Partial atrophy of the optic nerve. Optic nerve atrophy: what causes it, how it manifests and is treated. Classification of optical neuropathy

So serious ophthalmic disease, How descending atrophy the optic nerve begins to develop due to degenerative processes.

Sclerotic changes occur in the fibers of nerve tissue.

As the disease progresses, vision not only deteriorates, but may even disappear completely. It's connected with the death of nerve fibers that carry information about the retinal image to the brain.

Why does descending optic atrophy occur and how to recognize it?

Illness provoke the following reasons:

Consequences glaucoma.
Vasoconstriction, compressing the optic nerve - a tumor appears in the cranial cavity, resulting in the formation brain abscess.
Complications myopia.
Development in blood vessels atherosclerotic plaques— we are talking about the vessels that supply the optic nerves with blood. Thrombosis begins, the walls become inflamed. Violation of the structure of blood vessels often contributes to syphilis, vasculitis, diabetes mellitus or hypertension.
Injuries eyes.
Intoxication(ARVI, use of alcohol substitutes, narcotic substances, nicotine and quinine).

When the fibers of one optic nerve die, the pathology is considered unilateral. Atrophy in both eyes cause the following disorders and diseases:

syphilis;
intoxication;
tumor in the cavities of the skull;
blood supply disturbance(with atherosclerosis, diabetes mellitus, hypertension).

Symptoms of complete and partial atrophy

Symptoms of the disease depends on the type atrophy. The main sign of pathology is decreased visual acuity.

Important! Improve vision in case of atrophy glasses or contact lenses will not work.

Another characteristic symptom illness - visual field change. During the diagnosis of the disease, the patient describes in detail his feelings, according to which the doctor determines at what stage the disease is. The patient may observe the following phenomena:

you can see everything as if through a tube - tunnel vision;
before my eyes regularly spots appear, reminiscent of a mosaic;
image fragment, which is located in the bow, absent, the same thing is noticed from the side of the temples.

In patients disturbances are observed in color vision. A person does not distinguish the color red and does not perceive green shades.

A characteristic sign of the disease is slow recovery of vision when leaving the dark into the light and vice versa. This symptom often appears at the beginning of the disease, after which it actively progresses.

Reference. Atrophy may be partial, in this case vision remains relatively sharp.

Diagnostic methods

As diagnostic measures are carried out:

fundus analysis— the examination is carried out through the pupil; for convenience, it is first dilated with special drops;
acuity test vision;
calculation of the boundaries of the field of view ( spheroperimetry);
grade correct color perception;

Photo 1. You can check color perception using Rabkin’s polychromatic tables. Normally, the eye distinguishes all numbers.

perimetry using a computer, through which the affected areas of the optic nerve are identified;
videoophthalmography— determination of the nature of damage to nerve fibers;
x-ray skulls;
computed and magnetic resonance imaging;
dopplerography using a laser is an optional, additional diagnostic method.

Treatment. Is it possible to avoid disability?

During the treatment process, doctors do everything to “revitalize” nerve fibers V maximum quantity.

Important! The earlier the disease was identified and treatment started, the more chances for successful correction of the disease.

Nerves are stimulated by laser, alternating magnetic fields, electric current.

Also used as therapy:

medicinal impact;
blood transfusion;
taking B vitamins and special tonics, promoting vasodilation;
surgical intervention in severe cases.

Reference. Even if partial optic atrophy is diagnosed, disability must be registered. The purpose of the group depends on the stage of the pathology and the possibility of its correction.

Optic nerve atrophy is clinically a set of symptoms: visual impairment (decreased visual acuity and development of visual field defects) and blanching of the optic nerve head. Optic nerve atrophy is characterized by a decrease in the diameter of the optic nerve due to a decrease in the number of axons.

Optic nerve atrophy occupies one of the leading places in the nosological structure, second only to glaucoma and degenerative myopia. Optic nerve atrophy is considered to be the complete or partial destruction of its fibers with their replacement connective tissue.

According to the degree of decrease in visual functions, atrophy can be partial or complete. According to research data, it is clear that partial atrophy of the optic nerve affects men in 57.5%, and women in 42.5%. Most often, bilateral damage is observed (in 65% of cases).

The prognosis for optic atrophy is always serious, but not hopeless. Due to pathological changes reversible, treatment of partial optic nerve atrophy is one of the important areas in ophthalmology. With adequate and timely treatment, this fact makes it possible to achieve an increase in visual functions even with a long-term existence of the disease. Also in last years the number of this pathology of vascular origin has increased, which is associated with the growth of general vascular pathology - atherosclerosis, coronary disease hearts.

Etiology and classification

By etiology
- hereditary: autosomal dominant, autosomal recessive, mitochondrial;
- non-hereditary.
According to the ophthalmoscopic picture - primary (simple); secondary; glaucomatous.
According to the degree of damage (preservation of functions): initial; partial; incomplete; complete.
According to the topical level of the lesion: descending; ascending.
By degree of progression: stationary; progressive.
According to the localization of the process: one-sided; bilateral.

There are congenital and acquired optic atrophy. Acquired optic atrophy develops as a result of damage to the optic nerve fibers (descending atrophy) or retinal cells (ascending atrophy).

Congenital, genetically determined optic nerve atrophy is divided into autosomal dominant, accompanied by an asymmetric decrease in visual acuity from 0.8 to 0.1, and autosomal recessive, characterized by a decrease in visual acuity, often to the point of practical blindness already in early childhood.

Descending acquired atrophy is caused by processes that damage the fibers of the optic nerve at various levels (orbit, optic canal, cranial cavity). The nature of the damage is different: inflammation, trauma, glaucoma, toxic damage, circulatory disorders in the vessels supplying the optic nerve, metabolic disorders, compression of the optic fibers extensive education in the cavity of the orbit or in the cavity of the skull, degenerative process, myopia, etc.).

