus, the fields of vision may change (basically they narrow, which is accompanied by the disappearance of the so-called lateral vision), which can lead to the development of a “tunnel” type of vision, in which it seems that everything is seen as if through a tube, in other words, only visibility of objects directly in front of a person. Often scotomas become a companion to this type of vision; in particular, they mean the appearance of dark spots in any part of the visual field. Color vision disorder is also relevant.

Visual fields can change not only according to the type of “tunnel” vision, but also based on the specific location of the lesion. If scotomas, that is, the dark spots noted above, appear in the patient’s eyes, this indicates that those nerve fibers that are concentrated in maximum proximity to the central part of the retina or are located directly in it have been affected. The visual fields are narrowed due to damage to the nerve fibers; if the optic nerve is affected at a deeper level, then half of the visual field (nasal or temporal) may disappear. As already noted, the lesion can be either unilateral or bilateral.

Thus, we can summarize the symptoms under the following main points that determine the picture of the course:

the appearance of sector-shaped and central scotomas (dark spots);
decreased quality of central vision;
concentric narrowing of the field of view;
pallor of the optic nerve head.

Secondary optic nerve atrophy determines the following manifestations during ophthalmoscopy:

varicose veins;
vasoconstriction;
smoothing the area of the optic nerve boundaries;
disc blanching.

Diagnosis

Self-diagnosis, as well as self-medication (including treatment of optic nerve atrophy with folk remedies) for the disease in question should be completely excluded. In the end, due to the similarity of the manifestations characteristic of this pathology with manifestations, for example, of a peripheral form of cataract (accompanied initially by impaired lateral vision with subsequent involvement of the central parts) or with amblyopia (a significant decrease in vision without the possibility of correction), it is simply impossible to establish an accurate diagnosis on your own .

What is noteworthy is that even of the listed disease options, amblyopia is not a disease as dangerous as optic nerve atrophy can be for a patient. Additionally, it should be noted that atrophy can also manifest itself not only as an independent disease or as a result of exposure to another type of pathology, but can also act as a symptom of certain diseases, including diseases that end in death. Considering the seriousness of the lesion and all possible complications, it is extremely important to promptly begin diagnosing optic nerve atrophy, to find out the reasons that provoked it, as well as to adequately treat it.

The main methods on which the diagnosis of optic nerve atrophy is based include:

ophthalmoscopy;
visometry;
perimetry;
color vision research method;
CT scan;
radiography of the skull and sella turcica;
NMR scanning of the brain and orbit;
fluorescein angiography.

Also, a certain information content is achieved to compile a general picture of the disease through laboratory research methods, such as blood tests (general and biochemical), testing for borelliosis or syphilis.

Treatment

Before moving on to the specifics of the treatment, we note that it in itself is an extremely difficult task, because the restoration of damaged nerve fibers is in itself impossible. A certain effect, of course, can be achieved through treatment, but only under the condition of restoration of those fibers that are in the active phase of destruction, that is, with a certain degree of their vital activity against the background of such exposure. Missing this moment can cause final and irreversible loss of vision.

Among the main areas of treatment for optic nerve atrophy, the following options can be distinguished:

treatment is conservative;
therapeutic treatment;
surgical treatment.

Principles conservative treatment boil down to the sale of the following drugs in it:

vasodilators;
anticoagulants (heparin, ticlid);
drugs whose effect is aimed at improving the general blood supply to the affected optic nerve (papaverine, no-spa, etc.);
drugs that affect metabolic processes and stimulate them in the area of nerve tissue;
drugs that stimulate metabolic processes and have a resolving effect on pathological processes; drugs that stop the inflammatory process (hormonal drugs); drugs that help improve the functions of the nervous system (nootropil, Cavinton, etc.).

Physiotherapeutic procedures include magnetic stimulation, electrical stimulation, acupuncture and laser stimulation of the affected nerve.

The repetition of the course of treatment, based on the implementation of measures in the listed areas of influence, occurs after a certain time (usually within several months).

As for surgical treatment, it implies an intervention aimed at eliminating those formations that compress the optic nerve, as well as ligating the area of the temporal artery and implanting biogenic materials that help improve blood circulation in the atrophied nerve and its vascularization.

Cases of significant loss of vision due to the disease in question necessitate assigning the patient the appropriate degree of impairment to a disability group. Visually impaired patients, as well as patients who have completely lost their vision, are sent to a rehabilitation course aimed at eliminating the restrictions that have arisen in life, as well as compensating for them.

