Optic neuritis( NZH) is an inflammation that develops in the optic nerve fibers. The optic nerve is the union of more than 1 million axons of neurons that are located in the retina. These processes can transmit information about images that will be perceived in the form of an electrical impulse to the brain. Information is processed in the occipital lobe, after which a person becomes aware of everything that surrounds him.
Description of the disease
The optic nerve originates in the head located inside the eye. This site is available only under the condition of a special examination by a specialist. Outside the eyeball, nerve fibers envelop several shells that help ensure that signals are run at a higher speed, and also protect and feed the axons.
Depending on the site of the nerve, where the inflammation occurred, the following are distinguished:
- Papillitis is an inflammation in the intraocular nerve, which often develops in childhood.
- Retrobulbar neuritis is an inflammation of the nerve department located outside the eyeball. Often associated with multiple sclerosis.
- Neuroretinitis - a combination of papillitis and an inflammatory process in the layer of nerve fibers, is a self-limiting disease.
- Retrobulbar neuritis of the optic nerve can occur in acute and chronic form. Acute is characterized by a sharp decrease in visual acuity: during the day, vision may fall down to light. Patients experience pain during eye movement and exophthalmos. This form is found only in young people.
The photo shows the main localization of optic neuritis:
The chronic form is characterized by a slower decrease in vision. It has a worse prognosis, when compared with the acute form. After therapy, visual acuity can not be fully restored.
Causes of optic neuritis
Etiology is quite diverse - it can cause any infection:
- Viral infections: measles, chicken pox, epideprotitis, mononucleosis;
- Sore throat;
- Inflammatory processes in the brain or its membranes( meningitis,
encephalitis); - Infection of the paranasal sinuses;
- Caries;
- Fungal infection;
- Syphilis, tuberculosis, which is classified as granulomatous inflammation;
- Inflammatory processes of the eyeball;
- Injury of the eye.
Among the possible causes of neuritis are systemic diseases as well:
- Gout;
- Pathological pregnancy;
- Kidney pathology;
- Blood diseases;
- Diabetes mellitus;
- Allergy;
- Multiple Sclerosis;
- Pathology of connective tissue;
- Autoimmune pathologies;
- Hypo-and avitaminosis;
- Frequent use of alcoholic beverages, smoking;
- Lead poisoning and others.
Also identifies the idiopathic form of NZN, the etiology of which can not be established.
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It is very important to find the cause of these pains in time. For this purpose, duplex scanning of the vessels of the brain and neck is widely used. All about this study.
Risk factors for
Quite often, the causes of neuritis are autoimmune diseases.
Key Risk Factors:
- Age. NZH can occur at any age, but this pathology is common in people aged 20 to 40 years.
- Sexual accessory. Neuritis occurs twice as often in the female half of humanity.
- The presence of genetic mutations can cause the development of NZN.
Pathogenesis of neuritis
Changes during inflammation are manifested in the form of small-point infiltration and cell proliferation. As a result, inflammation can go from the soft shell of the brain to nerve fibers.
If the inflammation can be located directly in the trunk of the optic nerve, it will be interstitial in nature. The main manifestations of the pathology will be puffiness and infiltration of tissue, participation in which will take the leukocytes and plasma cells. The process of neovascularization is developing.
Symptoms of
- Pain syndrome. The overwhelming majority of patients note painful sensations that intensify during the movement of the eyeball. Neuritis can cause pain only in the first few days from the onset of the disease.
- Reduces visual acuity. The degree of symptom severity in NZN can be different. Most often, patients complain of only a slight loss of vision, which increases during exercise or in heat. The change in visual acuity is temporary, but it can rarely be irreversible.
- Decreased color vision. NZN is able to cause a change in color vision. Patients complain that red objects become discolored.
- The appearance of flashes of light. Patients note the sudden appearance of flashes of light.
- Sign of Uthoff. Patients characterized by a sharp increase in symptoms at elevated body temperature.
- The appearance of an afferent pupillary defect, which was called the pupil of M. Gann.
- A stain may appear before the eyes.
