Modern methods of treatment of optic nerve atrophy. Optic nerve atrophy (partial and complete) - causes, symptoms, treatment and prevention. Acquired and congenital form

Optic nerve atrophy consists in the development of such a pathology in which the optic nerve is partially or completely subject to destruction within its own fibers, after which these fibers must be replaced by connective tissue. Optic nerve atrophy, the symptoms of which are a decrease in visual functions in combination with a general blanching of the nerve disc, may be congenital or acquired by the nature of the occurrence.

general description

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

Optic nerve atrophy: causes

Congenital or hereditary pathologies that are relevant to the patient and are directly related to vision can be considered as the causes provoking the development of the disease we are considering. Atrophy of the optic nerve can also develop as a result of the transfer of any eye diseases or a certain type of pathological processes that affect the retina and directly the optic nerve. As examples of the latter factors, eye injury, inflammation, dystrophy, congestion, edema, damage due to toxic effects, compression of the optic nerve, and circulatory disorders of one scale or another can be distinguished. In addition, actual pathologies with damage to the nervous system, as well as the general type of disease, play an important role among the causes.

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

The development of the pathology we are considering can also be facilitated by diseases such as atherosclerosis and hypertension, as well as conditions whose development is provoked by beriberi, quinine poisoning, profuse bleeding and starvation.

In addition to these factors, optic nerve atrophy can also develop against the background of obstruction of the peripheral arteries of the retina and obstruction of the central artery in it. Due to these arteries, the optic nerve is supplied with food, respectively, if they are obstructed, its functions and general condition are violated. It should be noted that the obstruction of these arteries is also considered as the main symptom indicating the manifestation of glaucoma.

Optic nerve atrophy: classification

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

The congenital form of atrophy is considered as an atrophy resulting from genetic diseases, due to which visual impairment in the patient occurs from his very birth. Leber's disease was identified as the most common disease in this group.

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

At the heart of the mechanism primary form of atrophy of the optic nerve, the impact is considered, in which there is a compression of peripheral neurons within the visual pathway. The primary form (which is also defined as the simple form) of atrophy is accompanied by clear disc borders and pallor, vasoconstriction in the retina and the possible development of excavation.

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

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

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

A characteristic feature of the partial form of optic nerve atrophy (or initial atrophy, as it is also defined) is the incomplete preservation of visual function (vision itself), which is important with reduced visual acuity (due to which the use of lenses or glasses does not improve the quality of vision). Residual vision, although it is subject to preservation in this case, however, there are violations in terms of color perception. Saved areas in the field of view remain accessible.

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

Optic nerve atrophy: symptoms

The main symptom of this disease is, as noted earlier, a decrease in visual acuity, and this pathology is not amenable to any correction. The manifestations of this symptom may be different depending on the specific type of atrophy. The progression of the disease can lead to a gradual decrease in vision until complete atrophy is reached, at which vision will be completely lost. The duration of this process can vary from several days to several months.

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

With atrophy, vision can be impaired in various ways. So, the fields of vision can change (mostly they narrow, which is accompanied by the disappearance of the so-called side vision), which can reach the development of a “tunnel” type of vision, in which it seems that everything is seen as if through a tube, in other words, only visibility of objects directly in front of a person. Often scotomas become a companion of this type of vision, in particular, they mean the appearance of dark spots in any part of the visual field. There is also a problem with color vision.

Fields of vision can change not only according to the type of "tunnel" vision, but also based on the specific location of the lesion. If scotomas, that is, the dark spots noted above, appear before the patient's eyes, then this indicates that those nerve fibers that are concentrated as close as possible to the central section of the retina or are located directly in it were affected. The visual fields are narrowed due to damage to the nerve fibers, if the optic nerve is affected at a deeper level, then half of the visual field (nasal or temporal) may also be lost. As already noted, the lesion can be both unilateral and bilateral.

Thus, it is possible to summarize the symptoms under the following main points that determine the picture of the course:

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

Secondary atrophy of the optic nerve determines the following manifestations during ophthalmoscopy:

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

Diagnosis

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

Remarkably, even from the listed variants of diseases, amblyopia is not a disease as dangerous as optic nerve atrophy can be for a patient. Additionally, it should be noted that atrophy can also manifest itself not only as an independent disease or as a result of exposure to another type of pathology, but can also act as a symptom of individual diseases, including diseases that end in death. Given the seriousness of the lesion and all possible complications, it is extremely important to start diagnosing optic nerve atrophy in a timely manner, to find out the reasons that provoked it, and also to adequate therapy for it.

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

ophthalmoscopy;
visometry;
perimetry;
method for studying color vision;
CT scan;
X-ray of the skull and Turkish saddle;
NMR scan of the brain and orbit;
fluorescein angiography.

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

Treatment

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

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

conservative treatment;
therapeutic treatment;
surgical treatment.

Principles conservative treatment are reduced to the implementation of the following drugs in it:

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

Procedures for physiotherapy include magnetic stimulation, electrical stimulation, acupuncture and laser stimulation of the affected nerve.

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

As for surgical treatment, it implies an intervention focused on the elimination of those formations that compress the optic nerve, as well as ligation of the temporal artery area and implantation of biogenic materials that improve blood circulation in the atrophied nerve and its vascularization.

Cases of a significant drop in vision against the background of the transfer of the disease in question necessitate the assignment to the patient of the appropriate degree of damage to the disability group. Visually impaired patients, as well as patients who have completely lost their sight, are sent to a rehabilitation course aimed at eliminating the limitations that have arisen in life, as well as their compensation.

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

Optic nerve atrophy is clinically a combination of symptoms: visual impairment (decrease in 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. Atrophy of the optic nerve is considered to be the complete or partial destruction of its fibers with their replacement by connective tissue.

According to the degree of visual impairment, atrophy can be partial or complete. According to research data, it can be seen that men suffer from partial atrophy of the optic nerve in 57.5%, and women in 42.5%. Most often there is a bilateral lesion (in 65% of cases).