Let us repeat that optic nerve atrophy, which is treated using traditional medicine, has one very significant drawback: when using it, time is lost, which is almost precious as part of the progression of the disease. It is during the period of active independent implementation of such measures by the patient that there is an opportunity to achieve positive and significant results on their own scale due to more adequate treatment measures (and previous diagnostics, by the way, too); it is in this case that the treatment of atrophy is considered as an effective measure in which the return of vision is permissible . Remember that treatment of optic nerve atrophy with folk remedies determines the minimum effectiveness of the effect thus provided!

In recent decades, Israeli medicine has been among the leaders in the field of ophthalmology. This country employs highly qualified specialists with a worldwide reputation. Thanks to the use of modern, including innovative treatment methods, and high-precision, latest equipment, it is possible to achieve significant results even in difficult cases.

One of the successful areas in ophthalmology, treatment of optic atrophy in Israel, attracts many patients from other countries, since with high quality services, the cost of procedures and manipulations is much lower than in Europe or the USA.

Leading Israeli clinics for the diagnosis and treatment of optic atrophy

Diagnosis of the condition of the optic nerves

Basic diagnostic procedures

Additional Research

Fluorescein angiography,
Laser Dopplerography.

Operations for optic nerve atrophy

Types of operations

Vasoreconstructive,
Implantation of electrodes to the optic nerve head,
Nerve revascularization.

New methods for treating optic atrophy include tissue regenerative microsurgery, the use of stem cells and nanotechnology. The latter make it possible to deliver nutrients and drugs directly to the optic nerve using nanoparticles.

Treatment at the Top Assuta clinic

Oncogynecology at Top Assuta

Cost of treatment and diagnosis

Diagnostic procedures for examination for optic nerve atrophy will cost from $1,500 to $2,500. It all depends on the set of necessary procedures. If the patient has fresh research results from another clinic, the doctor can take them into account.

In case of mistrust or the need to clarify the diagnosis, the same diagnostic procedure can be prescribed again in the ophthalmology department in Israel.

The cost of treatment must be clarified when contacting the clinic. You can contact a consultant through the feedback form on the website and find out the approximate cost of the medical procedures performed.

For more information, see the section.

Optic nerve atrophy is the complete or partial destruction of its fibers with their replacement by connective tissue.

Causes of optic nerve atrophy

The causes of visual atrophy include heredity and congenital pathology; it can be a consequence of various eye diseases, pathological processes in the retina and optic nerve (inflammation, dystrophy, trauma, toxic damage, swelling, congestion, various circulatory disorders, compression of the optic nerve, etc.), pathology of the nervous system or general diseases.

More often, optic nerve atrophy develops as a result of pathology of the central nervous system (tumors, syphilitic lesions, brain abscesses, encephalitis, meningitis, multiple sclerosis, skull injuries), intoxication, alcohol poisoning with methyl alcohol, etc.

Also, the causes of the development of optic nerve atrophy can be hypertension, atherosclerosis, quinine poisoning, vitamin deficiency, fasting, and profuse bleeding.

Optic nerve atrophy occurs as a result of obstruction of the central and peripheral retinal arteries supplying the optic nerve, and it is also the main symptom of glaucoma.

Symptoms of optic atrophy

There are primary and secondary atrophy of the optic nerves, partial and complete, complete and progressive, unilateral and bilateral.

The main symptom of optic nerve atrophy is a decrease in visual acuity that cannot be corrected. Depending on the type of atrophy, this symptom manifests itself differently. Thus, as atrophy progresses, vision gradually decreases, which can lead to complete atrophy of the optic nerve and, accordingly, to complete loss of vision. This process can take place from several days to several months.

With partial atrophy, the process stops at some stage and vision stops deteriorating. Thus, progressive atrophy of the optic nerves is distinguished and complete.

Visual impairment due to atrophy can be very diverse. This can be a change in visual fields (usually narrowing, when “lateral vision” disappears), up to the development of “tunnel vision”, when a person looks as if through a tube, i.e. sees objects that are only directly in front of him, and scotomas often appear, i.e. dark spots in any part of the visual field; It could also be a color vision disorder.

Changes in visual fields can be not only “tunnel”, it depends on the localization of the pathological process. Thus, the appearance of scotomas (dark spots) right before the eyes indicates damage to nerve fibers closer to the central or directly in the central part of the retina; narrowing of the visual fields occurs due to damage to peripheral nerve fibers; with deeper lesions of the optic nerve, half of the visual field (or temporal , or nasal). These changes can occur in one or both eyes.

