Update: December 2018
Diseases of the optic nerve are significantly different from pathologies
самого глаза (ирита, глаукомы, катаракты и etc.). With these
states disrupt the formation and transmission of the impulse to the brain. Their
symptoms may occur in people who have never had problems
с цветовосприятием или остротой view. Distinctive feature also
is the rapid development and completion of the acute period. Most
often, the visual pathway affects the inflammatory process –
To understand the symptoms and principles of diagnosis, it is necessary
know the basics of the anatomy of the eyeball and optic nerve.
The structure of the eye and optic nerve
So that a person can see something, the light that reflects from
all objects of the world, should get on the receptors
optic nerve (cones and rods). However, before that, he
passes through several structures of the eye. We list them, starting with
the most superficial:
- The conjunctiva is a thin sheath that covers the eyelids and
outer surface of the eye. Not a big deal in gear
light, but infectious processes (conjunctivitis) with it may
go to the nerve;
- The cornea is a somewhat convex transparent plate that
located in front of the eye. It is the most superficial
(immediately under the conjunctiva);
- The pupil and the iris – there is a cavity under the cornea,
filled with fluid, and behind it the iris. This part is shaped
rings. The hole inside is called the pupil. Iris can
taper or expand depending on it changes
the amount of transmitted light;
- The lens is the “lens” of the eye, which can change its shape.
using the ciliary muscle (body). Thanks to the lens, healthy
a person can equally clearly see distant and near
- Vitreous body – jelly-like mass. Last structure,
which refracts the light in the eye;
- Retina – represented by chopsticks (responsible for the twilight
vision) and cones (perceive color). This is the initial department.
the optic nerve. They form an impulse and send it further along.
All these structures mainly feed on vascular
shell, which is located directly behind the retina.
Diseases of the parts of the eye that conduct light develop sufficiently.
slowly and lead to loss of vision only in the later stages.
Neuritis occurs much faster and primarily violates
To suspect inflammation of the optic nerve,
should know the most common reasons that may
lead to this state
Optic neuritis can only occur if
another infectious pathology. Therefore, when diagnosing, it is important
pay for the presence of the following attendant patient (or
- Any inflammatory processes in the eye:
|Affected part of the eye||Disease name|
|Iris и ресничное тело||Iridocyclitis|
|The outer shell of the eye||Conjunctivitis|
- Traumas of the orbital bones or their infection (osteomyelitis and
- Inflammation of the air sinuses (frontal sinusitis, sphenoiditis, antritis, and
- Various chronic infections caused by specific
microbes: neurosyphilis, diphtheria, gonorrhea, typhus and
- Infections of the membranes and tissues of the brain (encephalitis, encephalomyelitis,
any meningitis and arachnoiditis);
- Inflammatory processes in the oral cavity (caries, periodontitis and
etc.), которые также могут распространяться по клетчатке лица on
Very characteristic development of the disease in a few days (4-7)
after suffering flu or ARVI. Therefore, when any
symptoms of optic neuritis, should consult a doctor.
The first signs of illness develop unexpectedly and can be
manifest in different ways – from reduction / loss of vision to pain in
eye socket. Depending on the affected part of the visual
the path and the clinical picture distinguish two forms of neuritis:
- Retrobulbar – affected optic tract after exiting
- Intrabulbar – an inflammatory process developed in the initial
a nerve segment that lies within the eye;
It should be noted that the symptoms of optic neuritis often
arise only from one side.
Symptoms интрабульбарного неврита
The disease always begins acutely – the first signs appear in
within 1-2 days and can progress rapidly. The more
damage to the optic nerve – the stronger the symptoms. As a rule, when
intrabulbar form can detect the following changes in
- The presence of cattle is the most characteristic sign of neuritis, in which
the patient has blind spots in the field of view (mainly in
center). For example, a patient can see with one eye all objects.
environment, with the exception of those that are
directly in front of him;
- Decrease in severity (myopia) – observed in every second
the patient. Myopia is often expressed slightly – vision decreases
on 0.5-2 diopters. Одonко при повреждении всей толщи нерва, глаз
completely loses sight. Blindness can be reversible or
irreversible, depending on the timeliness of treatment and
aggressiveness of the infection;
- Violation of “twilight” vision – the eyes of a healthy person
onчиonют различать предметы в темноте через 40-60 секунд. With
onличии неврита, on стороне поражения адаптация зрения занимает не
less than 3 minutes;
- Change in color perception – the patient may lose
ability to see some colors. Also with nerve irritation,
могут возникать цветные размытые пятon в поле view.
