Eye diseases. Congestive papilla (disc) of the optic nerve (most important)

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Eye diseases. Congestive papilla (disc) of the optic nerve (most important)

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35. Congestive nipple (disc) of the optic nerve

Causes of a congestive disc are volumetric processes in the brain that lead to an increase in intracranial pressure: tumors, brain abscesses, gummas, tuberculomas, cysticercosis, meningiomas, hydrocephalus, injuries of the skull and orbits. Diagnosis is aided by targeted examinations.

Attention should be paid to the data of the anamnesis indicating hypertension syndrome, x-ray of the skull, diagnostic lumbar puncture, bilateral process in the fundus.

Changes in the fundus, characteristic of a congestive nipple, vary depending on the stage of the process. Initially, the patient does not complain, visual acuity is not changed. In the fundus, congestive hyperemia of the disc, blurring of its borders due to retinal edema, which spreads along the vessels and increases it in the upper and lower sections, are noted. As a result, an increase in the blind spot is determined, which is of great importance for diagnosis. Subsequently, the optic nerve disk increases in size, its marginal edema increases, the disk protrudes into the vitreous body, the veins expand, and the arteries narrow, the vessels sink in the edematous retina, hemorrhages appear from the dilated veins on the disk, and white foci of transudate are determined near the disk. Visual acuity gradually decreases, the blind spot increases even more.

In the future, a significant increase and blanching of the optic nerve is determined in the fundus, which mushroom-like protrudes above the level of the retina by 23 mm, which is determined using direct ophthalmoscopy. In the macular area, a "star" pattern may be observed. Patients complain of a significant decrease in vision. Vision changes depend on the localization of the pathological process in the brain.

Bitemporal and binasal hemianopsia are observed when the process is localized in the chiasm region, for example, with pituitary tumors, craniopharyngiomas. Homonymous hemianopsia is a consequence of the impact of the pathological focus on the visual tracts.

With a long-term congestive disc, the edema gradually decreases, the disc becomes grayish, its contours are indistinct, the caliber of the veins normalizes, and the arteries remain narrow. Subatrophy of the optic disc develops. Visual functions are still partially preserved.

If the process progresses, secondary atrophy of the optic nerve develops, which is expressed in the fact that the disc becomes white, its boundaries are fuzzy, the vessels narrow, especially the arteries, and the patient goes blind. This process is long, so the patient does not notice it immediately, but gradually over several years.

Author: Shilnikov L.V.

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