Every etiological factor cause atrophy of the optic nerve with certain ophthalmoscopic features typical for it. However, there are characteristics common to optic atrophy of any nature: blanching of the optic disc and impaired visual function.

The etiological factors of optic nerve atrophy of vascular origin are diverse: these are vascular pathology, acute vascular neuropathies (anterior ischemic neuropathy, occlusion of the central artery and vein of the retina and their branches), and a consequence of chronic vascular neuropathies (with general somatic pathology). Optic nerve atrophy occurs as a result of obstruction of the central and peripheral retinal arteries that supply the optic nerve.

Ophthalmoscopically, narrowing of the retinal vessels and blanching of part or all of the optic nerve head are detected. Persistent blanching of only the temporal half occurs with damage to the papillomacular bundle. When atrophy is a consequence of disease of the chiasm or optic tracts, then there are hemianopic types of visual field defects.

Depending on the degree of damage to the optic fibers, and therefore on the degree of decrease in visual functions and blanching of the optic nerve head, initial, or partial, and complete atrophy of the optic nerve is distinguished.

Diagnostics

Complaints: gradual decrease in visual acuity ( varying degrees severity), changes in the visual field (scotomas, concentric narrowing, loss of visual fields), impaired color vision.

Anamnesis: the presence of space-occupying brain formations, intracranial hypertension, demyelinating lesions of the central nervous system, lesions of the carotid arteries, systemic diseases (including vasculitis), intoxication (including alcohol), history of optic neuritis or ischemic neuropathy, occlusion of retinal vessels, taking medications with neurotoxic effects during the last year ; head and neck injuries, cardiovascular diseases, hypertension, acute and chronic disorders cerebral circulation, atherosclerosis, meningitis or meningo-encephalitis, inflammatory and volumetric processes paranasal sinuses, profuse bleeding.

Physical examination :

external examination of the eyeball (limited mobility of the eyeball, nystagmus, exophthalmos, ptosis of the upper eyelid)
study of the corneal reflex - may be reduced on the affected side

Laboratory research

biochemical analysis blood: blood cholesterol, low-density lipoproteins, lipoproteins high density, triglycerides; ·
coagulogram;
ELISA for herpes simplex virus, cytomegalovirus, toxoplasmosis, brucellosis, tuberculosis, rheumatic tests (if indicated, to exclude an inflammatory process)

Instrumental studies

visometry: visual acuity can range from 0.7 to practical blindness. When the papillomacular bundle is damaged, visual acuity is significantly reduced; with minor damage to the papillomacular bundle and involvement of peripheral nerve fibers of the optic nerve in the process, visual acuity decreases slightly; when only peripheral nerve fibers are affected, it does not change. ·
refractometry: the presence of refractive errors will allow a differential diagnosis with amblyopia.
Amsler test - distortion of lines, clouding of the pattern (damage to the papillomacular bundle). ·
perimetry: central scotoma (with damage to the papillomacular bundle); various forms of narrowing of the visual field (with damage to the peripheral fibers of the optic nerve); with damage to the chiasm - bitemporal hemianopsia, with damage to the optic tracts - homonymous hemianopsia. When the intracranial part of the optic nerve is damaged, hemianopia occurs in one eye.
- Kinetic perimetry for colors - narrowing the field of vision to green and red, less often to yellow and blue.
- Computer perimetry - determination of the quality and quantity of scotomas in the field of view, including 30 degrees from the point of fixation.
Dark Adaptation Study: Dark Adaptation Disorder. · study of color vision: (Rabkin tables) - disturbance of color perception (increased color thresholds), more often in the green-red part of the spectrum, less often in the yellow-blue.
tonometry: possible increase in IOP (with glaucomatous optic atrophy).
biomicroscopy: on the affected side - afferent pupillary defect: decreased direct pupillary reaction to light while maintaining a friendly pupil reaction.
ophthalmoscopy:
- initial atrophy of the optic disc – against the background of the pink color of the optic disc, blanching appears, which subsequently becomes more intense.
- partial atrophy of the optic disc – pallor of the temporal half of the optic disc, Kestenbaum’s symptom (decrease in the number of capillaries on the optic disc from 7 or less), arteries are narrowed,
- incomplete atrophy of the optic disc – uniform blanching of the optic nerve, moderately expressed Kestenbaum’s symptom (reduction in the number of capillaries on the optic disc), arteries are narrowed,
- complete atrophy of the optic nerve – total pallor of the optic nerve, vessels are narrowed (arteries are narrowed more than veins). Kestenbaum's symptom is pronounced (reduction in the number of capillaries on the optic disc - up to 2-3 or capillaries may be absent).

With primary atrophy of the optic disc, the boundaries of the optic disc are clear, its color is white, grayish-white, bluish or slightly greenish. In red-free light, the contours remain clear, whereas the contours of the optic disc normally become blurred. In red light for atrophy of the optic disc - of blue color. With secondary atrophy of the optic disc, the boundaries of the optic disc are unclear, blurred, the optic disc is gray or dirty gray, the vascular infundibulum is filled with connective or glial tissue (in long-term period the boundaries of the optic disc become clear).

