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Ischemic neuropathy of an optic nerve


Ischemic neuropathy of an optic nerve — an acute disorder of blood circulation in an optic disk.
Most often occurs at men of 60 — 70 years having atherosclerosis, a hypertension, Horton's disease (temporal giant-cell arteritis).

Анатомическое положение зрительного нерва

Anatomic position of an optic nerve

Symptoms of Ischemic neuropathy of an optic nerve:

Allocate two forms of ischemic neuropathy - front and back. They can be shown in the form of partial (limited) or full (total) defeat.

Front ischemic neuropathy - an acute disorder of blood circulation in intrabulbarny department of an optic nerve. The changes happening in a head of an optic nerve reveal at an oftalmoskopiya.

At total damage of an optic nerve sight decreases to the 100-th and even to a blindness, at partial - remains high, but characteristic wedge-shaped scotomas are noted, and the top of a wedge is always turned to a point of fixing of a look. Wedge-shaped losses are explained by the sectoral nature of blood supply of an optic nerve. Wedge-shaped defects, merging, cause quadrant or vague loss under review. Defects of a field of vision are more often localized in its lower half. Sight decreases within several minutes or hours. Usually patients precisely specify day and hour when sight sharply decreased. Harbingers in the form of a headache or a passing blindness can sometimes be noted, but more often the disease develops without harbingers. At an oftalmoskopiya the pale edematous optic disk is visible. For the second time retina vessels, first of all veins change. They are wide, dark, gyrose. On a disk and in a parapapillary zone there can be hemorrhages.

Duration of the acute period of a disease of 4-5 weeks. Then hypostasis gradually decreases, hemorrhages resolve and the atrophy of an optic nerve of different degree of manifestation is shown. Defects of a field of vision remain though can decrease considerably.

Back ischemic neuropathy Acute ischemic disorders develop on the course of an optic nerve behind an eyeglobe - in intraorbital department. These are back displays of ischemic neuropathy. The pathogeny and the clinical course of a disease are identical to that front ischemic neuropathy, but in the acute period there are no changes on an eyeground. An optic disk of natural color with a clear boundary. Only in 4-5 weeks there is a disk dekoloration, the partial or full atrophy begins to develop. At total damage of an optic nerve the central sight can decrease to the 100-th or to a blindness, as well as at front ischemic neuropathy, at partial visual acuity can remain high, but under review reveal characteristic wedge-shaped losses, is more often in the lower or nizhnenosovy parts. Diagnosis in an early stage is more difficult, than at ischemia of a head of an optic nerve. Differential diagnosis is carried out with retrobulbar neuritis, volume formations of an orbit and the central nervous system.

At 1/3 patients with ischemic neuropathy the second eye, on average in 1-3 years is surprised, but this interval can fluctuate from several days to 10-15 years.

Reasons of Ischemic neuropathy of an optic nerve:

In development of this pathology a main role is played by the following three factors: disturbance of the general hemodynamics, local changes in a wall of vessels, coagulative and lipoproteidny shifts in blood.

Disturbances of the general hemodynamics are most often caused by a hypertension, hypotonia, atherosclerosis, diabetes, emergence of stressful situations and plentiful bleedings, an atheromatosis of carotid arteries, okklyuziruyushchy diseases of brakhiotsefalny arteries, blood diseases, development of giant-cell arteritis.

Local factors. Now attach great value to the local local factors causing formation of blood clots. Among them - change of an endothelium of a wall of vessels, existence of atheromatous plaques and sites of a stenosis with formation of a turbulence of a blood-groove. The presented factors define pathogenetic the oriented therapy of this serious illness.

Treatment of Ischemic neuropathy of an optic nerve:

Treatment of ischemic neuropathy has to be complex, pathogenetic caused taking into account the general vascular pathology of the patient. First of all use is provided:

    * antispasmodics (sermi-it, ницерголин, trental, ksanti-nol, niacin, etc.);
    * thrombolytic drugs - plasmin (fibrinolysin) and its activators (an urokinase, a gemaza, a kavikinaza);
    * anticoagulants;
    * symptomatic means;
    * group B vitamins.

Carry out also magnetotherapies electro-  and  a lazerstimulyation  of an optic nerve.

The patients who had ischemic neuropathy of one eye have to be under dispensary observation, they need to carry out the corresponding preventive therapy.

Drugs, drugs, tablets for treatment of Ischemic neuropathy of an optic nerve:

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