Examination for suspected optic nerve atrophy

It is unacceptable to engage in self-diagnosis and self-medication for this pathology, because something similar happens with peripheral cataracts, when lateral vision is first impaired, and then the central parts are involved. Also, optic atrophy can be confused with amblyopia, in which vision can also be significantly reduced and cannot be corrected. It is worth noting that the above pathology is not as dangerous as optic nerve atrophy. Aatrophy can be not only an independent disease or a consequence of some local pathology in the eye, but also a symptom of a serious and sometimes fatal disease of the nervous system, so it is very important to establish the cause of optic nerve atrophy as early as possible.

If similar symptoms occur, you should immediately contact an ophthalmologist and neurologist. These two specialists are primarily involved in the treatment of this disease. There is also a separate branch of medicine - neuro-ophthalmology, doctors - neuro-ophthalmologists, who are engaged in the diagnosis and treatment of such pathologies. If necessary, neurosurgeons, therapists, otorhinolaryngologists, infectious disease specialists, oncologists, toxicologists, etc. can also take part in diagnosis and treatment.

Diagnosis of optic atrophy is usually not difficult. It is based on the determination of visual acuity and fields (perimetry), on the study of color perception. An ophthalmologist must perform an ophthalmoscopy, during which he detects blanching of the optic nerve head, narrowing of the vessels of the fundus and measures intraocular pressure. A change in the contours of the optic nerve head indicates the primary or secondary nature of the disease, i.e. if its contours are clear, then most likely the disease has developed for no apparent reason, but if the contours are blurred, then perhaps it is post-inflammatory or post-stagnant atrophy.

If necessary, an X-ray examination is carried out (craniography with a mandatory image of the sella region), computed tomography or magnetic resonance imaging of the brain, electrophysiological research methods and fluorescein angiographic methods, in which the patency of the retinal vessels is checked using a special substance administered intravenously.

Laboratory research methods can also be informative: a general blood test, a biochemical blood test, a test for syphilis or borelliosis.

Treatment of optic atrophy

Treatment of optic atrophy is a very difficult task for doctors. You need to know that destroyed nerve fibers cannot be restored. One can hope for some effect from treatment only by restoring the functioning of nerve fibers that are in the process of destruction, which still retain their vital functions. If this moment is missed, then vision in the affected eye can be lost forever.

When treating atrophy, it is necessary to keep in mind that this is often not an independent disease, but a consequence of other pathological processes affecting various parts of the visual pathway. Therefore, treatment of optic nerve atrophy must be combined with elimination of the cause that caused it. If the cause is eliminated in a timely manner and if atrophy has not yet developed, normalization of the fundus picture and restoration of visual functions occurs within 2-3 weeks to 1-2 months.

Treatment is aimed at eliminating edema and inflammation in the optic nerve, improving its blood circulation and trophism (nutrition), restoring the conductivity of not completely destroyed nerve fibers.

But it should be noted that the treatment of optic nerve atrophy is long-term, its effect is weak, and sometimes completely absent, especially in advanced cases. Therefore it should be started as early as possible.

As mentioned above, the main thing is the treatment of the underlying disease, against the background of which complex treatment of optic nerve atrophy is carried out. For this, various forms of drugs are prescribed: eye drops, injections, both general and local; tablets, electrophoresis. Treatment is aimed at

improvement of blood circulation in the vessels supplying the nerve - vasodilators (complamin, nicotinic acid, no-spa, papaverine, dibazol, aminophylline, trental, halidor, sermion), anticoagulants (heparin, ticlid);
to improve metabolic processes in nerve tissue and stimulate the restoration of altered tissue - biogenic stimulants (aloe extract, peat, vitreous, etc.), vitamins (ascorutin, B1, B2, B6), enzymes (fibrinolysin, lidase), amino acids (glutamic acid ), immunostimulants (ginseng, eleuthorococcus);
to resolve pathological processes and stimulate metabolism (phosphaden, preductal, pyrogenal); to relieve the inflammatory process - hormonal drugs (prednisolone, dexamethasone); to improve the functioning of the central nervous system (emoxipin, Cerebrolysin, Fezam, nootropil, Cavinton).

Medicines must be taken as prescribed by a doctor after diagnosis. The doctor will select the optimal treatment, taking into account concomitant diseases. In the absence of concomitant somatic pathology, you can independently take no-shpa, papaverine, vitamin preparations, amino acids, emoxypine, nootropil, fesam.

But you should not self-medicate for this serious pathology. Physiotherapeutic treatment and acupuncture are also used; methods of magnetic, laser and electrical stimulation of the optic nerve have been developed.

The course of treatment is repeated after several months.

Nutrition for optic nerve atrophy should be complete, varied and rich in vitamins. You need to eat as much fresh vegetables and fruits as possible, meat, liver, dairy products, cereals, etc.

If vision is significantly reduced, the issue of assigning a disability group is decided.

The visually impaired and the blind are prescribed a course of rehabilitation aimed at eliminating or compensating for the limitations in life that have arisen as a result of vision loss.

Treatment with folk remedies is dangerous because precious time is lost when it is still possible to cure atrophy and restore vision. It should be noted that for this disease, folk remedies are ineffective.

Complications of optic atrophy

The diagnosis of optic atrophy is very serious. At the slightest decrease in vision, you should immediately consult a doctor so as not to miss your chance of recovery. Without treatment and as the disease progresses, vision may disappear completely, and it will be impossible to restore it. In addition, it is very important to identify the cause of optic nerve atrophy and eliminate it as early as possible, because this can not only lead to loss of vision, but can also be fatal.

Prevention of optic atrophy

In order to reduce the risk of optic nerve atrophy, it is necessary to promptly treat diseases that lead to atrophy, prevent intoxication, conduct blood transfusions in case of profuse bleeding and, of course, promptly consult a doctor at the slightest sign of vision deterioration.

Ophthalmologist E.A. Odnoochko

Optic nerve atrophy (optic neuropathy) is partial or complete destruction of the nerve fibers that transmit visual stimuli from the retina to the brain. During atrophy, the nervous tissue experiences an acute lack of nutrients, which is why 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.

What is the optic nerve?

The optic nerve belongs to the cranial peripheral nerves, but essentially it is not a peripheral nerve either in origin, or in structure, or in function. This is the white matter of the cerebrum, the pathways that connect and transmit visual sensations from the retina to the cerebral cortex.

The optic nerve delivers nerve messages to the area of the brain responsible for processing and perceiving light information. It is the most important part of the entire process of converting light information. Its first and most significant function is the delivery of visual messages from the retina to the areas of the brain responsible for vision. Even the smallest injuries to this area can have serious complications and consequences.

Optic atrophy according to the ICD has ICD code 10

Causes

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

The following types of disease are distinguished:

Congenital atrophy - manifests itself at birth or a short period of time after the birth of the child.
Acquired atrophy is a consequence of adult diseases.

Factors leading to optic nerve atrophy may include eye diseases, central nervous system lesions, mechanical damage, intoxication, general, infectious, autoimmune diseases, etc. Optic nerve atrophy appears as a result of obstruction of the central and peripheral retinal arteries that supply the optic nerve, as well as is the main symptom of glaucoma.

The main causes of atrophy are:

Heredity
Congenital pathology
Eye diseases (vascular diseases of the retina, as well as the optic nerve, various neuritis, glaucoma, pigmentary degeneration of the retina)
Intoxication (quinine, nicotine and other drugs)
Alcohol poisoning (more precisely, alcohol surrogates)
Viral infections (flu, flu)
Pathology of the central nervous system (brain abscess, syphilitic lesion, skull injury, multiple sclerosis, tumor, syphilitic lesion, skull trauma, encephalitis)
Atherosclerosis
Hypertonic disease
Profuse bleeding

The cause of primary descending atrophy is vascular disorders with:

hypertension;
atherosclerosis;
spinal pathologies.

Secondary atrophy is caused by:

acute poisoning (including alcohol substitutes, nicotine and quinine);
inflammation of the retina;
malignant neoplasms;
traumatic injury.

Optic nerve atrophy can be caused by inflammation or dystrophy of the optic nerve, its compression or trauma, leading to damage to the nerve tissue.

Types of disease

Atrophy of the optic nerve of the eye occurs:

Primary atrophy(ascending and descending), as a rule, develops as an independent disease. Descending optic atrophy is most often diagnosed. This type of atrophy is a consequence of the fact that the nerve fibers themselves are affected. It is transmitted in a recessive manner by inheritance. This disease is linked exclusively to the X chromosome, which is why only men suffer from this pathology. It manifests itself at 15-25 years of age.
Secondary atrophy usually develops after the course of any disease, with the development of stagnation of the optic nerve or a violation of its blood supply. This disease develops in any person and at absolutely any age.

In addition, the classification of forms of optic nerve atrophy also includes the following variants of this pathology:

Partial optic atrophy

Complete atrophy

Any self-diagnosis is excluded - only specialists with the proper equipment can make an accurate diagnosis. This is also due to the fact that the symptoms of atrophy have much in common with amblyopia and cataracts.