optical coherence tomography of the optic disc (in four segments - temporal, superior, nasal and inferior): reduction in the area and volume of the neuroretinal rim of the optic disc, reduction in the thickness of the layer of nerve fibers of the optic disc and in the macula.
Heidelberg retinal laser tomography – decreasing the depth of the optic nerve head, the area and volume of the neuroretinal belt, increasing the excavation area. In case of partial atrophy of the optic nerve, the depth range of the optic nerve head is less than 0.52 mm, the rim area is less than 1.28 mm 2, the excavation area is more than 0.16 mm 2.
fluorescein angiography of the fundus: hypofluorescence of the optic nerve head, narrowing of the arteries, absence or decrease in the number of capillaries on the optic disc;
electrophysiological studies (visual evoked potentials) - decreased VEP amplitude and prolonged latency. When the papillomacular and axial bundles of the optic nerve are damaged, electrical sensitivity is normal; when peripheral fibers are damaged, the electrical phosphene threshold is sharply increased. Lability decreases especially sharply with axial lesions. During the period of progression of the atrophic process in the optic nerve, the retino-cortical and cortical time increases significantly;
Doppler ultrasound of blood vessels head, neck, eyes: decreased blood flow in the orbital, supratrochlear artery and intracranial part of the internal carotid artery;
MRI of brain vessels: foci of demyelination, intracranial pathology (tumors, abscesses, brain cysts, hematomas);
MRI of the orbit: compression of the orbital part of the optic nerve;
X-ray of the orbit according to Riese - a violation of the integrity of the optic nerve.

Differential diagnosis

The degree of decrease in visual acuity and the nature of visual field defects are determined by the nature of the process that caused the atrophy. Visual acuity can range from 0.7 to practical blindness.

Optic atrophy with tabes develops in both eyes, but the extent of damage to each eye may not be the same. Visual acuity decreases gradually, but because... the process during tabes is always progressive, it ultimately occurs in different terms(from 2-3 weeks to 2-3 years) bilateral blindness. The most common form of change in the visual field in tabetic atrophy is a gradually progressive narrowing of the boundaries in the absence of scotomas within the remaining areas. Rarely, with tabesa, bitemporal scotomas, bitemporal narrowing of the boundaries of the visual field, as well as central scotomas are observed. The prognosis for tabetic optic atrophy is always poor.

Optic nerve atrophy can be observed with deformations and diseases of the skull bones. Such atrophy is observed with a tower-shaped skull. Decreased vision usually develops in early childhood and rarely after 7 years. Blindness in both eyes is rare; sometimes blindness in one eye is observed with a sharp decrease in vision in the other eye. From the side of the visual field, there is a significant narrowing of the boundaries of the visual field along all meridians; there is no scotoma. Atrophy of the optic nerve with a tower-shaped skull is considered by most to be a consequence of congestive nipples developing due to increased intracranial pressure. Among other deformations of the skull, atrophy of the optic nerves is caused by dysostosis craniofacialis (Crouzon's disease, Apert's syndrome, marble disease, etc.).

Optic nerve atrophy can occur due to poisoning with quinine, plasmacide, fern when expelling worms, lead, carbon disulfide, botulism, and methyl alcohol poisoning. Methyl alcohol optic atrophy is not so rare. After drinking methyl alcohol, within a few hours paralysis of accommodation and dilation of the pupils appears, central scotoma occurs, and vision sharply decreases. Then vision is partially restored, but atrophy of the optic nerve gradually increases and irreversible blindness occurs.

Optic nerve atrophy can be congenital and hereditary, due to birth or postpartum head injuries, prolonged hypoxia, etc.

Diagnosis	Rationale for differential diagnosis	Surveys	Diagnosis exclusion criteria
Amblyopia	Significant decrease in vision in the absence of pathology from the anterior segment of the eye and retina.	Physical examinations	A small child has strabismus, nystagmus, and the inability to clearly fix his gaze on a bright object. In older children - decreased visual acuity and lack of improvement from its correction, impaired orientation in an unfamiliar place, squint, the habit of closing one eye when looking at an object or reading, tilting or turning the head when looking at an object of interest.
		Refractometry	Anisometropic amblyopia develops with uncorrected high degree anisometropia in the eye with more pronounced refractive errors (myopia more than 8.0 diopters, hyperopia more than 5.0 diopters, astigmatism more than 2.5 diopters in any meridian), refractive amblyopia - with a long-term absence of optical correction of hypermetropia , myopia or astigmatism with a difference in refraction of both eyes: hyperopia more than 0.5 diopters, myopia more than 2.0 diopters, astigmatic 1.5 diopters.
		HRT OCT	According to NRT: the depth range of the optic nerve head is more than 0.64 mm, the area of the optic nerve rim is more than 1.48 mm 2, the excavation area of the optic nerve is less than 0.12 mm 2.
Leber's hereditary atrophy	A sharp decline vision of both eyes in the absence of pathology from the anterior segment of the eye and retina.	Complaints and anamnesis	The disease develops in male members of the same family aged 13 to 28 years. Girls get sick very rarely and only if the mother is a proband and the father suffers from this disease. Heredity is associated with the X chromosome. A sharp decrease in vision in both eyes over several days. The general condition is good, sometimes patients complain of headache.
		Ophthalmoscopy	Initially, hyperemia and slight blurring of the optic disc borders appear. Gradually, the optic discs become waxy and pale, especially in the temporal half.
		Perimetry	In the field of view there is a central absolute scotoma on White color, peripheral boundaries are normal.
Hysterical amblyopia (amaurosis)	Sudden deterioration of vision or complete blindness in the absence of pathology from the anterior segment of the eye and retina.	Complaints and anamnesis	Hysterical amblyopia in adults is a sudden deterioration of vision that lasts from several hours to several months, developing against the background of severe emotional shocks. It is more often observed in women aged 16-25 years.
		Physical examinations	There may be a complete lack of reaction of the pupils to light.
		Visometry	Reduced visual acuity to varying degrees, up to blindness. With repeated studies, the data may be completely different from previous ones.
		Ophthalmoscopy	The optic disc is pale pink, the contours are clear, the Kestenbaum sign is absent.
		Perimetry	Concentric narrowing of the field of vision, characterized by a violation of the normal type of boundaries - the widest field of vision is red; less commonly, hemianopsia (homonymous or heteronymous).
		VEP	VEP data is normal.
Optic nerve hypoplasia	Bilateral decrease or complete loss of vision in the absence of pathology from the anterior segment of the eye and retina.	Visometry	Optic nerve hypoplasia is accompanied by bilateral vision loss (in 80% of cases from moderate to complete blindness).
		Physical examinations	The afferent pupillary reflex is absent. Unilateral optic disc changes are often associated with strabismus and can be seen by a relative afferent pupillary defect and unilateral weak or absent fixation (instead of positional nystagmus).
		Ophthalmoscopy	The optic disc is reduced in size, pale, surrounded by a faint pigment ring. The outer ring (about the size of a normal disc) consists of the lamina cribrosa, pigmented sclera and choroid. Options: yellow-white, small disc with a double ring or complete absence of nerve and vascular aplasia. With a bilateral process, the disc is often difficult to detect; in this case, it is determined along the course of the vessels.
		Perimetry	If central vision is preserved, defects in the visual fields may be detected.
		Consultation with a neurologist, endocrinologist, laboratory research	Optical hypoplasia of the nerve is rarely combined with septo-optic dysplasia (Morsier syndrome: absence of the transparent septum (septum pellucidum) and pituitary gland, which is accompanied by functional disorders thyroid gland and others hormonal disorders: possible growth retardation, hypoglycemia attacks, combination with mental retardation and malformations of brain structures).
Coloboma of the optic nerve head	Pathology of the optic nerve	Ophthalmoscopy	With ophthalmoscopy, the optic disc is enlarged in size (elongation of the vertical size), deep excavation or local excavation and increased crescent-shaped pigmentation with partial involvement of the lower nasal part of the optic disc in the process. When the choroid is also involved in the process, a line of demarcation appears, represented by bare sclera. Lumps of pigment may mask the boundary between normal tissue and coloboma. There may be glial tissue on the surface of the optic disc.
Coloboma of the optic nerve head	Pathology of the optic nerve	MRI	MRI - the membranes of the optic canal are weakly expressed or absent.
Morning glow syndrome	Pathology of the optic nerve	Physical examinations	Almost all patients with unilateral pathology have strabismus and high myopia in the affected eye.
		Visometry	Visual acuity is often reduced, but can also be very high.
		Refractometry	Often with a one-sided process - high myopia affected eye.
		Ophthalmoscopy	On ophthalmoscopy, the optic disc is enlarged and is located as if in a funnel-shaped cavity. Sometimes the head of the optic disc is raised; it is also possible to change the position of the head of the optic disc from a staphylomatous depression to its prominence; Around the nerve there are areas of transparent grayish retinal dysplasia and pigment clumps. The demarcation line between the optic disc tissue and the normal retina is indistinguishable. Many abnormally branching vessels are identified. Most patients have areas of local retinal detachment and radial retinal folds within the excavation.
		Perimetry	Possible defects in the visual field: central scotomas and enlargement of the blind spot.
		Consultations with an otolaryngologist	Morning glow syndrome occurs as an independent manifestation or can be combined with hypertelorism, cleft lip, palate and other anomalies.

Treatment

Treatment of optic nerve atrophies is very difficult task. In addition to pathogenetic therapy, tissue therapy, vitamin therapy, spinal tap in combination with osmotherapy, vasodilators, B vitamins, especially B1 and B12. Currently, magnetic, laser and electrical stimulation are widely used.

In the treatment of partial optic nerve atrophy, pharmacotherapy is usually used. The use of drugs makes it possible to influence various parts of the pathogenesis of optic nerve atrophy. But do not forget about the methods of physical influence and in different ways administration of drugs. The issue of optimizing routes of drug administration has also become relevant in recent years. Thus, parenteral (intravenous) administration vasodilators may promote systemic vasodilation, which, in some cases, can lead to steal syndrome and impair blood circulation in the eyeball. It is generally accepted that the therapeutic effect is greater when drugs are used topically. However, in diseases of the optic nerve, local use of drugs is associated with certain difficulties caused by the existence of a number of tissue barriers. Creation of therapeutic concentration medicinal product in a pathological focus is achieved more successfully with a combination of drug therapy and physical therapy.

Drug treatment (depending on the severity of the disease)
Conservative (neuroprotective) treatment is aimed at increasing blood circulation and improving the trophism of the optic nerve, stimulating vitally active nerve fibers that have survived and/or are in the stage of apoptosis.
Drug treatment includes neuroprotective drugs of direct (directly protect the retinal ganglia and axons) and indirect (reduce the effect of factors causing the death of nerve cells).

Retinoprotectors: ascorbic acid 5% 2 ml intramuscularly once a day for 10 days, in order to reduce the permeability of the vascular wall and stabilize endothelial cell membranes
Antioxidants: tocopherol 100 IU 3 times a day – 10 days, in order to improve the supply of oxygen to tissues, collateral circulation, strengthening the vascular wall
Drugs that improve metabolic processes (direct neuroprotectors): retinalamin for intramuscular 1.0 ml and/or parabulbar administration 5 mg 0.5 ml parabulbar once a day for 10 days
List of additional medicines:
- vinpocetine – adults 5-10 mg 3 times a day for 2 months. Has vasodilating, antihypoxic and antiplatelet effects
- cyanocobalamin 1 ml intramuscularly once a day for 5/10 days

Electrical stimulation is also used - it is aimed at restoring the function of nerve elements that were functional, but did not transmit visual information; the formation of a focus of persistent excitability, which leads to the restoration of the activity of nerve cells and their connections, which were previously weakly functioning; improvement of metabolic processes and blood circulation, which contributes to the restoration of the myelin sheath around the axial cylinders of the optic nerve fibers and, accordingly, leads to an acceleration of the action potential and the revival of the analysis of visual information.

