Eye diseases. Optic neuritis (most important)

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Eye diseases. Optic neuritis (most important)

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34. Optic nerve

In the diagnosis of diseases of the optic nerve, a decisive role belongs to functional studies, which also make it possible to judge the dynamics of the process. In addition to functional studies, X-ray of the skull, lumbar puncture, consultations of a neuropathologist, otolaryngologist and other specialists are of great help. For effective treatment, it is important to establish an etiological diagnosis, to find out the cause of the disease.

The most common causes of optic neuritis in children are infectious diseases, arachnoiditis, sinusitis, multiple sclerosis, etc. Lesions of the optic nerve are observed in the intraocular part of it (papillitis), behind the eye (retrobulbar neuritis) and in the intracranial region (opticochiasmatic arachnoiditis).

With papillitis, patients complain of a rapid drop in visual acuity, which is also established during the examination. Disturbances in color perception, changes in the field of vision, an increase in the blind spot are determined, and in the fundus there is hyperemia of the disc, blurring of its borders, vasodilation, deposition of exudate along the vessels and in the vascular funnel, as well as hemorrhages in the tissue and retina. Such changes may be absent at the beginning of retrobulbar neuritis, then visual acuity suffers first of all. There may be pain when moving the eyeball. With retrobulbar neuritis, the papillomacular bundle is more often affected, which is then manifested by blanching of the temporal half of the disc. After retrobulbar neuritis, descending atrophy of the optic nerve develops.

Characteristic of damage to the optic nerve in its intracranial part (opticochiasmal arachnoiditis) are complaints of a decrease in visual acuity (which is confirmed during examination), a change in the visual field of the chiasmatic type, manifested in the loss simultaneously in both eyes of the corresponding or opposite parts of the visual field (hemianopsia) . On the fundus of the pathology is not detected.

The disease is usually bilateral, prolonged, and may be accompanied by headache. With the development of the process in the fundus, there may subsequently be phenomena of stagnation of the optic nerve head and its atrophy. Pneumoencephalography, lumbar puncture help the diagnosis.

Treatment of neuritis etiological. It is necessary to prescribe antibiotics in combination with B vitamins, urotropin, glucose infusions, tissue therapy, nicotinic acid, angiotrophin, dibazol, aloe, FIBS.

Treatment should be long, repeated courses, since part of the visual fibers may be functionally inhibited or be in a state of parabiosis, i.e., have the ability to recover. If a patient has optic-chiasmatic arachnoiditis, the intervention of a neurosurgeon is possible. The operation is indicated for persistent progressive loss of vision, as well as an increase in the central scotoma, and consists in dissecting the moorings around the optic nerve and chiasm.

Author: Shilnikov L.V.

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