Atrophy of the optic nerve - Causes, symptoms and treatment. MF.

Atrophy of the optic nerve is called complete or partial destruction of its fibers with the replacement of their connective tissue.

Causes of optic nerve atrophy

The causes of atrophy of the visual can 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, edema, congestion, various circulatory disorders, compression of the optic nerve, etc.), pathology of the nervous system or in general diseases.

Often atrophy of the optic nerve develops due to pathology of the central nervous system( tumors, syphilitic damage, brain abscesses, encephalitis, meningitis, multiple sclerosis, traumas of the skull), intoxications, alcohol poisoning with methyl alcohol, etc.

Also, the causes of optic atrophy may be causedhypertensive disease, atherosclerosis, quinine poisoning, beriberi, starvation, profuse bleeding.

Atrophy of the optic nerve appears as a result of the obstruction of the central and peripheral artery of the retina that feeds the optic nerve, and it is also the main sign of glaucoma.

Symptoms of optic nerve atrophy

Isolate primary and secondary atrophy of the optic nerves, partial and complete, complete and progressive, one-sided and two-sided.

The main symptom of atrophy of the optic nerve is a reduction in visual acuity that is not compensable. Depending on the type of atrophy, this symptom manifests itself in different ways. So, with the progression of atrophy, vision gradually decreases, which can lead to complete atrophy of the optic nerve and, accordingly, to a complete loss of vision. This process can take several days to several months.

With partial atrophy, the process stops at some stage and vision ceases to deteriorate. Thus, the progressive atrophy of the optic nerves and the finished one are isolated.

Visual impairment during atrophy can be very diverse. This may be a change in the visual fields( more often narrowing, when "lateral vision" disappears), up to the development of "tunnel vision", when a person looks as though through a tube, i.e.sees objects that are just right in front of him, often there are scotomes, ie.dark spots in any part of the field of view;it can be a disorder of color perception.

Changing the visual fields can be not only "tunnel", it depends on the localization of the pathological process. So, the emergence of cattle( dark spots) right before the eyes indicates the damage of the nerve fibers closer to the central or directly in the central part of the retina, the narrowing of the visual fields arises from the defeat of peripheral nerve fibers, with deeper lesions of the optic nerve, half of the visual field( or temporal, or nasal).These changes can be on one or both eyes.

Examination for suspected atrophy of the optic nerve

It is unacceptable to engage in self-diagnosis and self-medication in this pathology, because something similar happens in peripheral cataracts, when lateral vision is violated first, and then the central departments are involved. Also, the atrophy of the optic nerves can be confused with amblyopia, in which vision can also be significantly reduced and not amenable to correction. It is worth noting that the above pathology is not as dangerous as atrophy of the optic nerve. Aetrophy 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 atrophy of the optic nerve as early as possible.

If you have similar symptoms, you should immediately contact an ophthalmologist and a neurologist. These two specialists take the main part in the treatment of this disease. There is also a separate branch of medicine - neurophthalmology, physicians - neurologists who are engaged in the diagnosis and treatment of such pathology. If necessary, neurosurgeons, therapists, otorhinolaryngologists, infectious disease specialists, oncologists, toxicologists, etc. can also take part in the diagnosis and treatment.

Diagnosis of optic atrophy usually presents no difficulties. It is based on the definition of acuity and fields of vision( perimetry), on the study of color perception. The ophthalmologist necessarily conducts an ophthalmoscopy, at which reveals pitting of the optic nerve disk, narrowing of the vessels of the fundus and measures the intraocular pressure. The change in the contours of the optic nerve disk speaks of 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 stitched, then perhaps it is post-inflammatory or post-stasis atrophy.

If necessary, an X-ray examination( craniography with a compulsory snapshot of the area of ​​the Turkish saddle), computer or magnetic resonance imaging of the brain, electrophysiological research methods and fluorescence-angiographic methods in which a patency of retinal vessels is checked using a special substance administered intravenously.

Informative may be laboratory methods of investigation: general blood test, biochemical blood test, test for syphilis or boreilliosis.

Treatment of optic atrophy

Treatment of optic atrophy is a very difficult task for doctors. It is necessary to know that the destroyed nerve fibers can not be restored. Some effect from the treatment can be hoped for only by the restoration of the functioning of nerve fibers in the process of destruction, which have still preserved their vital functions. If this moment is missed, then sight on the sick eye can be lost forever.

In the treatment of atrophy, it must be borne in mind that this is often not an independent disease, but a consequence of other pathological processes affecting various sections of the visual pathway. Therefore, the treatment of optic atrophy must be combined with the elimination of the cause that caused it. In the case of timely elimination of the cause and, if atrophy has not yet developed, within 2-3 weeks to 1-2 months, the picture of the fundus normalizes and the restoration of visual functions.

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

But it should be noted that the treatment of optic atrophy is long, the effect of it is poorly expressed, and sometimes completely absent, especially in neglected cases. Therefore, it must be started as soon as possible.

As mentioned above, the main thing is the treatment of the underlying disease, on the background of which complex treatment is performed directly atrophy of the optic nerve. For this purpose, various forms of drugs are prescribed: eye drops, injections, both general and local;tablets, electrophoresis. Treatment is directed to

• improvement of blood circulation in vessels nourishing the nerve - vasodilators( komplamin, nicotinic acid, no-shpa, papaverine, dibazol, euphyllin, trental, halidor, sermion), anticoagulants( heparin, ticlid);
• for improving metabolic processes in nerve tissue and stimulating the restoration of altered tissue - biogenic stimulants( aloe extract, peat, vitreous, etc.), vitamins( ascorutin, B1, B2, B6), enzymes( fibrinolysin, lidase), amino acids( glutamineacid), immunostimulants( ginseng, eleuturokokk);
• for resorption of pathological processes and stimulation of metabolism( phosphaden, preductal, pyrogenal), for the reduction of the inflammatory process - hormonal drugs( prednisolone, dexamethasone);on the improvement of the central nervous system( emoxipine, cerebrolysin, Fezam, nootropil, Cavinton).

Drugs should be taken as prescribed by the doctor after diagnosis. The doctor will choose the optimal treatment, considering the concomitant diseases. In the absence of concomitant somatic pathology alone, one can take no-shpu, papaverine, vitamin preparations, amino acids, emoxypin, nootropil, and fesam.

But self-medication with this serious pathology should not be dealt with. Also used physiotherapy, acupuncture;Methods of magnetic, laser and electrostimulation of the optic nerve were developed.

The course of treatment is repeated a few months later.

Nutrition for optic atrophy should be a full, varied and rich in vitamins. As food, it is necessary to consume as much fresh fruit and vegetables as possible, meat, liver, dairy products, cereals, etc.

With a significant decrease in vision, the issue of assigning a disability group is decided.

A visually impaired and blind person is assigned a course of rehabilitation aimed at eliminating or compensating for the disability caused by loss of sight.

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

Complications of optic nerve atrophy

Diagnosis of optic atrophy is very serious. At the slightest decrease in vision, you should immediately consult a doctor to not miss your chance of recovery. In the absence of treatment and with the progression of the disease, vision can disappear completely, and it will be impossible to restore it. In addition, it is very important to identify the cause, which caused the atrophy of the optic nerve, and as soon as possible to eliminate it, because it can be fraught with not only loss of vision, but also deadly.

Prevention of optic nerve atrophy

In order to reduce the risk of atrophy of the optic nerve, it is necessary to treat diseases that lead to atrophy, prevent intoxication, carry out blood transfusions with profuse bleeding and, of course, consult a doctor at the earliest signs of visual impairment.

Doctor ophthalmologist Odinochko EA