Optic Nerve Atrophy - Causes, Symptoms And Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Optic nerve atrophy

Violations in the work of the organs of vision cannot remain unnoticed by a person. This complication significantly reduces the quality of life and affects his work, study and daily activities.

Ophthalmology has achieved tremendous success and has learned to rid people of most eye diseases that seemed incurable in the past. However, optic atrophy is a difficult pathology to cope with. The functions of the eye suffer so much that it is not always possible to restore them. For this reason, many people become visually impaired.

It is possible to prevent irreversible consequences only if medical assistance is provided in the early stages of the development of the violation. Therefore, it is so important to know the main causes and symptoms leading to optic nerve atrophy.

Content:

• Optic atrophy - what is it?
• Causes of optic nerve atrophy
• Symptoms of optic nerve atrophy
• Diagnosis of optic nerve atrophy
• Treatment of optic nerve atrophy
• Forecast
• Answers to popular questions

Optic atrophy - what is it?

Optic atrophy is a condition in which the tissues of the optic nerve are malnourished. This causes the nerve to stop performing its functions. The longer the nerve is in this state, the higher the likelihood of death of its cells. They do not die all at once, but if the pathological factor is not eliminated, then, ultimately, the nerve trunk will undergo complete atrophy. It will no longer be possible to restore vision in such patients.

The optic nerve is represented by a second pair of cranial nerves. This pair inextricably links the brain and the eyeball. If nerve cells die, then vision will not be restored. It will be lost forever. Functionally, the optic nerve is divided into right and left halves, along which impulses from the nasal and temporal regions of the retina are transmitted separately. They pass through the outer shell of the eye and are collected in a compact bundle. Therefore, if the nerve is damaged in the area where it left the orbit, it leads to a violation of the functioning of both eyes.

Causes of optic nerve atrophy

Atrophy of the optic nerve is most often the result of certain disorders in the body. To stop the death of nerve tissue, it is necessary to find out the cause of this pathological process.

The disease can originate from that part of the nerve trunk, which is located closer to the eye (before the intersection of the nerves). In this case, they speak of ascending atrophy. If the nerve tissue is affected above the chiasm, but before entering the brain, then they speak of a descending form of atrophy.

Causes of ascending optic nerve atrophy:

• Glaucoma. This disease is always accompanied by an increase in intraocular pressure. Nerve tissue begins to suffer from nutritional deficiencies, which leads to its atrophy.
• Intrabulbar and retrobulbar neuritis. Neuritis is characterized by an infectious lesion of neurons in the cavity of the eyeball (intrabulbar inflammation), or outside it (retrobulbar form).
• Toxic damage to the optic nerve. Nerve cells are capable of destruction at an accelerated rate if they are influenced by the following substances: methanol, large doses of alcohol or tobacco, lead, carbon disulfide. Toxic damage to the optic nerve can be the result of taking certain medications, provided that their dose is exceeded. These drugs include: Co-trixomazole, Sulfalene, Sulfanilamide, etc.
• Tissue ischemia, accompanied by impaired blood flow to the optic nerve. A similar situation is observed with hypertension of 2 or 3 degrees, with any type of diabetes mellitus, with atherosclerosis.
• Stagnant disc, which is accompanied by edema of the initial part of the nerve trunk. Violation can be a consequence of a wide variety of pathological factors: traumatic brain injury, meningitis, hydrocephalus, spinal cord cancer.
• Tumor of the optic nerve, or of the tissues that surround it. In this case, the tumor should be up to the intersection. Atrophy develops due to the fact that the neurons of the nerve will be pinched by the growing neoplasm

Causes of the descending type of optic nerve atrophy:

• Intoxication. The penetration of poisons into the body can lead to damage to neurocytes located after the intersection. However, a similar situation is observed less often than in the case of the ascending type of the disease.
• Tumors of the nerve or surrounding tissues, which are located after the intersection. The descending form of optic nerve atrophy most often develops for this reason. These tumors are very dangerous because they affect the brain structures. It is difficult to treat them.
• Damage to nerve tissue by infectious agents. In this regard, neurosyphilis, tuberculosis of the nervous system, leprosy, herpes are dangerous.
• Cranial cavity abscess. This severe inflammation most often develops after suffering from meningitis or encephalitis.

Before starting the treatment of optic nerve atrophy, it is necessary to find out the reasons for its development.

Symptoms of optic nerve atrophy

Depending on where the lesion is concentrated (before or after the cross), there are 2 main symptoms of atrophy - anopsy and amblyopia. The first condition is characterized by loss of visual fields, and the second by a decrease in its acuity. The intensity of symptoms depends on the severity of the disease that led to the optic nerve atrophy.