The prognosis of optic nerve atrophy is always serious, but not hopeless. Due to the fact that pathological changes are reversible, the treatment of partial atrophy of the optic nerve 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 the long-term existence of the disease. Also in recent years, the number of this pathology of vascular genesis has increased, which is associated with an increase in the general vascular pathology - atherosclerosis, coronary heart disease.

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.
According to the degree of progression: stationary; progressive.
According to the localization of the process: one-sided; bilateral.

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

Congenital, genetically determined atrophy of the optic nerve 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 practical blindness already in early childhood.

Processes that damage the fibers of the optic nerve at various levels (orbit, optic canal, cranial cavity) lead to descending acquired atrophy. The nature of the damage is different: inflammation, trauma, glaucoma, toxic damage, circulatory disorders in the vessels that feed the optic nerve, metabolic disorders, compression of the optic fibers by a volumetric 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 ophthalmoscopic features typical of it. However, there are characteristics that are common to optic atrophy of any nature: blanching of the optic disc and impaired visual function.

The etiological factors of atrophy of the optic nerve of vascular origin are diverse: this is vascular pathology, and 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 appears as a result of obstruction of the central and peripheral retinal arteries that feed the optic nerve.

Ophthalmoscopy reveals narrowing of the retinal vessels, blanching of part or all of the optic nerve head. Persistent blanching of only the temporal half occurs with damage to the papillomacular bundle. When atrophy is due to 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, consequently, on the degree of decrease in visual functions and blanching of the optic disc, there are initial, or partial, and complete atrophy of the optic nerve.

Diagnostics

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

Anamnesis: the presence of volumetric formations of the brain, intracranial hypertension, demyelinating lesions of the central nervous system, lesions of the carotid arteries, systemic diseases (including vasculitis), intoxication (including alcohol), previous optic neuritis or ischemic neuropathy, retinal vascular occlusion, taking medications, having a neurotoxic effect, during the last year; head and neck injuries, cardiovascular diseases, hypertension, acute and chronic cerebrovascular accidents, atherosclerosis, meningitis or meningo-encephalitis, inflammatory and voluminous processes of the paranasal sinuses, profuse bleeding.

Physical examination :

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

Laboratory research

biochemical blood test: blood cholesterol, low density lipoproteins, high density lipoproteins, triglycerides; ·
coagulogram;
ELISA for herpes simplex virus, cytomegalovirus, toxoplasmosis, brucellosis, tuberculosis, rheumatic tests (according to indications, to exclude the inflammatory process)

Instrumental Research

visometry: visual acuity can range from 0.7 to practical blindness. With damage to the papillomacular bundle, visual acuity is significantly reduced; with a slight lesion of the papillomacular bundle and involvement in the process of peripheral nerve fibers of the ON, visual acuity decreases slightly; with damage only to peripheral nerve fibers - does not change. ·
refractometry: the presence of refractive errors will allow a differential diagnosis with amblyopia.
Amsler test - distortion of lines, blurring 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 chiasma - bitemporal hemianopsia, with damage to the visual tracts - homonymous hemianopsia. With damage to the intracranial part of the optic nerve, hemianopsia occurs in one eye.
- Kinetic perimetry for colors - narrowing of the field of view to green and red, less often to yellow and blue.
- Computer perimetry - determination of the quality and quantity of cattle in the field of view, including 30 degrees from the point of fixation.
dark adaptation study: dark adaptation disorder. Color vision study: (Rabkin's tables) - a violation of color perception (increased color thresholds), more often in the green-red part of the spectrum, less often in the yellow-blue.
tonometry: an increase in IOP is possible (with glaucomatous atrophy of the optic nerve).
biomicroscopy: on the side of the lesion - an afferent pupillary defect: a decrease in direct pupillary reaction to light while maintaining a friendly reaction of the pupil.
ophthalmoscopy:
- initial atrophy of the optic nerve disc - against the background of the pink coloration of the optic disc, blanching appears, which later becomes more intense.
- partial atrophy of the optic nerve - blanching of the temporal half of the optic nerve, 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 nerve - uniform blanching of the optic nerve, Kestenbaum's symptom is moderately pronounced (a decrease in the number of capillaries on the optic nerve disc), the arteries are narrowed,
- complete atrophy of the optic nerve - total blanching of the optic nerve, the vessels are constricted (the arteries are narrowed more than the veins). Kestenbaum's symptom is sharply expressed (a decrease in the number of capillaries on the optic disc - up to 2-3 or capillaries may be absent).

In primary atrophy of the ONH, the borders of the ONH are clear, its color is white, grayish-white, bluish or slightly greenish. In redless light, the contours remain clear, while the contours of the optic disk normally become fuzzy. In red light with atrophy of the optic disc - blue. With secondary atrophy of the ONH, the borders of the ONH are fuzzy, blurry, the ONH is gray or dirty gray, the vascular funnel is filled with connective or glial tissue (in the long term, the borders of the ONH become clear).

Optical coherence tomography of the ONH (in four segments - temporal, superior, nasal and inferior): reduction in the area and volume of the neuroretinal rim of the ONH, a decrease in the thickness of the nerve fiber layer of the optic disc and in the macula.
Heidelberg retinal laser tomography - a decrease in the depth of the optic nerve head, the area and volume of the neuroretinal rim, an increase in the excavation area. With 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 disc, narrowing of the arteries, absence or decrease in the number of capillaries on the optic disc;
electrophysiological studies (visual evoked potentials) - a decrease in the amplitude of the VPV and a lengthening of the latency. In case of damage to the papillomacular and axial bundle of optic nerves, electrical sensitivity is normal, in case of violation of peripheral fibers, the threshold of electrical phosphene is sharply increased. Lability is especially sharply reduced in axial lesions. During the progression of the atrophic process in the ON, the retino-cortical and cortical time increases significantly;
USDG of the vessels of the head, neck, eyes: decreased blood flow in the ophthalmic, supratrochlear artery and intracranial part of the internal carotid artery;
MRI of cerebral vessels: foci of demyelination, intracranial pathology (tumors, abscesses, brain cysts, hematomas);
MRI of the orbit: compression of the orbital part of the ON;
Radiography 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 nerve atrophy with tabes develops in both eyes, but the degree of damage to each eye may not be the same. Visual acuity falls gradually, but because. The process with tabes is always progressive, then eventually bilateral blindness occurs at different times (from 2-3 weeks to 2-3 years). The most common form of visual field change in tabetic atrophy is a gradually progressive narrowing of the boundaries in the absence of cattle within the remaining areas. Rarely, with tabes, 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.

Atrophy of the optic nerve can be observed with deformities and diseases of the bones of the skull. Such atrophy is observed with a tower-shaped skull. Visual impairment usually develops in early childhood and rarely after 7 years of age. Blindness in both eyes is rare, sometimes there is blindness in one eye with a sharp decrease in vision in the other eye. From the side of the field of view, there is a significant narrowing of the boundaries of the field of view along all meridians, there is no cattle. Atrophy of the optic nerve with a tower-shaped skull is considered by most to be a consequence of congestive nipples that develop on the basis of increased intracranial pressure. Of the other deformities of the skull, atrophy of the optic nerves is caused by dysostosis craniofacialis (Cruson's disease, Apert's syndrome, marble disease, etc.).

Atrophy of the optic nerve can be in case of poisoning with quinine, plasmacide, fern in the expulsion of worms, lead, carbon disulfide, botulism, in case of poisoning with methyl alcohol. Methyl alcohol atrophy of the optic nerve is not so rare. After the use of methyl alcohol, after a few hours, paralysis of accommodation and dilation of the pupils appear, a central scotoma occurs, and vision is sharply reduced. Then vision is partially restored, but atrophy of the optic nerve gradually increases and irreversible blindness sets in.

Atrophy of the optic nerve can be congenital and hereditary, with birth or postpartum head injuries, prolonged hypoxia, etc.

Diagnosis	Rationale for differential diagnosis	Surveys	Diagnosis Exclusion Criteria
Amblyopia	A significant decrease in vision in the absence of pathology from the anterior segment of the eye and retina.	Physical examinations	In a small child - the presence of strabismus, nystagmus, the inability to clearly fix the gaze on a bright object. In older children - a decrease in visual acuity and the absence of improvements from its correction, disorientation in an unfamiliar place, strabismus, 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-grade 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 absence of optical correction of hyperopia , myopia or astigmatism with a difference in refraction of both eyes: hypermetropia 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 rim of the optic nerve is more than 1.48 mm 2 , the area of excavation of the optic nerve is less than 0.12 mm 2. .
Leber's hereditary atrophy	A sharp decrease in vision in both eyes in the absence of pathology from the anterior segment of the eye and retina.	Complaints and anamnesis	The disease develops in men - 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 linked to the X chromosome. A sharp decrease in vision in both eyes for several days. The general condition is good, sometimes patients complain of headache.
		Ophthalmoscopy	Initially, there is hyperemia and slight blurring of the borders of the optic disc. Gradually, the optic disc acquires a waxy character, turns pale, especially in the temporal half.
		Perimetry	In the field of view - the central absolute scotoma in white, the peripheral borders 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 - a sudden deterioration in vision, lasting from several hours to several months, develops against a background of strong emotional upheavals. It is more common in women aged 16-25 years.
		Physical examinations	Perhaps the complete lack of reaction of pupils to light.
		Visometry	Reduced visual acuity of varying degrees up to blindness. In repeated studies, the data may be completely different from the previous ones.
		Ophthalmoscopy	The optic disc is pale pink, the contours are clear, Kestenbaum's symptom is absent.
		Perimetry	Concentric narrowing of the visual field, a violation of the normal type of boundaries is characteristic - the widest field of vision for red; less often, hemianopsia (homonymous or heteronymous).
		VIZ	VEP data is normal.
Hypoplasia of the optic nerve	Bilateral reduction 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 a bilateral decrease in vision (in 80% of cases from moderate to complete blindness).
		Physical examinations	Afferent pupillary reflex is absent. A unilateral change in the ONH is often associated with strabismus and can be seen by a relative afferent pupillary defect, as well as unilateral weak or absent fixation (instead of installation nystagmus).
		Ophthalmoscopy	The optic disc is reduced in size, pale, surrounded by a weakly expressed pigment ring. The outer ring (the size of a normal disc) consists of a cribriform plate, a pigmented sclera, and a choroid. Options: yellow-white small disc with a double ring or complete absence of the nerve and aplasia of the vessels. With a bilateral process, the disc is often difficult to detect, in which case it is determined along the course of the vessels.
		Perimetry	With the preservation of central vision, it is possible to detect defects in the visual fields.
		Consultation of a neuropathologist, endocrinologist, laboratory tests	Optical hypoplasia of the nerve is rarely combined with septo-optic dysplasia (Morsier's syndrome: absence of a transparent septum (septum pellucidum) and pituitary gland, which is accompanied by thyroid dysfunction and other hormonal disorders: growth retardation, hypoglycemia attacks, combined with mental retardation and malformations of brain structures) .
Optic nerve head coloboma	Pathology of the optic nerve	Ophthalmoscopy	With ophthalmoscopy, the optic disc is enlarged in size (lengthening of the vertical size), deep excavation or local excavation and increased sickle-shaped pigmentation with partial involvement of the lower nasal part of the optic disc. When the choroid is also involved in the process, a line of demarcation appears, represented by a bare sclera. Lumps of pigment may mask the border between normal tissue and coloboma. There may be glial tissue on the surface of the ONH.
Optic nerve head coloboma	Pathology of the optic nerve	MRI	MRI - shells of the optic canal are weakly expressed or absent.
Syndrome "morning light"	Pathology of the optic nerve	Physical examinations	Almost all patients with unilateral pathology have strabismus and high myopia of the affected eye.
		Visometry	Visual acuity is often reduced, but can be very high.
		Refractometry	Often with a unilateral process - high myopia of the affected eye.
		Ophthalmoscopy	With ophthalmoscopy, the optic disc is enlarged and is located, as it were, in a funnel-shaped cavity. Sometimes the head of the ONH is raised, it is also possible to change the position of the head of the ONH from a staphylomatous depression to its prominence; around the nerve are areas of transparent grayish retinal dysplasia and lumps of pigment. The demarcation line between the ONH tissues and the normal retina is indistinguishable. Determine the set of abnormally branching vessels. Most patients have areas of local retinal detachment and radial retinal folds within the excavation.
		Perimetry	Defects in the field of view are possible: central scotomas and an increase in the blind spot.
		Otolaryngologist consultations	The morning light syndrome occurs as an independent manifestation or can be combined with hypertelorism, cleft lip, palate and other anomalies.

Treatment

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

In the treatment of partial atrophy of the optic nerve, as a rule, pharmacotherapy is used. The use of drugs makes it possible to influence various links in the pathogenesis of optic nerve atrophy. But do not forget about the methods of physiotherapy and various ways of administering drugs. The issue of optimizing the routes of administration of drugs is also relevant in recent years. Thus, parenteral (intravenous) administration of vasodilators can contribute to systemic vasodilation, which, in some cases, can lead to steal syndrome and worsen blood circulation in the eyeball. The fact of a greater therapeutic effect with topical application of drugs is generally accepted. However, in diseases of the optic nerve, local application of drugs is associated with certain difficulties caused by the existence of a number of tissue barriers. The creation of a therapeutic concentration of the drug in the pathological focus is achieved more successfully with a combination of drug therapy and physiotherapy.

Medical 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 vital 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 that cause the death of nerve cells) action.

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 the membranes of endotheliocytes
Antioxidants: tocopherol 100 IU 3 times a day - 10 days, in order to improve the supply of oxygen to tissues, collateral circulation, strengthen the vascular wall
Drugs that improve metabolic processes (direct neuroprotectors): retinalamin for intramuscular injection of 1.0 ml and / or parabulbar administration of 5 mg of 0.5 ml parabulbar 1 time per day for 10 days
List of additional medicines:
- vinpocetine - adults 5-10 mg 3 times a day for 2 months. It has a vasodilating, antihypoxic and antiplatelet effect
- cyanocobalamin 1 ml intramuscularly 1 time per day 5/10 days

Electrical stimulation is already used - it is aimed at restoring the function of nerve elements that were functional, but did not conduct 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 previously functioned poorly; 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 of narrow specialists:

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

Treatment effectiveness indicators:

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).

- a process characterized by the gradual death of fibers.

Pathology is often caused by ophthalmic diseases.
The disease is diagnosed when the fibers are damaged. Nervous tissues are located in almost all human organs.

What it is

The optic nerve is a kind of transmission channel. With its help, the image enters the retina, then to the brain compartment.

The brain reproduces the signal, turning the description into a clear picture. The optic nerve is connected to many blood vessels from which it receives its nourishment.

In a number of processes, this relationship is violated. There is a death of the optic nerve, in the future comes blindness and disability.

Causes of pathology

In the course of scientific experiments, it was found that 2/3 of cases of optic nerve atrophy were bilateral. The cause is intracranial tumors, edema and vascular disorders, especially in patients aged 42-45 years.

The causes of the disease are:

Nerve damage. These include: chronic glaucoma, neuritis, neoplasms.
Neuropathy (ischemic), chronic neuritis, edema - a secondary pathology.
Hereditary neuropathy (Leber).
Neuropathy (toxic). The disease is caused by methanol. This component is found in surrogate alcoholic beverages and drugs (Disulfiram, Ethambutol).

The causes of the disease include: retinal damage, TEI-SAXA pathology, syphilis.

The development of atrophy in children is affected by a congenital anomaly, a negative hereditary factor, and malnutrition of the optic nerve. Pathology entails disability.

The main classification of the disease

Atrophy of the optic nerve is determined by pathological and ophthalmoscopic signs.

Acquired and congenital form

The acquired form is primary or secondary. Due to the influence of etiological factors. The process occurs as a result of: inflammation, glaucoma, myopia, in violation of metabolic processes in the body.

Congenital form: occurs against the background of a genetic pathology. There are 6 types of hereditary atrophy: infantile (from birth to 3 years), dominant (juvenile blindness from 3 to 7 years), opto-oto-diabetic (from 2 to 22 years), Beer's syndrome (complicated form, appears from 1 year) , growing (from an early age, gradually progressive), Lester's disease (hereditary), occurs at the age of 15 - 35 years.

Primary and secondary atrophy

The primary form is localized in a healthy eyeball. Occurs when microcirculation and nutrition of nerve fibers are disturbed.

The occurrence of secondary atrophy is due to various eye pathologies.

Descending and ascending form

Descending atrophy is characterized by an inflammatory process in the proximal zone of the axon. There is damage to the retinal disc.

With the ascending form, the retina is initially affected. Gradually, the destructive process is directed to the brain. The rate of degeneration will depend on the thickness of the axons.

Partial and full degree

Diagnosing the degree of damage:

initial (damage to some fibers);
partial (diameter damaged);
incomplete (the disease progresses, but vision is not completely lost);
complete (loss of visual functions in full).

There is unilateral and bilateral atrophy. In the first case, there is damage to the innervation of one eye, in the second - two.

Localization and intensity of optic disc pathology

Visual acuity is affected by the localization and intensity of the atrophic process:

Modification of the field of view. Violation is determined by topical diagnostics. The process is affected by localization, not intensity. The defeat of the papillomacular bundle provokes the occurrence of central scotoma. Damaged optic fiber contributes to the narrowing of the peripheral limits of the field of view.
Violation of colors. This symptomatology is clearly expressed in the descending form of the visual disc. The course of the process is due to the transferred neuritis or swelling. At the first stages of the disease, the visible outlines of green and red shades are lost.
Pale color of the optic disc. An additional examination using campimetry is required. It is necessary to collect information about the initial visual acuity of the patient. In some cases, visual sharpness exceeds one.

If unilateral atrophy is diagnosed, a second examination will be required to avoid damage to the other eye (bilateral atrophy).

Symptoms of eye disease

The main symptoms of the onset of atrophy are expressed by a progressive deterioration in vision in one or two eyes. Vision cannot be treated or improved by ordinary methods of correction.

Symptoms are expressed:

loss of lateral visibility (fields narrow);
the emergence of tunnel visibility;
the formation of dark spots;
a decrease in the pupil's reflex to light rays.

When the optic nerve is damaged, optic neuropathy develops, which leads to partial or complete blindness.

Proper medical diagnosis

An ophthalmological examination determines the presence and degree of the disease. The patient should be consulted by a neurosurgeon and a neurologist.

To establish the correct diagnosis, you need to go through:

ophthalmoscopy (viewing the fundus);
visometry (the degree of damage to visual perception is determined);
perimetry (fields of vision are examined);
computer perimetry (the affected department is determined);
evaluation score of color readings (determined by the location of the fiber);
video - ophthalmography (the nature of the pathology is revealed);
craniography (an x-ray of the skull is made).

Additional examinations may be prescribed, which consist in the passage of CT, magnetic nuclear resonance, laser dopplerography.

Treatment of the disease - prevent disability

After the diagnosis, the specialist prescribes intensive therapy. The task of the doctor is to eliminate the causes of the pathology, stop the progression of the atrophic process, and prevent complete blindness and disability of the patient.

Effective medical treatment of the patient

It is impossible to restore dead nerve fibers. Therefore, therapeutic measures are aimed at stopping inflammatory processes with the help of drugs.

This ophthalmic disease is treated:

vasodilators. The drugs stimulate blood circulation. The most effective: No-shpa, Dibazol, Papaverine.
Anticoagulants. The action of drugs is aimed at preventing blood clotting and the formation of thrombosis. The specialist is appointed: Heparin, Ticlid.
Biogenic stimulants. The process of metabolism in the nervous tissue structures is enhanced. This group of funds includes: Peat, Aloe Extract.
Vitamin complex. Vitamins are a catalyst for biochemical reactions that occur in the eye tissue structures. For the treatment of pathology, Ascorutin, B1, B6, B12 are prescribed.
Immunostimulants. Promote cell regeneration, suppress inflammatory processes (in case of infection). The most effective: Ginseng, Eleutherococcus.
Hormonal medications. Relieve inflammatory symptoms. Assigned: Dexamethasone, Prednisolone individually (in the absence of contraindications).

The patient receives certain results from acupuncture and physiotherapy (ultrasound, electrophoresis).

Surgical intervention - the main types of operations

The surgical event is indicated for patients with an unfavorable prognosis: optic nerve atrophy with the possibility of blindness.

Operation types:

Vasoconstructive. The temporal or carotid arteries are tied up, the blood flow is redistributed. Improves blood supply to the ophthalmic arteries.
Extrascleral. Transplanted own tissues. An antiseptic effect is created on the affected areas, a therapeutic effect is caused, blood supply is stimulated.
Decompression. The scleral or bone tubule of the optic nerve is dissected. There is an outflow of venous blood. The pressure on the beam section is reduced. Result: the functional abilities of the optic nerve are improved.

After medical or surgical treatment, it will be advisable to use alternative medicine.

Folk medicines stimulate metabolism and increase blood circulation. It is allowed to use folk remedies after consulting the attending physician (ophthalmologist).

Fighting illness in children

Therapy in children is aimed at saving nerve fibers and stopping the process. Without adequate treatment, the child will become completely blind and will become disabled.

Despite the measures taken at the beginning of treatment, atrophy of the optic nerve often progresses and develops. In some cases, the duration of therapy will be from 1 to 2 months. With advanced forms of atrophy, treatment lasts from 5 to 10 months.

After the examination, the doctor prescribes to the child:

magnetic stimulation;
electrical stimulation;
vasodilators;
biostimulating drugs;
vitamin cocktail;
enzymes.

If the medication does not bring results and the disease continues to progress, a course of laser therapy or surgical measures is prescribed.

Tabetic nerve atrophy

Tabes - a disease of the nervous system against the background of infection with syphilis. If timely treatment was not applied, the disease progresses, causing ocular trophic disorders.

Tabetic atrophy of the optic nerve is the only manifestation of tabes (an early symptom of neurosyphilis). The tabetic form of atrophy is characterized by a bilateral decrease in vision.

A sign of the disease is reflex immobility of the pupils. The optic nerve papilla becomes discolored, becomes gray-white.

There is a sharp drop in vision, the pathology is difficult to treat. Therapy is prescribed by a venereologist and a neuropathologist (treatment of the primary infection is mandatory). Initially, medications and vitamin preparations are prescribed that stimulate metabolic processes in tissue structures.

Assigned inside:

vitamin A;
vitamin C;
a nicotinic acid;
calcium (pangamat);
riboflavin.

After three days, intramuscular injections are prescribed: vitamin B, B6, B12. The preparations are combined with aloe or vitreous extract. Treatment is carried out under the strict supervision of a specialist in a medical institution.

Atrophy due to methyl alcohol poisoning

Methyl alcohol and technical alcohol mixtures can cause serious damage to vision. Pathology sometimes occurs when poisoning with methyl alcohol.

The first sign of poisoning is characterized by: migraine, dizziness, nausea, vomiting, diarrhea. The pupil becomes dilated, the clarity of vision is disturbed, light reflections are not distinguished. There is a sharp decrease in vision.

Therapy for this form of atrophy consists in the use of: alkalizing drugs, calcium, B vitamins, ascorbic acid.

In patients diagnosed with methyl arthrosis, the prognosis for recovery is pessimistic. Restoration of vision is observed only in 15% of patients.

Optic nerve atrophy is damage to the nerve fibers. With a prolonged process, neurons die off, which leads to loss of vision.

Diagnosis of atrophy

When examining patients with optic nerve atrophy, it is necessary to find out the presence of concomitant diseases, the fact of taking medications and contact with chemicals, the presence of bad habits, as well as complaints indicating possible intracranial lesions.

During a physical examination, the ophthalmologist determines the absence or presence of exophthalmos, examines the mobility of the eyeballs, checks the reaction of the pupils to light, the corneal reflex. Be sure to check visual acuity, perimetry, the study of color perception.

Basic information about the presence and degree of optic nerve atrophy is obtained using ophthalmoscopy. Depending on the causes and form of optic neuropathy, the ophthalmoscopic picture will differ, however, there are typical characteristics that occur with various types of optic nerve atrophy.

These include: blanching of the ONH of varying degrees and prevalence, changes in its contours and color (from grayish to waxy), excavation of the disc surface, a decrease in the number of small vessels on the disc (Kestenbaum's symptom), narrowing of the caliber of retinal arteries, changes in veins, etc. Condition The optic disc is refined using tomography (optical coherence, laser scanning).

An electrophysiological study (VEP) reveals a decrease in lability and an increase in the threshold sensitivity of the optic nerve. With the glaucomatous form of optic nerve atrophy, an increase in intraocular pressure is determined using tonometry.

The pathology of the orbit is detected using a plain radiography of the orbit. Retinal vessels are examined using fluorescein angiography. The study of blood flow in the ophthalmic and supratrochlear arteries, intracranial section of the internal carotid artery is performed using Doppler ultrasound.

If necessary, an ophthalmological examination is supplemented by a study of the neurological status, including a consultation with a neurologist, x-rays of the skull and sella turcica, CT or MRI of the brain. If a patient has a brain mass or intracranial hypertension, a neurosurgeon should be consulted.

In the case of a pathogenetic connection between optic nerve atrophy and systemic vasculitis, a consultation with a rheumatologist is indicated. The presence of orbital tumors dictates the need for examination of the patient by an ophthalmic oncologist. Therapeutic tactics for occlusive lesions of the arteries (orbital, internal carotid) is determined by an ophthalmologist or vascular surgeon.

With atrophy of the optic nerve caused by an infectious pathology, laboratory tests are informative: ELISA and PCR diagnostics.

The differential diagnosis of optic nerve atrophy should be made with peripheral cataract and amblyopia.

Forecast

The degree of vision loss in a patient depends on two factors - the severity of the nerve trunk lesion and the time of initiation of treatment. If the pathological process has affected only part of the neurocytes, in some cases, it is possible to almost completely restore the functions of the eye, against the background of adequate therapy.

Unfortunately, with atrophy of all nerve cells and the cessation of impulse transmission, the patient is likely to develop blindness. The way out in this case may be surgical restoration of tissue nutrition, but such treatment is not a guarantee of restoration of vision.

Physiotherapy

There are two physiotherapy methods, whose positive effect is confirmed by scientific research:

Pulsed magnetotherapy (PMT) - this method is not aimed at restoring cells, but at improving their work. Due to the directed action of magnetic fields, the content of neurons “thickens”, which is why the generation and transmission of impulses to the brain is faster.
Bioresonance therapy (BT) - its mechanism of action is associated with the improvement of metabolic processes in damaged tissues and the normalization of blood flow through microscopic vessels (capillaries).

They are very specific and are used only in large regional or private ophthalmological centers, due to the need for expensive equipment. As a rule, for most patients, these technologies are paid, so BMI and BT are used quite rarely.

Prevention

Optic nerve atrophy is a serious disease.

To prevent it, you need to follow some rules:

consultation with a specialist at the slightest doubt in the visual acuity of the patient;
prevention of various types of intoxication;
timely treat infectious diseases;
do not abuse alcohol;
monitor blood pressure;
prevent eye and craniocerebral injuries;
repeated blood transfusion for profuse bleeding.

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

Complications

The diagnosis of optic nerve atrophy is very serious. At the slightest decrease in vision, you should immediately consult a doctor so as not to miss your chance for recovery. In the absence of treatment and with the progression of the disease, vision may disappear completely, and it will be impossible to restore it.

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

Disability

Disability group I is established with IV degree of visual analyzer dysfunction - significantly pronounced functional impairment (absolute or practical blindness) and a decrease in one of the main categories of life activity to degree 3 with the need for social protection.

The main criteria for the IV degree of visual analyzer dysfunction.

blindness (vision is 0) in both eyes;
visual acuity with correction of the best eye is not higher than 0.04;
bilateral concentric narrowing of the boundaries of the field of view up to 10-0° from the point of fixation, regardless of the state of central visual acuity.

Disability group II is established with the III degree of visual analyzer dysfunction - severe functional impairment (low vision of a high degree), and a decrease in one of the main categories of life activity to degree 2 with the need for social protection.

The main criteria for severe visual impairment are:

visual acuity of the best eye from 0.05 to 0.1;
bilateral concentric narrowing of the boundaries of the field of view up to 10-20 ° from the point of fixation, when labor activity is possible only in specially created conditions.

III group of disability is established at the II degree - moderate impairment of functions (low vision of an average degree) and a decrease in one of the main categories of life activity to 2 degrees with the need for social protection.

The main criteria for moderate visual impairment are:

decreased visual acuity in the better seeing eye from 0.1 to 0.3;
unilateral concentric narrowing of the boundaries of the field of view from the point of fixation less than 40°, but more than 20°;

In addition, when making a decision on the disability group, all diseases that the patient has are taken into account.

1178 10/10/2019 6 min.

Partial optic nerve atrophy (POA) is one of the most common ophthalmic diseases. This disease poses a serious danger, since it can go from partial in the case of improper treatment or lack thereof to complete - when a person goes completely blind.

Description of partial optic nerve atrophy (POA) and ICD-10 code

Atrophy in ophthalmology is the death of tissues, fibers of the optic nerve. Atrophied tissue is replaced by simple connective tissue, which is unable to transmit signals from nerve cells to the organs of vision. As a result of the disease, the ability to see is sharply reduced, and if treatment is not started in time, partial atrophy can be replaced by complete atrophy, which will lead to absolute loss of vision. The ICD disease code is H47.2.

In the case of partial atrophy of the optic nerve head (OND), a person can see, however, the colors are transmitted incorrectly, the contours of objects are distorted, turbidity appears before the eyes, vagueness, and other visual defects occur.

diagram of the structure of the eyeball

Vision in this case can decrease both extremely sharply (in a few days), and rather gradually (over several months). Usually, having decreased, vision in this case stabilizes - it is this fact that gives reason to talk about partial atrophy. If vision, having decreased, no longer falls, a complete partial atrophy of the optic nerve is diagnosed. However, the disease can also be progressive - in this case, it just leads to complete blindness (if not treated).

Previously, partial atrophy of the optic nerve, not to mention complete, was the basis for the appointment of disability. Modern medicine, fortunately, makes it possible to cure pathology, especially if it is detected at the earliest stages.

Reasons for the death of the ONH

The main causes of partial atrophy of the optic nerve are the most common eye pathologies:

myopia (including age-related);
glaucoma;
retinal lesions;
defects in optic fibers;
tumor-like formations of any etiology in the organs of vision;
inflammatory processes.

stages of optic nerve atrophy

In addition to the above, sometimes (less often) the following pathologies become the causes of the disease:

syphilis;
encephalitis;
meningitis;
purulent brain abscess.

optic nerve diagram

The appearance of cattle (blind spots) is also a common symptom in this disease. In this case, a person sees the picture partially, some areas fall out of the general view, in their place - whitish cloudy spots.

Why bestoxol drops are prescribed can be read.

Diagnostics

As a rule, this disease is diagnosed without any difficulty. It is impossible not to notice a sharp decrease in vision, so the vast majority of patients themselves turn to an ophthalmologist, who already makes a diagnosis. Examination of the organs of vision of a sick person in this case will necessarily show the deformation of the optic nerve, its color is paler than necessary.

In children

Partial atrophy of the optic nerve is a disease typical of adults; it is rare in children. However, in recent years, ophthalmologists have noticed a rejuvenation of the disease, so cases of pathology in adolescents and children are no longer surprising. Sometimes the disease occurs even in newborns.

The causes of illness in children are as follows:

severe heredity (leads to congenital CHAD);
pathology of the retina, nerve - dystrophy, trauma, swelling, congestion, inflammation;
pathologies of a neurological nature - meningitis, encephalitis, head trauma, purulent abscesses of the meninges, tumor-like formations;

photo of the fundus with partial atrophy

In addition to the above, this disease in children can develop as a result of prolonged beriberi, high blood pressure, excessive mental and physical stress with malnutrition.

The causes of optic neuritis can be found.

Treatment and prognosis

Usually, with timely access to a doctor, the prognosis for this disease is favorable. The goal of therapy is to stop the deformation of the tissues of the optic nerve, maintaining the level of vision that is still available. It is impossible to restore full vision in this case, since already deformed tissues of the optic nerve cannot be restored.

The method of therapy is selected depending on the underlying cause that gave rise to the disease. Usually, the following types of medications are used in the treatment of partial atrophy of the optic nerve:

improving cerebral blood supply;
activating metabolic processes, metabolism;
expanding vessels;
multivitamins;
stimulants of biological processes.

Also, in the treatment, means are necessarily used that activate the regeneration processes in the tissues of the organs of vision, which improve metabolic processes. It:

stimulants- extracts of aloe, peat;
glutamic acid as an amino acid;
extracts of ginseng, eleutherococcus as vitamin supplements and immunostimulants.

Drugs are also prescribed to help resolve pathological processes faster, stimulating metabolism:

Pyrogenal;
Phosfaden;
Preductal.

It is unacceptable to use any medications prescribed independently - all medications must be taken strictly for medical purposes and the scheme proposed by the specialist.

No folk remedies and alternative medicine can help health in this case. Therefore, you should not waste precious time, but you should immediately consult a doctor for qualified help.

How to treat through surgery and physiotherapy

If the disease requires surgical intervention, then the operation will be the main method in this case. And if the vision has fallen sufficiently, there are grounds for assigning a disability group.

optic nerve pathways

The emphasis in therapy is on the elimination of the underlying disease, which was the direct cause of atrophy. In order to achieve the result of treatment faster and more efficiently, additional procedures are prescribed:

ultrasound;
magnetic resonance procedure;
electrophoresis;
laser;
oxygen therapy.

In this case, it is important to start treatment as early as possible. The sooner therapy begins, the greater part of the optic nerve can be saved. In addition, atrophied fibers cannot be restored, so that part of the nerve that is affected will not recover.

How to treat lazy eye in adults can be read.

Prevention

To cope with this disease as quickly as possible, it is important to seek medical help in a timely manner. In addition, abstinence from alcohol and drugs will help prevent the occurrence of pathology. The fact is that alcohol and drug intoxication is one of the factors that provoke atrophy.

Video

What is atrophy and signs of the disease, we learn from the video.

Conclusion

Partial atrophy of the optic nerve is a serious pathology, and if you do not pay attention to it in time, it can lead to complete blindness. Therefore, be sure to visit an ophthalmologist if vision begins to decline sharply and for no reason - the sooner you start treatment, the greater part of the optic nerve will be saved.

Optic atrophy may be congenital and acquired.

In the second case, the causes of atrophy are most often pathological processes of the retina or optic nerve.

The disease can develop after a syphilitic lesion, meningitis, with tumors and multiple sclerosis, with a brain abscess, with various intoxications or poisonings.

The cause of the pathology can also be vascular atherosclerosis, starvation, hypertension, beriberi, profuse bleeding.