- The optic nerve disk is hyperemic, its boundaries can merge with the retina. There may be multiple hemorrhages in the retina.
Inflammation of the optic nerve of various etiologies can have certain specific symptoms, for example, with edematous neuritis it is necessary to suspect the relapse of neurosyphilis.
Tuberculosis neuritis is characterized by the appearance of solitary tuberculosis - a tumor-like formation on the surface of the disc.
Diagnosis
During the diagnostics, the following tests are carried out:
- Routine examination. The oculist assesses visual acuity, light perception.
- Ophthalmoscopy. It is the effect on the eye of light, which allows you to study the structure of the back of the eye. As a result, the specialist will be able to determine the condition of the visual disc, which swells during NZN.
- The reaction of the pupil to light. In PZH, pupil narrowing during exposure to light occurs to a lesser extent in comparison with a healthy person.
- Tests to determine the response to visual stimuli. The patient is put in front of the screen with a chessboard. To the head are attached sensors that will be able to count the response of the brain. Tests help determine the presence of delayed conduction of the nerve impulse.
Using a magnetic resonance scan will make pictures of the patient's body. For this study, you need to enter a contrast agent into the optic nerve, as a result, you can see the nerve fiber on the pictures.
Treatment of
If suspected, an urgent hospitalization of the patient is necessary.
At the time when the etiology of the disease is unknown, a therapy is prescribed that can suppress infectious disease and reduce the intensity of the inflammatory process, in addition, drugs are prescribed for dehydration, desensitization, improvement of metabolic processes in nerve tissues and fibers, and immunocorrection.
Specialists prescribe a course of up to 7 days of antibacterial drugs or sulfonamides, which have a broad spectrum of action intramuscularly. It is important to remember that it is not possible to prescribe medications that are capable of exerting an ototoxic effect, for example, streptomycin, gentamicin. This group of drugs has a toxic effect on nerve fibers.
The use of corticosteroids in the form of retrobulbar injections is shown on the background of taking prednisolone orally for 2 weeks. Multiplicity of oral corticosteroid should be at least 4 times a day for 5 days, after a gradual decrease in the dose of the drug begins.
In addition, orally it is necessary to take Diacarb according to the scheme of 3 days of admission, 2 days break. This will help reduce the severity of edema. On its background take panangin 2 tablets three times a day. Nicotinic acid or trental is also used to improve blood supply.
Inside take a complex of B vitamins, piracetam, make intramuscular injections of Actovegin. Within a few months, it is necessary to take dibazol.
After clarification of the causes of neuritis of the optic nerve, therapy is carried out, which is aimed solely at the cause of the disease, for example, the use of antituberculosis drugs, the use of antiviral drugs and immunocorrective therapy if the causative agent is the herpes virus.
If a person has been diagnosed with a toxic bilateral retrobulbar optic neuritis of the optic nerve that occurs as a consequence of methyl alcohol poisoning, then a similar treatment is prescribed, however without using antibacterial drugs.
In such cases, an intake of 30% ethanol solution up to 100 ml is prescribed as an emergency aid, after 2 hours the administration is repeated, but the dose is halved. It is also necessary to wash the stomach with sodium bicarbonate.
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Consequences and Forecast
This disease has a good prognosis. Most patients completely restore vision within 1 year after the onset of symptoms.
If the inflammation of the optic nerve arose as a result of multiple sclerosis or visual neuromyelitis, then the patients have repeated episodes of exacerbation. Patients who do not have concomitant pathologies that are capable of increasing the likelihood of inflammation of nerve fibers are rarely subjected to repeated development of optic neuritis.
Prevention measures
Preventive measures to prevent the onset of toxic neuritis are the complete rejection of alcohol-containing products and toxic liquids, as well as the cessation of smoking.
Optic neuritis refers to diseases that can occur even without special therapy, however in such cases atrophy of the optic nerve is possible. At the appearance of the first signs of NZH it is necessary to contact a specialist as soon as possible so that life can again appear in all colors.
Neurologist M.М.Sperling on optic neuritis: