How to prevent inflammation of the optic nerve? Inflammation of the optic nerve: symptoms and treatment

Inflammation optic nerve(optic neuritis, optoencephalitis) is a serious ophthalmological pathology, a disease characterized by the development of inflammation of the optic nerve. In this case, demyelination occurs, a decrease in the fat layer in the structure nerve fibers, ensuring the transmission of signals to the central nervous system. Inflammation of the nerve of the eye is most often combined with other diseases and pathologies of a neurological nature. In patients diagnosed with optoencephalitis, it is noted a sharp decline visual function combined with strong pain symptoms, which increase with eye movement.

The optic nerve consists of one billion sensory processes (axons) of a structure such as the retina of the eye, which transmit information and signals to the brain about the perceived image through electrical impulses. The final processing of the received data occurs in the occipital zone of the brain.

The membranes, as well as the space under the optic nerve sheath, are inextricably linked with the brain and central nervous system. For this reason, when inflammatory diseases brain, intracranial pressure may increase, pathological processes will affect the optic nerve.

Inflammation of the nerve of the eye medical practice diagnosed in people aged 18 to 50 years. In older people, younger children age groups Optic neuritis is observed extremely rarely.

Depending on the localization of inflammatory processes, ophthalmological pathology is classified into retrobulbar and intrabulbar neuritis. In the retrobulbar form of inflammation, which can occur acutely or chronically, pathological processes are localized outside eyeball. The receptive bundle of nerve fibers is damaged. At first, the inflammation covers one eye, but if timely effective treatment is not prescribed, the pathology spreads to the second. healthy eye. With intrabulbar optic neuritis, the inflammatory process affects the optic nerve head.

The main reasons that provoked optoencephalitis are due to endo- and exofactors of various nature. Inflammation of the optic nerve can develop against the background of chronic viral, bacteriological, cold (respiratory) infections, and local diseases.

Optic neuritis is accompanied by neurological pathologies, chronic infections, promoting the development of destructive processes in the nerve fibers responsible for the conduction of impulses. Optic neuritis is diagnosed in multiple sclerosis. Pathology may also be a characteristic harbinger of this neurological disease CNS.

The main causes of optoencephalitis:

• inflammation of the membranes of the brain;
• alcohol, drug intoxication;
• acute, chronic bacterial diseases(herpes, gonorrhea, brucellosis, tuberculosis, syphilis);
• focal, local ascending, descending infections (sinusitis, rhinitis, tonsillitis);
• non-infectious diseases (gout, erysipelas, blood pathologies);
• mechanical injuries, damage to deep structures of the eye;
• difficult pregnancy;
• inflammation of the inner membranes of the eye,
• decreased twilight vision;
• organic lesions of various parts of the central nervous system;
• chronic dysfunction of internal organs.

Individuals with symptoms of brain damage are at risk. Ophthalmological pathology is diagnosed with inflammatory processes in the oral cavity, serious dental diseases(caries, periodontitis). The development of optic neuritis is promoted by autoimmune diseases(neuromyelitis optica), long-term use of certain medications, radiation exposure.

If treatment is not prescribed in a timely manner, the inflammation quickly spreads to other, deeper structures of the eye, which, in turn, can become the main cause of weakened visual function and lead to complete blindness.

Symptoms

Symptoms and the intensity of their manifestation depend on age, general physiological state patients, immunity, localization. Symptoms diagnosed for inflammation of the nerve of the eye:

• cutting pain syndrome in the orbital area, increasing with eye movement;
• headaches, severe migraine;
• decreased visual acuity;
• change in color perception;
• “blind” White spot, blurry spots in the visibility zone;
• narrowing of peripheral vision;
• dilated pupil, photophobia;
• changes in twilight vision;
• high fever, chills, nausea, vomiting, loss of consciousness.

Decreased optical function of the eye, symptoms of neuritis intensify after excessive physical activity, overwork, disturbances in sleep and rest patterns, adoption hot bath, visits to the bathhouse, sauna.

As a rule, inflammation in the early stages develops in one eye, but if treatment is neglected, after six to seven days it is possible that the inflammatory process will spread to the healthy eye.

Symptoms of inflammation of the nerve of the eye appear in the form of small point infiltrations and proliferation of cellular structures. Inflammation may have varying degrees heaviness will spread with soft meninges on nerve fibers, affecting the optic nerve trunk. If the inflammation is localized in the nerve trunk, the pathological process becomes interstitial in nature, which leads to the formation of edema and infiltration of surrounding tissues.

Disruption of metabolism in the cellular structures of fibers transmitting nerve impulses, if treatment is not prescribed in a timely manner, will lead to their atrophy in areas of inflammation. In retrobulbar form initial stages there is a sharp decrease in vision, discomfort, discomfort when moving the affected eye.

Diagnostics

To establish accurate diagnosis When the first symptoms appear, you must undergo an examination by an ophthalmologist. Treatment of optoencephalitis can be prescribed after complex diagnostics, determining the form, stage of the disease, the reasons that provoked the development of inflammation in the optic nerve.

Patients are prescribed special tests to check color vision. IN mandatory an ophthalmoscopy is performed to determine changes in various structures of the eye using directional light beam. If necessary, MRI and fluorescein angiography are additionally prescribed.

Treatment methods

Treatment of optic neuritis should be under the full supervision of a physician. The treatment regimen is prescribed to patients after a comprehensive diagnosis. When prescribed in a timely manner, effective treatment the prognosis is favorable. Pathological symptoms, the optical functions of the eye will be completely restored. At neglected form The disease may result in one-sided blindness.

Inflammation of the optic nerve, treatment of this disease is carried out in a hospital. Taking into account the root cause that provoked the development of ophthalmological pathology, in addition to the main therapeutic techniques, treatment is aimed at relieving the symptoms of secondary diseases. It is important to stop the spread in time pathological process, eliminate the symptoms of inflammation, overcome infection, restore metabolism in nerve fibers in all structures of the diseased eye.

Treatment of neuritis is carried out using antibiotics:

• Streptomycin;
• Penicillin;
• Gentamicin.

Steroid, non-steroidal, hormonal, anti-inflammatory drugs, immunomodulators to increase protective forces organism are also used. Antibacterial medications may be prescribed to eliminate the infection. medications wide range actions.

To relieve swelling and reduce inflammatory reactions, glucocorticosteroids are prescribed. Local treatment involves the use of ointments, tablets, injections. Additionally, detoxification therapy is carried out, and complex vitamin and mineral supplements are prescribed. Duration treatment course from two to six weeks. Treatment, pharmacological preparations, duration complex therapy prescribed by the attending ophthalmologist.

Treatment of neuritis surgically, decompression of the optic nerve sheath, which is aimed at normalization intracranial pressure, relieving inflammatory edema, eliminating the main symptoms are prescribed in severe cases.

Timely prescribed treatment of retrobulbar and intrabulbar forms of opticoneuritis guarantees full recovery optical functions of the eye. However, relapses should not be ruled out.

Considering the rapid progression of inflammation in the optic nerve, at the first symptoms you should immediately contact a medical center or an ophthalmologist for diagnosis.

Damage to the optic nerve is a pathology characterized by inflammation of the nerve sheaths or fibers. Its symptoms may be: pain when moving the eyeballs, blurred vision, changes in color perception, photopsia, the eye may swell. Patients may complain of a decrease in the peripheral field of vision, vomiting, nausea, darkening of the eyes, and fever. Each form of optic nerve damage has its own symptoms.

Intrabulbar neuritis develops suddenly and acutely, and the nerve is completely or partially affected. Total inflammation greatly impairs vision, sometimes causing blindness. A characteristic feature The disease is considered to be the formation of scotoma. A person's adaptation to darkness and color perception are impaired. After a month, symptoms may subside, and severe course blindness and atrophy of nerve fibers develop.

The most important thing clinical sign intracranial retrobulbar inflammation considered low vision. Symptoms include decreased vision and pain in the eye socket. The transversal form of retrobulbar neuritis is severe. In many cases the person goes blind. During the first three weeks of the disease, changes in the fundus of the eye are not observed, but they manifest themselves later.

Symptoms may vary depending on the reasons that caused the nerve inflammation:

• If the disease is caused by rhinitis, the patient complains of deterioration in visual acuity, poor perception bright colors, changing the size of the blind spot.
• With syphilis, minor defects in the form of redness of the disc are observed. In severe forms of the disease, the severity worsens, peripheral vision.
• Neuritis caused by tuberculosis is characterized by the development of a tumor-like formation that completely covers the optic nerve head. Sometimes it goes to the retina.
• Damage to the optic nerve is considered dangerous when typhus. If the disease is advanced, then after a few weeks nervous atrophy occurs.
• With malaria, one optic nerve is affected and swelling develops.

Causes

One of the factors that can provoke diseases of the optic nerve is multiple sclerosis. This damages the myelin covering the nerve cells of the spinal cord and brain. Brain damage develops immune system. People with brain disorders are at risk. Damage to the optic nerve is caused by: autoimmune diseases, like sarcoidosis, lupus erythematosus.

Neuromyelitis optica leads to the development of neuritis. This occurs because the disease is accompanied by inflammation of the spinal cord and optic nerve, but no damage to brain cells. The appearance of neuritis is also provoked by other factors:

• The presence of cranial arteritis, characterized by inflammation of the intracranial arteries. Disturbances occur in the blood circulation, blocking flow to the cells of the brain and eyes required quantity oxygen. Such phenomena provoke a stroke and loss of vision in the future.
• Viral, infectious, bacterial diseases, measles, syphilis, cat scratch disease, herpes, rubella, Lyme disease, neuroretinitis lead to inflammation of the nerve, the development of chronic or purulent conjunctivitis.
• Long-term use some medicines, which can provoke the development of nerve inflammation (Ethambuton, prescribed for the treatment of tuberculosis).
• Radiation therapy. Prescribed when certain diseases, which are difficult.
• Various mechanical effects - severe intoxication of the body, tumors, insufficient intake nutrients into the cornea, retina.

Diagnostic methods

Methods for detecting inflammation of the optic nerve are based on clinical manifestations, since in most cases the pathology is not detected during fundus examination. To exclude the presence multiple sclerosis, a study of the cerebrospinal fluid, MRI (magnetic resonance imaging) is carried out. With the help of timely diagnosis, you can prevent and cure this disease, otherwise blindness and nerve atrophy will develop.

This diagnostic method refers to objective methods of examination by contrasting the vessels inside the eye with fluorescein, which is administered intravenously. At pathological conditions eye barriers that work normally are destroyed, and the bottom of the eye takes on the appearance that is characteristic of a particular process. Interpretation of fluorescein angiograms is based on a comparison of the characteristics of the passage of fluorescein through the wall of the retina and choroidal vessels with clinical picture diseases. The price of the study is 2500-3000 rubles.

Electrophysiological study

Such diagnostic procedure is a series of highly informative methods for studying the functions of the retina, optic nerve, and areas of the cerebral cortex. Electrophysiological examination of the eye is based on recording its reaction to specific stimuli. The ophthalmologist and the doctor who conducts the examination work closely with each other to set the right task and decide on the diagnostic method. This study is considered the most informative and effective. The cost of diagnostics is 2500-4000 rubles.

Treatment

If inflammation is suspected, the patient requires urgent hospitalization. While the cause of the disease remains unknown, therapy is carried out to suppress infectious lesion, reducing the intensity of the inflammatory process. Tablets are prescribed for desensitization, dehydration, improvement metabolic processes in nerve fibers and tissues, increasing the body's immune forces. Medical staff a course of antibiotics or sulfonamide solutions is prescribed intramuscularly for up to seven days.

Treatment of neuritis involves the use of corticosteroids simultaneously with Prednisolone. Diacarb is taken orally, which reduces the severity of edema. At the same time, Panangin is prescribed to reduce symptoms, Trental or A nicotinic acid» – to improve blood supply. Piracetam, a complex of B vitamins, is taken internally, and Actovegin injections are prescribed. Dibazol is prescribed for several months.

When the cause of the development of the pathology is clarified, therapy is carried out aimed at eradicating it (use antiviral drugs, anti-tuberculosis, etc.), further rehabilitation, prevention with the use of tablets and ointments. If bilateral toxic retrobulbar neuritis is diagnosed, occurring in response to sending methyl alcohol, a similar treatment is prescribed without antibacterial medications.

Which doctors should you contact?

If vision decreases, pain occurs during movement of the eyeballs, or areas of the visual field narrow and fall out, you should immediately consult an ophthalmologist. He deals with the treatment, diagnosis, and prevention of eye diseases. During your appointment, the ophthalmologist will carefully listen to your complaints, determine your visual acuity, examine the transparent media of the eye, the fundus, and measure intraocular pressure. After this he will appoint additional methods diagnostics and treatment.

Where to treat eye disease

When choosing a clinic for the treatment of vision pathologies, pay attention to the ability of the medical institution to provide complete and timely diagnosis, effective and modern methods therapy and their cost. Consider the level of equipment of the hospital and the professionalism of the specialists. The experience of doctors helps to achieve best results in the treatment of eye diseases. Below you will find a list of clinics in Moscow and St. Petersburg where you can go if you have inflammation of the optic nerve:

• Clinic "Echinacea", Moscow, st. Skladochnaya, 6, building 7. Treatment of neuritis here is carried out in four directions: examination, elimination of the factor that caused harm, stopping the destruction of the nerve, blocking the activity of infection, stimulating regeneration.
• Moscow Eye Clinic, Moscow, Semenovsky Lane, 11. This is an ophthalmological center high level which provides treatment, prevention, diagnosis eye diseases. The clinic employs leading ophthalmologists who have extensive practical experience and scientific achievements. The medical institution is equipped with innovative world-class operating and diagnostic equipment, which allows complex operations and diagnostics.
• Center for Eye Surgery, Moscow, Smolensky Boulevard, 2. The staff of this institution consists of international-level specialists. Implemented into practice Newest technologies. The participation of specialists in pathology conferences and the study of new ophthalmic trends helps ensure the safety and quality of services.
• Ophthalmological center ARTOX, Moscow, st. Gilyarovsky, 39. This is medical institution combines the main methods of traditional ophthalmology and modern technologies.
• Clinic "Medinef", St. Petersburg, st. Botkinskaya, 15, bldg. 1. A multidisciplinary highly professional medical institution that owns unique technique prevention and prognosis early stages diseases. The clinic cooperates with many medical institutes, leading medical and preventive institutions in Russia.
• Ophthalmological clinic "Excimer", St. Petersburg, Apraskin lane, 6. This medical institution has been operating for 17 years. Offers a full range of high-tech services for children and adults. The clinic has a modern diagnostic equipment, unique microsurgical systems, uses advanced technologies and techniques for solving various eye problems. It employs highly qualified ophthalmologists of various specializations.
• Medical Center"Eleos", St. Petersburg, Bolshevikov Ave., 25/1. The activities of this institution are based on the organization of work wide range specialists who own modern instrumental and clinical methods research.

All nerves of the eye can be divided into three groups: sensory, motor and secretory.

• Sensory nerves provide regulation of metabolic processes and protection, warning about some external influence, for example, hitting foreign body on the cornea, or inflammatory process inside the eye, for example, iridocyclitis. The sensitivity of the eye is provided by the trigeminal nerve.
• Motor nerves provide movement of the eyeball due to coordinated tension of the extraocular muscles, the work of the sphincter and dilator of the pupil, as well as changes in the width of the palpebral fissure. Oculomotor muscles, during their work providing depth and three-dimensional vision, are controlled by the oculomotor, abducens and trochlear nerves. The width of the palpebral fissure is regulated by the facial nerve.
• The pupillary muscles are controlled by nerve fibers belonging to the autonomic nervous system.
• Secretory fibers primarily regulate the functioning of the lacrimal gland and pass as part of the facial nerve.

The structure of the nervous system of the eyeball

Of the twelve pairs of cranial nerves, five are involved in the nervous regulation of the eye: oculomotor, abducens, trochlear, facial and trigeminal nerves.
The oculomotor nerve starts from the nerve cells of the brain and is closely connected with the nerve cells of the trochlear, abducens, auditory, facial nerves And spinal cord, due to which a coordinated reaction of the eyes, head and torso to visual and auditory stimuli, as well as changes in body position, is ensured. The oculomotor nerve enters the orbit through the superior orbital fissure. It provides the work of the levator muscle upper eyelid, as well as the superior, inferior, internal rectus and inferior oblique muscles. In addition, the oculomotor nerve contains branches that regulate the functioning of the ciliary muscle and the sphincter of the pupil.
The trochlear and abducens nerves also pass into the orbit through the superior orbital fissure, innervating the superior oblique and external rectus muscles, respectively.
The facial nerve includes not only motor nerve fibers, but also branches that regulate the functioning of the lacrimal gland. It ensures the movement of facial muscles, including the orbicularis oculi muscle.
The trigeminal nerve is mixed, that is, it regulates muscle function, sensitivity, and also contains autonomic nerve fibers. The trigeminal nerve, true to its name, is divided into three large branches.
The first branch is the optic nerve. Entering the orbit through the superior orbital fissure, the optic nerve divides into three main branches: the nasociliary, frontal and lacrimal nerves.
║ The nasolacrimal nerve passes in the muscular funnel, dividing in turn into anterior and posterior ethmoidal, long ciliary and nasal branches, in addition, giving off a connecting branch to the ciliary ganglion.
The ethmoidal nerves provide sensitivity to the cells of the ethmoidal labyrinth, the nasal cavity, the skin of the wings and the tip of the nose.

Long ciliary nerves pass through the sclera in the region of the optic nerve, heading further in the supravascular space to the anterior segment of the eye, where, together with short ciliary nerves extending from the ciliary ganglion, they form a nerve plexus in the region of the ciliary body and the circumference of the cornea. This nerve plexus provides sensitivity and regulation of metabolic processes in the anterior segment of the eye. In addition, the long ciliary nerves carry sympathetic nerve fibers that extend from nerve plexus internal carotid artery, which regulate the work of the pupil dilator.
The short ciliary nerves originate from the ciliary ganglion and pass through the sclera around the optic nerve, providing nerve control choroid eyes. The ciliary or ciliary nerve ganglion is a union of nerve cells involved in the sensory system - due to the nasociliary root; motor – through the oculomotor root; autonomic - sympathetic nerve fibers, innervation of the eyeball. The ciliary ganglion is located 7 mm posterior to the eyeball under the external rectus muscle, in contact with optic nerve. In turn, the short and long ciliary nerves, together, regulate the functioning of the sphincter and dilator of the pupil; sensitivity of the cornea, iris, ciliary body; as well as the tone of blood vessels and metabolic processes in the eyeball. The subtrochlear nerve is the last branch of the nasociliary nerve, providing sensitive innervation to the skin in the area of ​​the root of the nose, the inner corner of the eyelids and, partially, the conjunctiva.
║ The frontal nerve after entering the orbit is divided into two branches: the supraorbital and supratrochlear nerves, which provide sensitivity to the skin of the middle part upper eyelid and forehead area.
║ The lacrimal nerve in the orbit is divided into superior and inferior branches. The upper branch provides nervous regulation the functioning of the lacrimal gland, sensitivity of the conjunctiva and the skin of the outer corner of the eye with the area of ​​the upper eyelid. The inferior branch connects to the zygomaticotemporal nerve, a branch of the zygomatic nerve, providing sensation to the skin of the zygomatic region.
The second branch - the maxillary nerve, due to its division into two main branches - the infraorbital and zygomatic, provides nervous regulation only of the auxiliary organs of the eye: the middle of the lower eyelid, the lower half of the lacrimal sac, the upper half of the lacrimal duct, the skin of the forehead and the zygomatic region.
Third branch trigeminal nerve does not participate in the innervation of the eye.

Diagnostic methods

• External examination – width of the palpebral fissure, position of the upper eyelid.
• Assessing the range of movements of the eyeball - checking the work of the extraocular muscles.
• Determination of pupil size, direct and friendly reaction of the pupil to light.
• Assessment of skin sensitivity, according to the areas of innervation of the corresponding nerves.
• Determination of pain at the exit points of the trigeminal nerve.

Symptoms of diseases

• Marcus-Gunn syndrome.
• Paresis and paralysis of the oculomotor muscles.
• Paralytic strabismus.
• Horner's syndrome.
• Ptosis of the upper eyelid.
• Trigeminal neuralgia.
• Dysfunction of the lacrimal gland.

Each optic nerve begins with certain group nerve cells that are found in the ganglia or brain. The entire nervous system related to the eyes completely regulates the functioning of the muscular system, the sensitivity of the auxiliary apparatus and the eye itself.

The course of metabolic processes and the tone of blood vessels are also under the control of the nervous system. Each optic nerve has a specific pattern, course, and anatomy of passage through the orbit and brain. If certain signs are present, the pattern of the nerve passage allows us to understand which part of the branches of the facial, trigeminal or other nerves is damaged.

The brain has 12 pairs of cranial nerves, and only five of them are involved in neural regulation ocular apparatus. These include the facial nerve, oculomotor nerve, trigeminal nerve, abducens nerve and trochlear nerve. The trigeminal nerve is divided into three branches.

The origin of the oculomotor nerve refers to nerve cells located in the human skull. The nerve cells of the oculomotor nerve are closely connected with the cells of the abducens, auditory facial, trochlear nerves, as well as with the spinal cord. Thanks to this close cooperation, coordinated work of the eyes, torso, head and their simultaneous reaction to changes in body posture, visual and external auditory stimuli arises.

The oculomotor nerve enters the orbit directly from a point located in the superior orbital fissure. Its job is to ensure the functioning of the muscle responsible for raising the upper eyelid. The oculomotor nerve nuclei also provide control over the inferior, superior, internal rectus, and inferior oblique muscles. The structure of the oculomotor nerve is also represented by branches that regulate the work of the sphincter of the pupillary region of the eye and the ciliary muscle.

The trochlear nerve, like the abducens nerve, passes into the orbit itself through the orbital fissure, located above. The abducens nerve innervates the external rectus muscle, and the trochlear nerve innervates the superior oblique muscle.

The basis of the facial nerve is made up of several motor nerve fibers; branches necessary for regulating the functioning of the entire lacrimal gland also take part in its structure. The facial nerve provides contraction of the facial muscles located on the face, including the orbicularis oculi muscle passing through here.

The facial nerve canal begins its course at the bottom of the internal ear canal. Its location provides for passage to the greater petrosal nerve, in this place the structure and anatomy provide for the formation of a bend - the elbow of the facial nerve canal. Next, the canal of the facial nerve changes its horizontal course to a vertical one and its course ends with the stylomastoid foramen at back wall internal tympanic cavity.

The trajectory of the facial nerve completely follows all the bends of the canal. Coming from the stylomastoid foramen, this nerve penetrates into parotid gland, where it is already divided into branches (there are five in total). Three temporal branches of the facial nerve, which control the functioning of the orbicularis muscle, take part in the innervation of the eye muscles. The work of the orbicularis muscle is also influenced by the two zygomatic branches of the facial nerve.

The facial nerve is initially motor, but after joining the structure of the intermediate nerve it becomes mixed. The nuclei of the facial nerve, when exposed to light pulses, provide a blink reflex and squinting during sharp light stimulation of the pupil. The anatomy of the facial nerve makes it possible for lacrimation under the influence of certain irritating factors. The intermediate branch of the facial nerve takes part in the innervation of the lacrimal gland.

The topography of the facial nerve is important for diagnosing the level of its damage and identifying the localization of pathology or inflammation.

The trigeminal nerve is mixed, because he regulates the work eye muscles, is responsible for sensitivity and also contains nerve fibers autonomic system. In accordance with its name, the entire trigeminal nerve is divided into three branches. The branches of the trigeminal nerve perform certain work in the implementation of visual function.

The first branch is the optic nerve; its branch enters the orbit through the palpebral fissure. In turn, upon entering the orbit, the optic nerve is divided into three branches - the lacrimal, nasociliary (nasolacrimal) and frontal nerves.

• The course of the nasolacrimal nerve is located in the muscular infundibulum, where it divides into posterior and anterior ethmoidal, nasal and ciliary branches. The nasolacrimal nerve also gives off one branch to the ciliary ganglion. The ethmoidal nerves are responsible for the sensitivity of the ethmoidal labyrinth, nasal cavity. At the exit point, the ethmoidal nerves provide full sensation to the tip and alae of the nose. In the area of ​​the optic nerve, long ciliary nerves pass through the sclera; their anatomy provides for a further course in the supravascular space towards the anterior parts of the eye. In this place of the eyeball, together with the short ciliary nerves, in the formation of which the ciliary ganglion participates, a nerve plexus is formed. This nerve plexus is located around the cornea and in the region of the ciliary body. The main function of the nerve plexus is considered to provide regulation of metabolic processes in the area anterior section eyes. The nerve plexus also affects the sensitivity of the anterior parts of the eye. The long ciliary nerves also contain sympathetic nerve fibers that extend from the internal carotid artery, or rather from its nerve plexus. These sympathetic fibers control the performance of their function as a pupillary dilator.
  The ciliary ganglion also gives rise to short ciliary nerves, the course of which goes through the sclera and around the optic nerve. Short ciliary nerves provide regulation of the choroid.
  The ciliary nerve (or ciliary) ganglion is a union of several groups of nerve cells that participate in the innervation of the eyeball. Sensory innervation is carried out through the nasociliary root. The oculomotor root takes part in motor innervation. Autonomic innervation is controlled by sympathetic nerve fibers.
  The ciliary ganglion is located posterior to the eyeball at a distance of approximately 7 mm. It is located under the external rectus muscle, where it contacts the optic nerve. The combined action of short and long ciliary nerve fibers provides control over the work of the dilator and sphincter of the pupil; these fibers also take part in providing sensitivity to the cornea, iris and the ciliary body itself. The nerves of the ciliary ganglion control the tone of the blood vessels and the metabolic processes occurring in the eyeball. The last, but no less important, branch of the nasociliary nerve is the subtrochlear nerve, its topography provides for the provision of sensitive innervation skin nose in the area of ​​its root. The infratrochlear nerve controls the sensitivity of the eyelids at the point of their inner angle, as well as partial sensitivity of the conjunctiva.
• The frontal branch of the trigeminal nerve at the entrance to the orbit is divided into two more branches, the course of which determines their function. The supraorbital and suprapubic nerves provide sensitivity to the skin of the middle part of the upper eyelid and also in the forehead.
• The lacrimal nerve of the trigeminal nerve is divided into inferior and superior branches. The first upper one is directly involved in the nervous regulation of the lacrimal gland; it also affects the sensitivity of the conjunctiva and the area of ​​the eye at the point of its external contact with the part of the upper eyelid. The second, that is, the lower, branch has a connection with the zygomaticotemporal nerve, which is a branch of the zygomatic nerve. The inferior branch provides innervation to the skin in the area of ​​the zygomatic bone.