In addition, optic nerve atrophy can manifest itself in a stationary form (that is, in a complete form or a non-progressive form), which indicates a stable state of actual visual functions, as well as in the opposite, progressive form, in which a decrease in the quality of visual acuity inevitably occurs.

Symptoms of 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 partial atrophy of the optic nerve, pathological changes reach a certain point and do not develop further, and therefore vision is partially lost.

With partial atrophy, the process of vision deterioration stops at some stage, and vision stabilizes. Thus, it is possible to distinguish between progressive and complete atrophy.

Alarming symptoms that may indicate that optic nerve atrophy is developing are:

narrowing and disappearance of visual fields (lateral vision);
the appearance of “tunnel” vision associated with color sensitivity disorder;
the occurrence of scotomas;
manifestation of the afferent pupillary effect.

The manifestation of symptoms can be unilateral (in one eye) or multilateral (in both eyes at the same time).

Complications

In order to prevent the occurrence of pathologies of the optic nerve, it is necessary to carefully monitor your health and undergo regular examinations by specialists (rheumatologist, endocrinologist, neurologist, ophthalmologist). At the first signs of vision deterioration, you should consult an ophthalmologist.

Diagnostics

Optic nerve atrophy is a fairly serious disease. In case of even the slightest decrease in vision, it is necessary to visit an ophthalmologist so as not to miss precious time to treat the disease. Any self-diagnosis is excluded - only specialists with the proper equipment can make an accurate diagnosis. This is also due to the fact that the symptoms of atrophy have much in common with amblyopia and.

An examination by an ophthalmologist should include:

visual acuity test;
examination through the pupil (diluted with special drops) of the entire fundus of the eye;
spheroperimetry (precise determination of the boundaries of the field of view);
laser dopplerography;
assessment of color perception;
craniography with an image of the sella turcica;
computer perimetry (allows you to identify which part of the nerve is damaged);
video-ophthalmography (allows us to identify the nature of damage to the optic nerve);
computed tomography, as well as magnetic nuclear resonance (clarifies the cause of optic nerve disease).

Treatment of optic nerve atrophy of the eye

When treating optic nerve atrophy, the following actions are performed:

Biogenic stimulants (vitreous body, aloe extract, etc.), amino acids (glutamic acid), immunostimulants (Eleutherococcus), vitamins (B1, B2, B6, ascorutin) are prescribed to stimulate the restoration of altered tissue, and are also prescribed to improve metabolic processes
Vasodilators are prescribed (no-spa, diabazole, papaverine, sermion, trental, zufillin) to improve blood circulation in the vessels supplying the nerve
To maintain the functioning of the central nervous system, Fezam, Emoxipin, Nootropil, Cavinton are prescribed
To accelerate the resorption of pathological processes - pyrogenal, preductal
Hormonal drugs are prescribed to stop the inflammatory process - dexamethasone, prednisolone.

Medicines are taken only as prescribed by a doctor and after an accurate diagnosis has been established. Only a specialist can choose the optimal treatment, taking into account concomitant diseases.

Patients who have completely lost their vision or have lost it to a significant extent are prescribed an appropriate course of rehabilitation. It is aimed at compensating and, if possible, eliminating all the restrictions that arise in life after suffering optic nerve atrophy.

Basic physiotherapeutic methods of therapy:

color stimulation;
light stimulation;
electrical stimulation;
magnetic stimulation.

To achieve a better result, magnetic and laser stimulation of the optic nerve, ultrasound, electrophoresis, and oxygen therapy can be prescribed.

The earlier treatment is started, the more favorable the prognosis of the disease. Nervous tissue is practically irreparable, so the disease cannot be neglected; it must be treated in a timely manner.

In some cases, with optic atrophy, surgery and surgical intervention may also be relevant. According to research results, optic fibers are not always dead, some may be in a parabiotic state and can be returned to life with the help of a professional with extensive experience.

The prognosis for optic nerve atrophy is 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.

Prevention

Optic atrophy is a serious disease. To prevent it, you need to follow some rules:

Consultation with a specialist if there is the slightest doubt about the patient’s visual acuity;
Prevention of various types of intoxication
promptly treat infectious diseases;
do not abuse alcohol;
monitor blood pressure;
prevent eye and traumatic brain injuries;
repeated blood transfusion for profuse bleeding.

Timely diagnosis and treatment can restore vision in some cases, and slow or stop the progression of atrophy in others.