Anopsia

Anopsia is a loss of visual fields. The field of vision is understood as the zone that each person sees. To visualize it, you can simply cover half of your eye with your hand. Will the person only see? pictures, since the organ of vision does not perceive the rest of it. So, with atrophy of the optic nerve, such a loss of half of the image happens in ordinary life, when the eye is not covered by anything. Both left and right fields can fall out.

Neurologists distinguish between tymponal and nasal anopsia. In the first case, half of the picture falls out, which is located closer to the temporal part of the eye, and in the second case, half of the image falls out, which is closer to the nose. Also, anopsy can be left and right, depending on the side from which the visual field is lost.

If optic nerve atrophy has just begun to develop, then such a symptom may not manifest itself, since the remaining intact neurons will transmit the resulting image to the brain. When atrophy permeates the entire nerve trunk, anopsy will definitely make itself felt.

Features of anopsy, depending on the degree of damage to nerve cells and the concentration of optic nerve atrophy:

• Complete atrophy with damage to the entire nerve trunk, which is concentrated to the intersection (ascending atrophy) leads to the fact that the eye from the side of damage completely ceases to perceive the picture.
• Complete atrophy concentrated after criss-crossing (descending type) results in a loss of the right or left visual field in both eyes.
• Incomplete atrophy, concentrated before and after the intersection, leads to the fact that the field of vision in one eye (from the side of the lesion) falls out. Sometimes this symptom may not manifest itself.

Ophthalmologists and neurologists are able to determine the type of atrophy and its location by the nature of the anopsy.

Amblyopia

Amblyopia, that is, decreased visual acuity, develops in all people with optic atrophy.

There are 4 degrees of severity of amblyopia:

1. A mild degree of impairment develops in the early stages of optic atrophy. The person does not experience any discomfort. It can arise in him only when trying to examine in detail an object located in the distance.
2. The average degree of amblyopia develops when damaged are many neurons. Objects that are in the distance, the patient is not able to see. Those objects that are located nearby, he sees well.
3. Severe amblyopia indicates that the atrophy is progressing. Vision is reduced so much that a person does not see objects that are near him.
4. Blindness indicates that complete atrophy of the optic nerve has occurred.

Vision begins to fall unexpectedly for a person. If he does not receive treatment, then this process does not stop. As a result, the patient may become completely blind.

Diagnosis of optic nerve atrophy

Atrophy of the optic nerve is not difficult to diagnose. The violation is detected by ophthalmologists even at an early stage of its development. For this, the doctor performs an examination of the fundus.

Ophthalmoscopy, as a technique, is carried out in a dark room. The doctor examines the initial section of the nerve trunk using a special instrument (ophthalmoscope) and a light source. Also, the procedure can be carried out using a special apparatus. This improves the diagnostic accuracy. A person does not need to prepare in advance for the procedure.

Ophthalmoscopy does not always allow detecting the onset of atrophy, since pathological changes in nerve cells can occur, but this does not manifest itself by external signs. Other diagnostic methods, such as urine and blood tests, and cerebrospinal fluid sampling, do not provide complete information about the disease, but are only clarifying.

Modern medical institutions have the following techniques that can detect optic nerve atrophy and clarify the cause of the disease:

• PAH (fluorescent angiography). A contrast agent is injected into the patient's vein, which penetrates into the vessels of the eye. The doctor illuminates the organ of vision with a special lamp and assesses its condition. This allows you to identify insufficient blood circulation in the eyeball and the initial signs of tissue damage.
• HRTIII (eyeball laser tomography). It is a non-invasive method for evaluating the structures of the eyeball. It allows you to identify atrophy of the initial trunk of the optic nerve.
• OCT (optical coherence tomography). The condition of the nerve fiber is assessed using high-precision infrared radiation.
• CT or MRI of the brain. These are highly accurate techniques that are aimed at finding the cause of atrophy. A similar study is prescribed if there is a suspicion of tumor processes or other masses, for example, cysts or areas of an abscess.

Treatment is indicated for all patients immediately after contacting a doctor. Therapy will prevent the progression of atrophy.

Treatment of optic nerve atrophy

The phrase that "nerve cells do not regenerate" is hopelessly outdated. Recent studies show that damaged neurocytes have the ability to grow. They increase the number of connections with tissues, and can also take over the functions that previously died nerve cells performed. However, neurocytes cannot multiply.

It will not be possible to cure the atrophy of the optic nerve. If the trunk was not completely affected, then vision can be restored, but only partially. It is not often possible to bring it back to normal and it is difficult to do it. If the process of transmission of impulses from the eye to the brain is disrupted, then the problem can only be dealt with by surgery.

It is important to eliminate the cause that led to the optic nerve atrophy. Otherwise, all efforts will be useless. If it is impossible to cure the underlying pathology, as is the case with some malignant tumors, then you need to immediately focus on restoring the functions of the eye.

How to restore a nerve?

Recently (10-15 years ago), patients were prescribed vitamins and angioprotectors. Modern ophthalmologists assign these drugs only an auxiliary function. The therapy is based on taking medications that allow to normalize metabolic processes in neurons (antihypoxants) and stimulate blood flow to nerve cells (nootropics, antiplatelet agents, etc.).

Drugs that are used for optic nerve atrophy:

• Antihypoxants and antioxidants (Mexidol, Trimetazidin, Trimectal). These drugs allow to restore damaged tissue and prevent further damage to nerve cells, eliminating hypoxia. If the patient is in the hospital, the drugs are administered intravenously. At home, take tablet forms of drugs.
• Microcirculation correctors (Trental and Actovegin). They are aimed at improving metabolism in nerve cells and stimulating their nutrition. Medicines are available both in tablet form and in the form of a solution for injection.
• Nootropics: Piracetam, Cerebrolysin, Glutamic acid. These drugs stimulate blood flow to nerve cells, thereby triggering their regeneration.
• Drugs that reduce the permeability of the vascular wall (Emoxipin). They are aimed at protecting the optic nerve from damage. Emoxipin has recently been used in ophthalmic practice, it is administered parabulbar. There is a drug in service only at large medical centers.
• Vitamins B6, B12, PP, C. They are aimed at improving metabolic processes in neurons.

This is how the standard treatment regimen for optic nerve atrophy looks like.

In 2010, ophthalmologists proposed a different approach to therapy using peptide bioregulators. Today, ophthalmological centers use drugs such as Cortexin and Retinalamin. Studies have shown that these products improve vision by 2 times. They work in two ways: they stimulate nerve cells to repair and resist damage to them.

Cortexin is injected subcutaneously into the temporal region, or intramuscularly. In this case, subcutaneous administration is preferred, since it allows you to create a high concentration of active active ingredient in the right place. Retinalamin is injected into the parabulbar tissue.

If you combine the classical and peptide treatment regimen, then the likelihood of restoration of visual function increases, although even such complex therapy does not always lead to positive results.

Physiotherapy

Two methods of treating optic nerve atrophy have been scientifically proven to be effective: UTI and BT.

Pulse magnetotherapy allows the damaged cells to be restored and improves their functioning. Under the influence of magnetic fields, neurons thicken and better transmit impulses from the organs of vision to the brain.

Bioresonance therapy is aimed at improving metabolism in damaged tissues and at normalizing the blood supply to the nerve through the means of small blood vessels.

These methods are available in large clinics, as they are implemented on expensive equipment. Moreover, patients have to pay for such treatment on their own.

Operation

There are two types of surgery that are indicated for patients with optic nerve atrophy:

• Operations to redistribute blood flow in the eye area. It is cut in one place, and in another it becomes more intense. Doctors can bandage some of the blood vessels on the face, allowing significant amounts of blood to flow to the eye. The operation is rarely performed, as it can cause severe complications.
• Transplantation of revascularizing tissues. In this case, tissues that are abundantly supplied with blood (muscles, conjunctiva) are transplanted into the area of atrophy. Thanks to this, new vessels begin to sprout to damaged neurons and nourish them naturally. This operation is quite common.

In the past years, stem cell therapy was actively used in Russia. However, such therapy is now prohibited by law. You can take the course in Germany and Israel.

Forecast

The prognosis is determined by the degree of damage to the nerve trunk and the timeliness of therapy. Vision can be restored if only a few neurons are affected. When all cells of the optic nerve are affected, the person will develop complete blindness. Sometimes an operation helps to cope with the problem, but not a single specialist will give a guarantee of success.

Answers to popular questions

• Can optic nerve atrophy be a congenital pathology? This situation is rare. The first symptoms of the disease are detected early, before the age of one year. The sooner the child begins to receive treatment, the better.
• Can optic atrophy be completely cured? No, this impairment is incurable, but therapy allows you to restore and maintain visual functions.
• Is optic atrophy often diagnosed in children ? In children, pathology is rarely diagnosed.
• Are alternative therapy methods effective ? No, non-traditional methods of treatment will not allow you to cope with the disease.
• Is the person shown disability? The second group of disability is given to people with a decrease in visual acuity of 0.3-0.1 dp. In case of complete blindness, a person is recognized as a disabled person of the first group.
• How long is the treatment? Treatment should be lifelong.

Article author: Mochalov Pavel Alexandrovich | d. m. n. therapist

Education: Moscow Medical Institute. IM Sechenov, specialty - "General Medicine" in 1991, in 1993 "Occupational Diseases", in 1996 "Therapy".