The second branch extending from the trigeminal nerve is the maxillary nerve; its location pattern also has certain features. The anatomy of the maxillary nerve is represented by the branches extending from it, these nerves are called the infraorbital and zygomatic. The entire maxillary nerve and its branches extending from the trigeminal nerve are involved in the nervous regulation of the auxiliary structures of the eye - the lower part of the lacrimal sac, the middle of the lower eyelid, the upper part of the tear duct, the skin in the forehead and in the projection of the zygomatic bone.

The third branch of the trigeminal nerve does not participate in the innervation of the eyeball and its auxiliary structures.

The nuclei of the trigeminal nerve are divided into motor and sensory, each of which performs a strictly defined function. At the same time, all branches of the trigeminal nerve work in close cooperation.

Diagnosis of disorders in the functioning of the nerves of the eye

The influence of various external and internal factors with an irritating effect can lead to pathological muscle damage. Inflammation, bruises, cessation nerve impulses cause a wide variety of symptoms, which not only affect visual function, but can also affect auditory function. The trigeminal, facial and oculomotor nerves, when damaged, also affect appearance, causing certain changes. In order to determine the affected area and choose the course of treatment, the ophthalmologist must first conduct a diagnosis, which consists of the following measures.

• An external inspection is carried out. The condition of the palpebral fissure, its size and shape is assessed. The position of the upper eyelid is determined.
• Job oculomotor nerves is assessed by the amount of movement that the eyeball can make.
• The size and shape of the pupil and its reaction to light are determined.
• Whether there is damage to the trigeminal or facial nerves or not can be determined by determining the sensitivity of the skin at the exit point of certain branches of the nerves.
• Damage to the trigeminal nerve at its exit points causes pain.

Symptoms of disturbances in the functioning of the nerves of the eye

Knowing the course of the branches of the optic nerves and what structures of the eyeball they are responsible for, it is possible to identify certain symptoms, corresponding to somatic and nervous diseases. The ophthalmologist will pay attention to the presence or absence of:

• Marcus-Gunn syndrome;
• strabismus caused by paralysis;
• paralysis and paresis of the oculomotor nerves;
• ptosis of the upper eyelid;
• trigeminal neuralgia;
• changes in facial expressions;
• dysfunction of the lacrimal gland.

If these signs are detected, the patient should be referred for further examination.

The frontal nerve, entering the orbit, splits into two branches: the supraorbital nerve and the supratrochlear nerve, which provide skin sensitivity in middle region upper eyelid and frontal area.

The lacrimal nerve divides in the orbit into a superior and inferior branch. The superior branch makes possible the work of the lacrimal gland, provides sensitivity to the conjunctiva, as well as the skin at the outer corner of the eye and the area of ​​the upper eyelid. When the lower branch of the lacrimal nerve is connected to the zygomaticotemporal nerve (its branch), sensitivity of the skin in the zygomatic region is ensured.

2. The second branch is the maxillary nerve. It is divided into two main branches - the infraorbital branch and the zygomatic branch, which provides nervous regulation of the auxiliary organs: the middle of the lower eyelid, the upper half of the lacrimal duct, the lower half of the lacrimal sac, the skin of the forehead, the skin of the zygomatic region.

3. The third branch, arising from the trigeminal nerve, is not involved in the innervation of the eye.

Methods for diagnosing diseases of the optic nerves

External examination, determining the width of the palpebral fissure and the position of the upper eyelid.

Inspection of the ability to move the eyeball, checking the functioning of the extraocular muscles.

Measurement of pupil size, including direct and friendly reaction pupil to light.

Inspection of skin sensitivity, according to the areas of innervation by the corresponding nerves.

Palpation for tenderness of the trigeminal nerve exit points.

Signs of eye nerve diseases

Marcus-Gunn syndrome.

Paralysis and paresis of the extraocular muscles.

Horner's syndrome.

Upper eyelid.

Dysfunction of the lacrimal glands.

Trigeminal neuralgia.