Diagnosis and treatment of optic nerve atrophy. What is eye atrophy and can it be cured? Congenital optic atrophy

One of the most serious and dangerous ophthalmological pathologies is eye atrophy. The patient's visual acuity is significantly reduced. The eyeball becomes deformed and becomes smaller. This pathology is promoted by severe injuries, prolonged inflammatory processes, etc.

Atrophy of the eyeball

Pathogenesis of atrophic changes

The visual organs are the most vulnerable. The mucous membrane does not protect the eyes from injuries, penetration of fragments and other foreign bodies. Atrophy of the eyeball can appear at any age in both sexes.

The pathological condition is characterized by the inability of the affected eye to perform its physiological functions. It is impossible to restore visual functionality even with surgery.

Atrophic changes occur after wounds and injuries to the eye. The pathological condition develops as a result of prolonged lack of treatment for inflammation or retinal detachment. Blindness can be avoided if you seek help from a doctor in time. The ophthalmologist will identify the cause and prescribe a therapeutic course aimed at eliminating it.

According to statistics, in recent years the number of domestic and criminal injuries to the visual organs has increased significantly. Many people become disabled due to ocular dysfunction. After penetrating ocular wounds, a person experiences hypotension, which is the main mechanism for the development of atrophy.

Violation of the integrity of the fibrous capsule often occurs due to contusion. Hypotension appears due to diabetic coma, low intracranial pressure, etc. If this pathology is not treated, it soon occurs.

In particularly severe cases, the ophthalmologist advises completely removing the atrophied eye. Enucleation reduces the risk of infection, inflammation and the development of cancer.

A prosthesis is later placed in place of the removed visual organ. This is necessary not only from an aesthetic point of view, but also to prevent damage to pathologically altered tissues of the orbit.

Why does the eye atrophy?

If the eye becomes deformed, becomes smaller, and vision rapidly declines, there is definitely a reason for this. Most often, atrophy of the eyeball occurs due to retinal detachment, uveitis or neuroretinitis. Inflammatory processes destroy tissue at the cellular level. Retinal detachment is a total process that can be treated in the early stages.

The eye atrophies due to hypotonic syndrome. The functioning of the ciliary muscle is impaired. Secretory capacity decreases. Uveoscleral outflow increases. Due to lack of moisture, the retinal vessels dilate and the capillaries become permeable.

Thus, the fluid comes out of the vascular bed. Normal tissue trophism is disrupted. The consequences of improper nutrition of the eye structures are the following disorders:

• degenerative changes in the retina;
• corneal deformation;
• damage to the optic nerve head;
• reduction of the eyeball;
• blindness;
• ocular atrophy.

Injuries that provoke eye atrophy, depending on the cause, are divided into the following groups:

• agricultural;
• production;
• children's;
• household;
• received in combat conditions.

Agricultural injuries are caused by the horns or hooves of animals. The situation is complicated by the presence of earth inside the eye. This poses a risk of infection. The possibility of an unfavorable outcome is high. Occupational injuries are relevant for workers in mines and chemical plants.

Children do not always follow safety precautions; their coordination of movements is impaired. They can accidentally injure their eyes with a pencil, ski pole, compass, wire, etc. Atrophy of the eyeball often occurs due to household injuries.

Failure to follow safety precautions when using home appliances is a common cause. Combat wounds are the most dangerous and almost always result in the need for enucleation.

Clinical picture of the atrophic process

The nature of the symptoms depends on the stage of development of the disease. The degree of the disease is determined based on the characteristics of pathological changes in the structures of the eye and the size of the anterior-posterior axis (APA). Ophthalmologists distinguish 3 stages of eye atrophy:

1. Initial. Traumatic cataracts develop, and degenerative changes appear in the cornea. The vitreous body begins to become cloudy. The retina peels off in one quadrant. PZO is more than 18 mm.
2. Developed. The iris and cornea completely atrophy. Moorings are formed in the vitreous body. The retina peels off in several quadrants. PZO is less than 17 mm.
3. Far gone. The retina peels off completely. Appears. PZO is less than 15 mm.

Vision is rapidly deteriorating. At the last stage of development, the diseased eye retains the ability to perceive light. A person distinguishes between light and darkness. When the pathological process is completed, the eye becomes completely blind.

The affected visual organ becomes smaller, the cornea becomes cloudy and white. Additional symptoms depend on the cause of the pathological process. Atrophy may be accompanied by the following manifestations:

• severe headache or eye pain;
• in the eye;
• burning in the eye socket;
• blepharospasm;
• the appearance of spots before the eyes;
• the presence of a dark veil;
• photophobia;
• soreness of the eyelids.

Ocular atrophy is the final stage of injury or advanced ophthalmological disease. Sometimes it can be avoided if you consult a doctor in time. Early diagnosis of the root cause is the key to maintaining the ability to see with the affected eye.

Diagnosis and treatment of pathology

In case of injuries, injuries or other damage to the organs of the optical system, you should immediately consult a doctor. The ophthalmologist will conduct an examination. A comprehensive examination will help identify the cause of the violation. In modern ophthalmology, the following diagnostic methods are used:

• biomicroscopy;
• tonometry;
• visometry;
• perimetry;
• echography;
• optical coherence tomography;
• ophthalmoscopy;
• Ultrasound of the eyeball.

Eye atrophy cannot be cured. The aesthetic defect is eliminated by removing the affected visual organ and subsequent prosthetics. If the pathological process has not yet begun, the ophthalmologist prescribes treatment aimed at eliminating the injury or disease.

Therapy begins with removal of the traumatic cataract through vitrectomy. If a retinal detachment is present, surgery is performed and stitches are placed.

Next, keratectomy and keratoplasty are performed to eliminate retracted scars. The sooner the above procedures are carried out, the higher the likelihood of a favorable outcome and the absence of atrophic processes.

The second stage of therapy is the extraction of the damaged lens. Then a cordectomy, removal of foreign bodies, vitrectomy and restoration of muscle functionality are performed.

After all surgical procedures, silicone is injected into the eyeball. Medications are also prescribed. Anesthetic injections are given. Enucleation is a last resort.

The eyeball is removed only if complete blindness occurs and there is no positive effect from treatment within 2 months. It is important to contact a professional medical facility immediately after receiving an injury or detecting the first adverse symptoms. Only in this case is there a chance to save the eye and the ability to see.

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

Toxic damage to the organ of vision is a disease that can lead to atrophy of the optic nerve (occurring as retrobulbar neuritis with characteristic changes in color perception and central scotomas) and, as a consequence, to loss of vision (blindness).

Damage to the optic nerve is observed during general intoxication with arsenic compounds. An early symptom is a concentric narrowing of the visual field. Then visual acuity decreases. Lesions of the optic nerve may sometimes represent the only signs of poisoning and, as a rule, are bilateral, leading to rapid and significant loss of vision due to developing atrophy of the optic nerves. In the fundus there are signs of neuritis or blanching of the optic nerve head. Retinal edema, vitreous opacities, and uveitis may also occur.

In cases of lead poisoning, retinopathy develops with arteriosclerosis and periarteritis, hemorrhages and exudate appear in the fundus, more often with kidney damage and arterial hypertension. A typical eye lesion is retrobulbar neuritis (sometimes with mild hyperemia of the optic disc or hemorrhages). There is a central scotoma, often bilateral; the boundaries of the field of view are narrowed only slightly. As the process progresses, optic nerve atrophy develops, sometimes leading to blindness.

Carbon disulfide has a specific effect on the optic nerve. With chronic intoxication, neuritis of the retrobulbar type with a central scotoma and, less commonly, with simultaneous narrowing of the peripheral boundaries of the visual field can develop. The central scotoma appears earlier than other symptoms, color perception is impaired (especially significant for red). The defeat is always two-sided. Other ocular manifestations of chronic carbon disulfide intoxication may include pinpoint superficial keratitis, paralysis of the external muscles of the eye, paralysis of accommodation, nystagmus, and impaired adaptation to darkness.

With phosphorus poisoning, retrobulbar neuritis can develop, and sometimes trigeminal neuralgia occurs, which forces the patient to consult an ophthalmologist for pain in the eye area.

With retrobulbar neuritis in the background alcoholism Both eyes are always affected. At first, the decrease in visual acuity is slight, then there is a progressive drop in visual acuity to 0.1 or less. During the examination, a decrease in visual acuity is revealed, a change in refraction is often observed, and the development of myopia is more often noted. The field of vision narrows concentrically, paracentral absolute and relative scotomas appear, and the blind spot expands significantly. Characterized by a pronounced impairment of color vision, narrowing of the boundaries of color vision, and impaired dark adaptation. Intraocular pressure in patients with chronic alcoholism tends to decrease. Eye motor disorders are detected: convergence disorder, nystagmus, ptosis. Possible reflex immobility of the pupil and anisocoria. On examination, pronounced disturbances of microcirculation in the conjunctiva of the eyeball, narrowing of the arteries and dilatation of the veins of the retina, degenerative lesions on the periphery of the retina, swelling of the retina around the optic nerve head, pallor or hyperemia of the optic nerve are detected.

Chingamine (delagil, resoquine, chloraquine) and hydroxychloroquine (plaquenil) often lead to corneal edema, accompanied by the deposition of white granules in the stroma. In this regard, patients complain of fogging and rainbow circles around the light source. The sensitivity of the cornea is usually reduced. Sometimes retinal damage is observed, which is associated with the toxic effect of drugs on its pigment epithelium. Pigment accumulations are found as mottling in the macula area. Peripheral retinal pigmentation and narrowing of the visual field may occur. Changes are reversible only in the early stage of toxic damage.

Ethambutol also has a toxic effect on the optic nerve. The process occurs as a retrobulbar neuritis with a decrease in central vision, a concentric narrowing of the visual field, and central scotomas.

Toxic injuries with methyl alcohol occur when inhaling vapors, absorption from the surface of the skin, or ingestion instead of ethyl alcohol. The lethal dose is from 40 to 250 ml, but taking even 5 to 10 ml can lead to blindness. Individual tolerance varies, older people are less resilient, alcoholics are less susceptible to its effects. Decreased vision usually occurs 1 to 2 days after poisoning and progresses rapidly, up to complete blindness. In the field of view there are absolute central scotomas, possibly combined with a concentric narrowing of the field of view.

Taking into account the course of toxic lesions of the optic nerve, four stages are distinguished: Stage I - the phenomena of moderate hyperemia of the optic nerve head and vasodilatation predominate; Stage II - stage of papilledema; Stage III - ischemia, vascular disorders; Stage IV - the stage of atrophy, degeneration of the optic nerves.

Patients with acute toxic damage to the optic nerves (poisoning) are subject to immediate hospitalization; Delay in providing urgent assistance is fraught with serious consequences, including complete blindness or death. In case of chronic toxic damage to the optic nerves, hospitalization is indicated for the first course of emergency treatment to develop the most effective comprehensive individual treatment cycle. Subsequently, courses of treatment using methods that have proven to be the most effective can be carried out on an outpatient basis.

Treatment is focused on the stage of the disease (the effectiveness of treatment for patients with neuritis depends on the initial functional data): in the first stage - detoxification therapy; at the second stage - intensive dehydration (furosemide, acetazolamide, magnesium sulfate), anti-inflammatory therapy (glucocorticoids); in the third stage, vasodilators are preferred (drotaverine, pentoxifylline, vinpocetine); in the fourth stage - vasodilators, stimulating therapy, physiotherapy. For partial atrophy of the optic nerves of toxic origin, some surgical methods are used: electrical stimulation, with the introduction of an active electrode to the optic nerve, catheterization of the superficial temporal artery (with infusion of sodium heparin (500 units), dexamethasone 0.1% 2 ml, Actovegin 2 times a day day for 5 - 7 days). An effective method of treating diseases of the optic nerve of toxic origin is long-term repeated administration of pharmacological agents to the optic nerve through a catheter implanted into the retrobulbar space.

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:

1. Ascending type - the disease occurs from that part of the nerve trunk that is closer to the eye (before the chiasm);
2. 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.

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:

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:

1. 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;
2. 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;
3. Severe – indicates the activity of the pathology. The sharpness is reduced so much that even objects located nearby become difficult to distinguish;
4. 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:

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:

1. 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;
2. 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.

Among all the senses that a person has, vision is the most important. The body receives more than 65-70% of all information about the world around us precisely through its ability to see. That is why such a pathology as eye atrophy represents a serious problem not only in ophthalmology.

Vision and the eye

The ability to perceive a picture of the world becomes possible thanks to the existence of a visual analyzer. Its composition includes the following components.

1. Perceiving organ. This is the eye. His device is entirely aimed at perceiving photons of light and processing them into an electrical nerve impulse.
2. Conductive system. These include the nerve fibers through which impulses pass from the eye to the neurons of the visual zone of the cerebral cortex.
3. Central analyzer. The area of ​​the cerebral cortex that is responsible for processing information coming from the eyes.

A person has two paired organs located in special recesses in the bones of the facial skull. They are called eye sockets. Each recess completely accommodates the eye and contains several openings through which blood vessels and nerves pass to the eye. The optic nerve also passes through here.

Each eye is a separate organ with all its associated auxiliary apparatus:

• Eyeball. This is the base of the eye. Its shape is very close to oval. Although one of its sides is more rounded. Her eye is turned outward. There is a transparent stratum corneum, which ensures the free passage of light photons into the eye cavity. The cavity itself is filled with a transparent vitreous body. Its functions are to maintain a constant shape of the eye and ensure trophism of some of its parts. The other end of the eyeball has a more elongated shape. Photoreceptor cells are located here. Together they make up the retina of the eye, which in the region of the most elongated area passes into the optic nerve. It runs from the eye into the cranial cavity through a large opening in the orbit.
• The auxiliary apparatus of the eye is also located in the orbital cavity. It is represented by four pairs of muscles and nerves of the eye. They provide friendly eye movements in all planes. This is the so-called internal auxiliary apparatus
• External auxiliary apparatus of the eyes. It includes the eyelids, eyelashes and lacrimal glands. Their main function is to protect the organs of vision.

The vision mechanism looks like this:

1. Photons of light, penetrating the eye cavity and reaching the retina, excite the latter's receptors. Their number is in the hundreds of thousands. And each of them is designed for a specific wavelength of light. These are the so-called rods and cones. It is in violations of these cells that atrophy of the retina lies. So, excitation of the receptors leads to the formation of a nerve impulse, which is carried along the processes of these cells to the optic nerve.
2. The nerve impulse travels along the optic nerves from each eye to the cranial cavity, where they, as part of the conduction tract of the analyzer, reach the occipital lobes of the cerebral hemispheres.
3. Neurons of the occipital lobes of the cerebral hemispheres process the information received and, together with the extrapyramidal system, form a visual image perceived by the human consciousness.

Atrophy and its mechanisms

Atrophy, in the literal sense of the word, is translated as lack of nutrition. But in medicine, this term means a significant reduction in the volume of an organ. Up to its complete absence. In other words, atrophy is an extreme degree of dystrophy.

It is important! The mechanism of atrophy is a reduction in the size of the organ and the complete loss of its functions. The latter occurs due to a decrease in the number of working cells, which ensure the functioning of the organ.

The trigger for atrophy is a decrease in the supply of nutrients and oxygen to individual cells. The metabolism of these cells slows down and they gradually die. A dead cell undergoes “disposal”: it is broken down into its component molecules, which are then transported to other parts of the body. The place of the missing cell must be taken by a new one, but its formation is not possible due to the fact that the trophism of the tissues is impaired and cell division is not possible. Therefore, the remaining cells try to get closer to each other due to one simple principle that is characteristic of all living beings: the body does not tolerate emptiness. So, over and over again, the death of cells without corresponding inflammation by new ones leads to a decrease in the size of organs.

Dystrophy and atrophy of the visual analyzer

In relation to the visual analyzer, atrophic processes follow the same principles as in any other part of the body. And any part of the visual analyzer can undergo atrophic processes. And not only those that consist of cells.

The concept of eye atrophy includes several, sometimes separately occurring, atrophic changes in its constituent parts. If dystrophy affects only the organ of vision itself, then this condition is called atrophy of the eyeball. More common manifestations include atrophy of the cornea, vitreous body, retina and lens. Lens atrophy is a rare example of dystrophy of non-cellular structures of the body. Violation of its trophism does not lead to a decrease in size. They are preserved, but the optical functions of the lens are significantly changed.

In all other parts of the eye, dystrophic changes occur according to the basic principles. Thus, retinal atrophy, the treatment of which, along with optic nerve dystrophy, is one of the most important problems in ophthalmology, begins with a reduction in the number of cones. Therefore, its manifestations often begin with a deterioration in color vision. The fact is that the metabolism of cones is higher than that of rods.

Disturbances in the nutrition of the nervous system of the eye begin clinically with a general deterioration in vision. Thus, atrophy of the optic nerve of one eye in the initial stages is hardly noticeable due to the fact that general vision does not suffer. It can be identified with a special study. Bilateral nerve damage results in a general deterioration of vision.

Causes of atrophy

All causes of dystrophic eye lesions are usually divided into two large groups. These are external and internal reasons. Accordingly, they distinguish between primary and secondary atrophy:

• External reasons. They lead to the development of so-called secondary atrophy. This group includes various injuries to the eyes and their auxiliary apparatus, traumatic brain injuries, inflammatory diseases of the eyes and brain.
• Internal causes lead to primary atrophy. This group is significantly smaller than the previous one. This includes various hereditary and degenerative diseases of the eyes, nerve cells, and brain.

Treatment of the disease

In the treatment of dystrophic diseases, great importance is given to diagnosing their causes. Thus, secondary changes respond well to therapeutic effects. At first, treating the underlying disease is sufficient. In primary diseases, the main emphasis is on maintaining cell metabolism and improving it.

Sometimes they resort to surgical methods. Thus, treatment of optic nerve atrophy caused by its compression by a tumor or hematoma will be absolutely ineffective without surgically eliminating the cause. For example, lens atrophy is a direct indication for its removal and subsequent replacement.