There are several forms of atrophy:

Primary atrophy occurs after the deterioration of the trophism of the nerve, microcirculation disorders. It includes descending atrophy of the optic nerve (a consequence of damage to the fibers of the optic nerve) and ascending (a consequence of damage to retinal cells).
Secondary atrophy is the result of damage to the optic disc in pathologies occurring in the retina and in the optic nerve.
Not all forms of pathology cause visual impairment. For example, when peripheral fiber atrophy without involvement of the papillomacular bundle, vision is preserved.
In a special form, hereditary Leber atrophy of the gender type is distinguished. The disease develops mainly in men of the same family aged 13 to 28. The clinical picture is characterized by a sharp decrease in vision in both eyes at once for two to three days.
Glaucomatous atrophy I arises as a result of the collapse of the cribriform plate as a result of an increase in intraocular pressure.

Atrophy can be complete or partial. With complete atrophy, the function of the optic nerve is completely lost. With partial atrophy, visual impairment occurs.

In the course of the disease, the nutrition of the nerve fibers deteriorates. Vision begins to gradually deteriorate up to complete blindness. No vision correction is possible, sometimes with the rapid development of the process, vision is lost irretrievably within three months.

With atrophy, the symptoms can be of a different nature: narrowing of the visual fields, color perception disorder, or the appearance of black spots in the visual field (the most common symptom). In this case needed as soon as possible contact an ophthalmologist for diagnosis and treatment.

Diagnostics abroad

Abroad, the diagnosis of atrophy of the optic nerves is carried out using modern techniques:

The examination begins with an ophthalmoscopy.
Spheroperimetry helps to determine the boundaries of vision.
Computerized perimetry is used to detect atrophied parts of the nerve.
Video ophthalmography helps to identify the nature of the damage.
Additional examinations, such as an x-ray of the skull, CT, MRI help determine the presence or absence of a brain tumor, which may be one of the causes of the pathology.
Also, fluorescein angiography and laser dopplerography can be prescribed as an examination.

As a rule, all procedures abroad are carried out in one clinic. Also, the patient undergoes a mandatory examination to detect hypertension, atherosclerosis, diabetes, etc.

Modern methods of treatment

It is difficult to treat the pathology, since the nerve fibers are not restored. Therefore, treatment should be started as soon as possible. until complete destruction of the nerve fibers occurs.

First of all, during treatment, the inflammatory process is eliminated, swelling in the optic nerve is removed, trophism and blood circulation are improved.

Ophthalmologists in many countries (Israel, Germany, etc.) have already gained a lot of practical positive experience in the treatment of the disease, thanks to close cooperation with research centers around the world.

At the beginning of treatment, it is necessary to provide the nerve with vitamins and nutrition. For this, the most modern medicines are used abroad.

In some cases, a surgical method of nutrient delivery may be used. Allows you to achieve a positive effect of physiotherapy. Well helps to improve blood circulation and normalize metabolism helps magnetostimulation, exposure to the nerve magnetic alternating fields. Improvement may occur after the first 15 procedures.

Laser and electrical stimulation (impact on the nerve with impulses) are also used to treat atrophy. A good effect is observed after a few sessions.

One of the newest methods of combating the disease was the use of tissue regenerative microsurgery.

Stem cells and the latest advances in nanotechnology are used for treatment, thanks to which nanoparticles are used to deliver nutrients to the optic nerve.

More often, no single method is used for treatment, but the complex use of several methods. Thanks to this approach, ophthalmology abroad has achieved outstanding results in the treatment of eye pathologies.

Stem cell treatment

The newest method of treatment abroad is stem cell therapy. Stem cells are injected into the area of the optic nerve. The introduction is carried out every 2 hours up to 10 times a day.

A simpler method of introducing stem cells without surgical intervention has also been developed..

The method of introducing stem cells consists in their replanting to the patient, with an interval of 3 months to six months for three procedures. A simple lens is used as the base of the stem cell carrier.

Cytokines, interleukins, growth factors contained in stem cells, which activate regenerative processes and support the vital activity of cells, give a positive effect.

Where to apply?

Treatment of the disease abroad is carried out in leading clinics in Germany, Israel, USA, Austria, Finland, Switzerland. Treatment is usually carried out in courses of up to 14 days, based on the diagnosis of the disease, the identification of the causes of the pathology and their elimination.

Germany

In Germany, treatment is carried out:

At the University Hospital of Cologne;
In the university multidisciplinary clinic L. Maximilian, Munich;
In the ophthalmological clinic of Dr. med. G. Palme in Düsseldorf;
In the clinic of St. Martinus in Düsseldorf;
At the Ophthalmological Medical Center at the University Hospital in Essen;
at the University Center for Ophthalmology in Frankfurt am Main;
At the clinic for refractive and ophthalmic surgery in Duisburg.

Optic nerve atrophy in children is treated at the Clinic for Psychomotor Disorders, Periocular Surgery and Pediatric Ophthalmology in Tübingen.

Israel

In Israel, the treatment of pathology is carried out:

At the Hadassah University Hospital in Jerusalem by Dr. Yitzhak Chemo;
At the Ichilov Clinic by Dr. Shimon Kurtz;
At the Assuta clinic;
At the Herzelia Medical Center;
At the medical center Yitzhak Rabin;
At the medical center Sourasky;
Rambam Medical Center.

Austria

In Austria, treatment is carried out:

At the University Eye Clinic in Vienna, Dr. E. Ergun;
At the Laser Eye Surgery Clinic in Vienna by Dr. Reinhard Schranz;
At the Ophthalmology Center of the Confraternite-Private Clinic Josefstadt by Dr. Christian Lammerhuber.

Switzerland

In Switzerland, qualified and effective treatment can be obtained:

At the Hirslanden im Park clinic in Zurich;
At the Cecile Hirslanden clinic in Lausanne;
At the Hirslanden Clinic in Zurich;
At the Generale Beaulieu clinic in Geneva;
In the clinic in Leukerbad.

China

Treatment of optic nerve atrophy in adults and children is successfully carried out in China:

In Beijing - Beijing United Family Hospital and Clinics;
at the Tongren Hospital in Beijing;
at the Daqing People's Hospital.