Indications for consultation with specialists:

consultation with a therapist – for assessment general condition body;
consultation with a cardiologist – high level blood pressure- one of the main risk factors for the development of occlusions of retinal and optic nerve vessels;
consultation with a neurologist - to exclude demyelinating disease of the central nervous system and clarify the topical affected area visual pathways;
consultation with a neurosurgeon - if the patient develops signs of intracranial hypertension or symptoms characteristic of a brain space-occupying lesion;
consultation with a rheumatologist - in the presence of symptoms characteristic of systemic vasculitis;
consultation with a vascular surgeon to decide on the need for surgical treatment if there are signs of an occlusive process in the system of the internal carotid and orbital arteries (the appearance of scotoma fugax in the patient);
consultation with an endocrinologist - in the presence of diabetes mellitus/other pathology of the endocrine system;
consultation with a hematologist (if blood diseases are suspected);
consultation with an infectious disease specialist (if vasculitis of viral etiology is suspected).
consultation with an otolaryngologist - if inflammation or neoplasm is suspected in the maxillary or frontal sinus.

Indicators of treatment effectiveness:

an increase in the electrical sensitivity of the optic nerve by 2-5% (according to computer perimetry),
increase in amplitude and/or decrease in latency by 5% (according to VEP data).

This condition is the final stage of damage to the optic nerve. This is not a disease, but rather a sign of a more serious disease. Possible causes include direct trauma, pressure on the optic nerve or toxic damage, and nutritional deficiencies.

Causes of optic nerve atrophy

The optic nerve is made up of nerve fibers that transmit impulses from the eye to the brain. It contains approximately 1.2 million axons that originate in retinal cells. These axons have a thick myelin sheath and cannot regenerate after injury.

If fibers in any part of the optic nerve degenerate, its ability to transmit signals to the brain is impaired.

Regarding the causes of ASD, scientific studies have found that:

Approximately 2/3 of cases were bilateral.
The most common cause of bilateral ADN is intracranial neoplasms.
The most common cause of unilateral damage is traumatic brain injury.
Vascular factors are a common cause of AD after the age of 40 years.

In children, causes of ADN include congenital, inflammatory, infectious, traumatic and vascular factors, including perinatal strokes, mass lesions and hypoxic encephalopathy.

Let's look at the most common causes of ASD:

Primary diseases affecting the optic nerve: chronic glaucoma, retrobulbar neuritis, traumatic optic neuropathy, formations compressing the optic nerve (for example, tumors, aneurysms).
Primary retinal diseases, such as occlusion of the central retinal artery or central vein.
Secondary diseases of the optic nerve: ischemic optic neuropathy, chronic neuritis or papilledema.

Less common causes of ASD:

Hereditary optic neuropathy (eg, Leber optic neuropathy).
Toxic neuropathy, which can be caused by exposure to methanol, certain drugs (disulfiram, ethambutol, isoniazid, chloramphenicol, vincristine, cyclosporine and cimetidine), alcohol abuse and tobacco products, metabolic disorders(eg, severe renal failure).
Retinal degeneration (eg, retinitis pigmentosa).
Retinal storage diseases (eg, Tay-Sachs disease)
Radiation neuropathy.
Syphilis.

Classification of optic nerve atrophy

There are several classifications of ADS.

According to the pathological classification, ascending (anterograde) and descending (retrograde) optic nerve atrophy is distinguished.

The ascending ADS looks like this:

In diseases with anterograde degeneration (for example, toxic retinopathy, chronic glaucoma), the atrophy process begins in the retina and spreads towards the brain.
The rate of degeneration is determined by the thickness of the axons. Larger axons decay faster than smaller ones.

Descending optic atrophy is characterized by the fact that the atrophy process begins in the proximal part of the axon and spreads towards the optic nerve head.

According to ophthalmoscopic classification there are:

Primary ADS. In diseases with primary atrophy (for example, tumor of the pituitary gland, optic nerve, traumatic neuropathy, multiple sclerosis), degeneration of optic nerve fibers leads to their replacement by columns of glial cells. With ophthalmoscopy, the optic disc is white and has clear edges, and blood vessels retinas are normal.
Secondary ADS. In diseases with secondary atrophy (eg, papilledema or inflammation of the optic disc), degeneration of nerve fibers is secondary to papilledema. On ophthalmoscopy, the optic disc has a gray or dirty gray color, its edges are unclear; retinal blood vessels may be altered.
Sequential ADS. With this form of atrophy (for example, with retinitis pigmentosa, myopia, occlusion of the central retinal artery), the disc has a waxy pale color with clear edges.
Glaucomatous atrophy is characterized by a cup-shaped optic disc.
Temporary optic disc pallor can occur with traumatic neuropathy or nutritional deficiencies, and is most common in patients with multiple sclerosis. The disc is pale in color with clear edges and normal vessels.

According to the degree of damage to nerve fibers, they are distinguished:

Partial atrophy of the optic nerve - the process of degeneration affects not all fibers, but a certain part of them. This form of optic nerve subatrophy is characterized by incomplete loss of vision.
Complete atrophy of the optic nerve - the degeneration process affects all nerve fibers, leading to blindness.

Symptoms of optic atrophy

The main symptom of optic atrophy is blurred vision. The clinical picture depends on the cause and severity of the pathology. For example, with partial atrophy of the optic nerves of both eyes, bilateral symptoms of visual impairment are observed without it. total loss, manifesting itself first as a loss of clarity and impaired color perception. When the optic nerves are compressed by the tumor, the visual field may decrease. If partial optic atrophy is left untreated, visual impairment often progresses to complete loss.

Depending on the etiological factors, patients with AD may also exhibit other symptoms that are not directly related to this pathology. For example, with glaucoma, a person may suffer from eye pain.

Characterizing the clinical picture of ADN is important in determining the cause of neuropathy. Rapid onset is characteristic of neuritis, ischemic, inflammatory and traumatic neuropathy. Gradual progression over several months is characteristic of toxic neuropathy and atrophy due to nutritional deficiencies. The pathological process develops even more slowly (over several years) with compressive and hereditary ADN.

If the patient young complains of pain in the eyes associated with their movement, the presence of neurological symptoms (for example, paresthesia, ataxia, weakness in the limbs), this may indicate the presence of demyelinating diseases.

In older adults with signs of ADN, the presence of temporary vision loss, double vision (diplopia), fatigue, weight loss, and muscle pain may suggest ischemic neuropathy due to giant cell arteritis.

In children, the presence of flu-like symptoms in the recent past or recent vaccination indicates parainfectious or post-vaccination optic neuritis.

Diplopia and facial pain suggest multiple neuropathy of the cranial nerves, observed with inflammatory or neoplastic lesions of the posterior orbit and the anatomical area around the sella turcica.

Short-term blurred vision, diplopia and headaches indicate the possibility of increased intracranial pressure.

Diagnosis of optic nerve atrophy

Described clinical picture can be observed not only with ADN, but also with other diseases. To establish the correct diagnosis, if vision problems occur, you need to consult an ophthalmologist. He will hold comprehensive examination eye, including ophthalmoscopy, with which you can study the optic nerve head. With atrophy, this disc has a pale color, which is associated with a change in blood flow in its vessels.

To confirm the diagnosis, you can perform optical coherence tomography, an examination of the eyeball that uses infrared light waves for visualization. The ophthalmologist also evaluates color vision, the reaction of the pupils to light, determines the acuity and impairment of visual fields and takes measurements intraocular pressure.

It is very important to determine the cause of ADN. For this purpose, the patient may undergo computer or magnetic resonance imaging of the orbits and brain, laboratory examination for the presence of genetic abnormalities or diagnosis of toxic neuropathy.

How to treat optic nerve atrophy?

How to treat optic nerve atrophy? The importance of vision for a person cannot be overestimated. Therefore, if you have any symptoms of optic atrophy, you should never resort to treatment on your own. folk remedies, you should immediately contact a qualified ophthalmologist.

It is necessary to begin treatment at the stage of partial atrophy of the optic nerve, which allows many patients to retain some vision and reduce the degree of disability. Unfortunately, with complete degeneration of nerve fibers, it is almost impossible to restore vision.

The choice of treatment depends on the cause of the disorder, for example:

Treatment of descending optic atrophy caused by an intracranial tumor or hydrocephalus is aimed at eliminating compression of the nerve fibers by the tumor.
When inflammatory diseases optic nerve (neuritis) or ischemic neuropathy is used intravenous administration corticosteroids.
For toxic neuropathy, antidotes are prescribed to those substances that caused damage to the optic nerves. If atrophy is caused medicines, their use is stopped or the dose is adjusted.
Neuropathy due to nutritional deficiencies is treated with dietary adjustments and prescriptions. multivitamin preparations, which contain the necessary for good vision microelements.
With glaucoma it is possible conservative treatment, aimed at reducing intraocular pressure, or performing surgery.

In addition, there are methods of physiotherapeutic, magnetic, laser and electrical stimulation of the optic nerve, which are aimed at preserving the functions of the nerve fibers as much as possible.

There are also scientific works, which showed the effectiveness of treating ADN using the introduction of stem cells. Using this still experimental technique, it is possible to partially restore vision.

Prognosis for ADN

The optic nerve is part of the central, not peripheral nervous system, which makes it impossible to regenerate after damage. Thus, ADN is irreversible. Treatment of this pathology is aimed at slowing down and limiting the progression of the degeneration process. Therefore, every patient with optic nerve atrophy should remember that the only place where this pathology can be cured or its development stopped is the ophthalmology departments in medical institutions.

The prognosis for vision and life with AD depends on the cause of it and the degree of damage to the nerve fibers. For example, with neuritis, after the inflammatory process subsides, vision may improve.

Prevention

In some cases, the development and progression of ADN can be prevented by proper treatment of glaucoma, toxic, alcohol and tobacco neuropathy, maintaining a complete and rich nutrients diet.

Optic nerve atrophy is a consequence of degeneration of its fibers. It can be caused by many diseases, from glaucoma and blood supply disorders (ischemic neuropathy) to inflammatory processes (for example, multiple sclerosis) and formations that compress the nerve (for example, intracranial tumors). Effective treatment possible only at the stage of partial atrophy of the optic nerve. The choice of treatment method depends on etiological factors. In this regard, it is necessary to establish the correct diagnosis in time and direct all efforts to preserve vision.

Useful video about optic atrophy

Acquired optic atrophy develops as a result of damage to the optic nerve fibers (descending atrophy) or retinal cells (ascending atrophy).

Descending atrophy is caused by processes that damage the fibers of the optic nerve at various levels (orbit, optic canal, cranial cavity). The nature of the damage is different: inflammation, trauma, glaucoma, toxic damage, circulatory disorders in the vessels supplying the optic nerve, metabolic disorders, compression of the optic fibers by a space-occupying formation in the orbital cavity or in the cranial cavity, degenerative process, myopia, etc.).

Each etiological factor causes atrophy of the optic nerve with certain typical ophthalmoscopic features, for example, glaucoma, circulatory disorders in the vessels supplying the optic nerve. However, there are characteristics common to optic atrophy of any nature: blanching of the optic disc and impaired visual function.

Based on the ophthalmoscopic picture, primary (simple) atrophy is distinguished, which is characterized by pallor of the optic nerve head with clear boundaries. The number of small vessels on the disc is reduced (Kestenbaum's symptom). The retinal arteries are narrowed, the veins may be of normal caliber or also slightly narrowed.

The time during which pallor of the optic nerve head develops and its severity depend not only on the nature of the disease that led to optic nerve atrophy, but also on the distance of the source of damage from the eyeball. For example, with inflammatory or traumatic damage to the optic nerve, the first ophthalmoscopic signs of optic nerve atrophy appear several days to several weeks after the onset of the disease or the moment of injury. At the same time, when a space-occupying lesion affects the optic fibers in the cranial cavity, initially only visual disturbances, and changes in the fundus in the form of optic nerve atrophy develop after many weeks and even months.

Congenital optic atrophy

When identifying ophthalmoscopic signs of optic nerve atrophy, it is necessary to conduct a thorough clinical examination of the patient, including determination of visual acuity and the boundaries of the visual field for white, red and green colors, study of intraocular pressure.

If atrophy develops against the background of papilledema, even after the edema disappears, the boundaries and pattern of the disc remain unclear. This ophthalmoscopic picture is called secondary (post-edema) optic nerve atrophy. The retinal arteries are narrowed in caliber, while the veins are dilated and tortuous.

When found clinical signs optic nerve atrophy, it is necessary to first establish the cause of the development of this process and the level of damage to the optic fibers. For this purpose, not only a clinical examination is carried out, but also CT and/or MRI of the brain and orbits.

In addition to etiologically determined treatment, symptomatic complex therapy is used, including vasodilator therapy, vitamins C and B, drugs that improve tissue metabolism, various options for stimulating therapy, including electrical, magnetic and laser stimulation of the optic nerve.

Hereditary atrophies come in six forms:

with a recessive type of inheritance (infantile) - from birth to three years of age there is a complete decrease in vision;
with the dominant type (juvenile blindness) - from 2-3 to 6-7 years. The course is more benign. Vision decreases to 0.1-0.2. In the fundus there is segmental blanching of the optic disc; there may be nystagmus and neurological symptoms;
opto-oto-diabetic syndrome - from 2 to 20 years. Atrophy is combined with retinal pigmentary dystrophy, cataracts, diabetes mellitus and diabetes insipidus, deafness, urinary tract;
Beer's syndrome is a complicated atrophy. Bilateral simple atrophy already in the first year of life, reggae drops to 0.1-0.05, nystagmus, strabismus, neurological symptoms, damage to the pelvic organs, the pyramidal tract suffers, joins mental retardation;
gender-related (more often observed in boys, develops in early childhood and grows slowly);
Leicester's disease (Lester's hereditary atrophy) - in 90% of cases occurs between the ages of 13 and 30 years.

Symptoms Acute onset sharp drop vision for several hours, less often - several days. The lesion is a type of retrobulbar neuritis. The optic disc is initially unchanged, then blurring of the boundaries and changes in small vessels appear - microangiopathy. After 3-4 weeks, the optic disc becomes paler on the temporal side. In 16% of patients, vision improves. Most often, reduced vision remains for life. Patients are always irritable, nervous, and worried headache, fatigue. The cause is optochiasmatic arachnoiditis.

Optic nerve atrophy in some diseases

Optic nerve atrophy is one of the main signs of glaucoma. Glaucomatous atrophy is manifested by paleness of the disc and the formation of a depression - an excavation, which first occupies the central and temporal sections, and then covers the entire disc. Unlike the above diseases leading to disc atrophy, with glaucomatous atrophy the disc has a gray color, which is associated with the characteristics of damage to its glial tissue.
Syphilitic atrophy.

Symptoms The optic disc is pale, gray, the vessels are of normal caliber and sharply narrowed. Peripheral vision narrows concentrically, there is no scotoma, color perception suffers early. There may be progressive blindness that occurs quickly, within a year.

It occurs in waves: a rapid decrease in vision, then during the period of remission - improvement, during the period of exacerbation - repeated deterioration. Miosis develops, divergent strabismus, changes in pupils, lack of reaction to light while maintaining convergence and accommodation. The prognosis is poor, with blindness occurring within the first three years.

Features of optic nerve atrophy from compression (tumor, abscess, cyst, aneurysm, sclerotic vessels), which can be in the orbit, anterior and posterior cranial fossa. Peripheral vision suffers depending on the location of the process.
Foster-Kennedy syndrome - atherosclerotic atrophy. Compression can cause carotid artery sclerosis and sclerosis ophthalmic artery; Ischemic necrosis occurs from softening during arterial sclerosis. Objectively - excavation caused by retraction of the cribriform plate; benign diffuse atrophy (with sclerosis of small vessels of soft meninges) grows slowly, accompanied by atherosclerotic changes in the retinal vessels.

Optic nerve atrophy in hypertension is the outcome of neuroretinopathy and diseases of the optic nerve, chiasm and optic tract.

Optic disc atrophy (another name is optic neuropathy) is a destructive pathology that affects the nerve fibers that transmit visual impulses to the human brain. During the course of the disease, nerve fibers are replaced by connective tissue, which is physiologically incapable of performing visual functions. The consequences of atrophy can be moderate severity or severe (total blindness).

Atrophy of the nervous tissue of the eye can be expressed in two forms: acquired and hereditary (congenital). Congenital is formed in a child as a result of diseases of genetic etiology. A disease acquired during life (ascending or descending atrophy) can be triggered by glaucoma, inflammation, myopia, profuse bleeding, hypertension or the presence of a brain tumor.

Main symptoms of nerve damage eyeballs boil down to a decrease in visual acuity, which cannot be corrected independently with the help of flexible lenses or glasses. If atrophy is progressive, then vision can decrease significantly in a period from several days to 2-3 months. Sometimes the disease ends in complete blindness. In the case of incomplete (partial) atrophy of the optic nerve, vision drops to a certain level, and the process stops.

Visual dysfunction can manifest itself in the form of a narrowing of the visual field, when the lateral visibility of objects is completely absent. Next, the tunnel develops peripheral vision. If you do not resort to treatment in time, small spots will begin to appear in parts of the patient’s field of vision. dark spots(scotomy). The disease is also accompanied by color perception disorder.

All of the above signs will be identified at the next appointment. at the ophthalmologist.

Diagnostics

An analysis of the state of the visual apparatus should begin with a visit to an ophthalmologist (ophthalmologist). Ophthalmoscopy involves examination of the patient's blood vessels and fundus, and instrumental examination of the optic nerve disc. After these manipulations, the doctor will voice the need for an in-depth examination.

To accurately diagnose optic nerve dystrophy, the following studies are necessary:

Fluorescein angiography. Using this method, you can examine even the smallest vessels of the visual organs. The procedure of highly sensitive photography occurs after the introduction of a special coloring substance into them. Thus, areas with impaired blood supply are detected;
General and biochemical blood test. A patient's blood test is necessary to identify possible infections and inflammatory processes that affect the functioning of the eyes;
Magnetic resonance and CT scan. The study helps to obtain detailed, three-dimensional picture the state of the optic nerve and orbit on the screen of a tomograph. The complete image is formed from many slices, which are layered on top of each other. The methods are highly informative, non-contact, and make it possible to study the fundus and fibers of the human optic nerve;
X-ray examination of the skull or craniography. A photograph of the patient’s skull is necessary to exclude or determine compression of the optic nerve by the bones of the skull;
For glaucoma and concomitant nerve atrophy, tonometry can provide important information - measuring intraocular pressure.

In some cases, the ophthalmologist refers the patient for consultation to other narrow specialists: neurosurgeon, neurologist, rheumatologist and vascular surgeon. Later, all data will be compared to make a final diagnosis.

Treatment

As shown medical practice However, it is not possible to completely restore the optic nerve in glaucoma, since the destroyed nerve fibers will never return to their previous state.

In order to at least partially cure optic nerve atrophy, therapeutic measures should be started as early as possible. You need to know what this dystrophy can be independent disease, but can only be a consequence of other certain processes of a pathological nature. In the case of the latter option, treatment will be aimed at identifying and stopping these pathologies. Complex therapy includes a whole course of drugs in the form of tablets, injections, and eye drops.

Therapeutic restoration of the optic nerve consists of the following stages:

Taking medications to improve the flow and circulation of blood entering the vessels. To the so-called vasodilator medications include No-shpu, Eufillin, Papaverine, Sermion, tablets based on nicotinic acid. Anticoagulants (Heparin, Tiklid) showed excellent results.
The use of agents that stimulate the regeneration of atrophied tissues and metabolic processes in them. This type of preparation includes biostimulants (aloe extract, peat, vitreous), vitamin complexes (Ascorutin, group B1, B2, B6), specific enzymes (Lidase), immunostimulants (ginseng, tincture of Eleutherococcus), amino acids in the form of glutamic acid.
Optic nerve atrophy may be preceded by any inflammatory process. It can be stopped with the help of hormonal drugs (Dexamethasone, Prednisolone).
An obligatory stage of treatment is to improve the functioning of the patient’s central nervous system. This can be achieved with the help of the following drugs: Cerebrolysin, Phezam, Nootropil. These medications should never be prescribed independently. Get recommendations from a specialist.
Physiotherapeutic procedures. For patients with partial or complete atrophy, stimulation of the optic nerve using a magnetic or laser device is indicated. Electrophoresis and ultrasound will help in treatment.

Statistics show that treatment with folk remedies is ineffective and can cause irreparable harm, as a person wastes time and the disease gradually progresses.

In particularly severe and advanced cases, the patient will be prescribed surgery. It involves eliminating tumors that compress areas of the optic nerve. It is possible to introduce biomaterials that will stimulate blood flow to the atrophied nerve.

The above treatment in combination gives a positive result, but it must be repeated after a certain period of time.

If, even after therapy, vision continues to decline, then the person is assigned a disability of the corresponding group.

Prognosis for partial optic nerve atrophy

Partial atrophy, or the diagnosis of PAZN, is a condition in which a certain percentage of residual vision is preserved, but color perception is impaired and the visual fields are narrowed. This phenomenon cannot be corrected, but also does not progress.

The destructive process, as with complete dystrophy, can be provoked by various infectious diseases, severe intoxications, hereditary factors, injuries, eye diseases such as glaucoma, inflammation, and damage to retinal tissue. If a person has lost peripheral vision in one eye, they should immediately contact their local ophthalmologist.

PAI of both eyes is a disease whose symptoms are severe or average degree expressiveness. Characterized by a gradual deterioration of vision and its acuity, painful sensations during the movement of the eyeballs. Some patients develop tunnel vision, in which all visual vision is limited to objects that are just in front of the eyes. The final symptom is the appearance of scotomas or blind spots.

The peculiarity of partial atrophy of the optic nerve is that the correct and timely treatment gives a favorable prognosis. Of course, doctors will not be able to restore initial visual acuity. The main goal of therapy is to maintain vision at a constant level. Specialists prescribe vasodilators, drugs that improve metabolism and blood flow in the body.

All patients should additionally take multivitamins and immunostimulants.

Prevention

Measures to prevent partial loss of vision or complete blindness include timely contact with an ophthalmologist and proper treatment of diseases that cause atrophy processes. It is extremely important to try to avoid all kinds of injuries and damage associated with the visual organs or the cranial bone.