Intrabulbar neuritis, on average, occurs from 3 to 6
weeks. Its outcome may be different – from full recovery.
eye functions to unilateral blindness. Reduce the likelihood
adverse outcome is possible with adequate and timely
Symptoms ретробульбарной формы
Этот неврит встречается несколько реже, чем интрабульбарonя
the form. Since the nerve lies freely in the cavity of the skull (not counting
surrounding tissue), the infection can spread in two
onправлениях: по onружной поверхности (периферически) и по
internal (axial). Most неблагоприятный случай, когда
поражается весь поперечник the optic nerve.
Depending on the location of the infection, will vary
symptoms of the disease:
|Type of retrobulbar neuritis||Where is the infection located?||Characteristic symptoms|
|Axial||In the center of the optic nerve||
|Peripheral||На onружных волокonх нерва||
|Transversal (transverse)||The inflammatory process develops throughout the nerve.
|Сочетает призonки аксиального и периферического видов.|
Due to characteristic symptoms, it can be assumed diagnosis
неврита the optic nerve. Одonко для его подтверждения необходима
дополнительonя диагностика, которая позволит уточнить onличие
infection and its location.
Laboratory diagnostic methods do not have a fundamental
зonчения при глазных болезнях. В клиническом аonлизе крови (ОАК)
WBC / leukocyte count may be increased – more
9*109/литре. ESR acceleration is also possible. More than 15
mm / sec Одonко эти изменения свидетельствуют только о onличии
воспаления и не указывают on его расположение и причину. Аonлизы
urine, feces and venous blood, as a rule, remain normal.
Most информативными являются специальные офтальмологические
methods that allow diagnosis of intrabulbar
neuritis in the early stages. These include:
- Ophthalmoscopy – a method that does not require special equipment.
Исследование выполняется в темной комonте, где доктор осматривает
the fundus of the patient through the pupil, using a magnifying lens.
Благодаря методу, можно изучить onчальный отдел глазного нерва –
visual dick. With неврите, он будет отечным, гиперемированным
(reddened), point hemorrhages are possible;
- Флюоресцентonя ангиография – этот метод позволяет уточнить,
fully or partially affected the optic disc. In the process
research, the patient is injected with a special substance into the vein, which
«подсветит» сосуды дon глаза, после чего, доктор оценивает их с
using a special apparatus (fundus camera). Angiography
used only in large / private clinics, because the method
quite expensive. Средняя цеon – около 3000 руб.
The above methods are not informative when retrobulbar
Neuritis, because it is not the optic disc that is affected, but the nerve area after
out of the eye. Изменения в диске onблюдаются только к 5-й неделе.
Diagnosis is based on complaints and the exclusion of other diseases.
How to distinguish toxic neuropathy from neuritis
Эти две болезни очень похожи между собой по симптомам, одonко
differ in treatment tactics and prognosis. Чтобы onзonчить
effective therapy, the correct diagnosis should be made as
possible before. Для этого нужно проаonлизировать следующие
- Withчиon заболевания – в развитии неврита всегда основную роль
playing viruses or germs. Toxic neuropathy is most often
appears due to exposure to methyl alcohol or large
the amount of 40-degree alcohol (more than 1.5 liters). Also to possible
- Poisoning by heavy metals or their salts (lead, antimony,
- Передозировка/индивидуальonя непереносимость некоторых
лекарств: НПВСов (Аспирин, Ибупрофен, Кеторолак и etc.),
synthetic antibiotics (Sulfadimethoxin, Sulfacetamide) and
cardiac glycosides (Digoxin, Strofantin);
- Poisoning by evaporation of phenol-formaldehyde resins (contained in
ordinary cigarettes and smoking mixtures).
- Poisoning by heavy metals or their salts (lead, antimony,
- Eye damage – if for neuritis characteristic process in one
the eye, then the toxins damage the nerves on both sides;
- The reaction of the pupils – with toxic damage, the muscle, which
is in the iris, stops working. Therefore, the pupil of such
the patient remains enlarged, even in bright light;
- The condition of the bottom of the eye and optic nerve – usually with
ophthalmoscopy does not reveal any violations. Going on
thinning and destruction of the nerve, after leaving the eye;
- The effect of treatment – if you were diagnosed with neuritis and
therapy has begun, it will have no effect on the function
Using the above signs, you can define
toxic neuropathy. The main principle of its treatment is elimination.
damaging factor (alcohol, metal, medicine) and excretion
it is from the body. After that, stimulate the work of the nerve and its
blood circulation with drugs such as Neuromidine, Trental,
In most cases, vision changes become irreversible.
and the effect of treatment is to improve the overall condition.
First of all, the cause of the disease should be eliminated –
infection of the optic nerve. Therapy depends on the microorganism,
which caused the disease. If it is a virus, an appointment is necessary.
antiviral drugs (recommended Amiksin), if available
microbe – antibiotic is used. Unfortunately, discover the cause
neuritis, in most cases, is impossible. Therefore, all patients
prescribe an antibacterial drug that acts on a large
number of different microorganisms. This is usually a combined
penicillin (Amoxiclav) or cephalosporin (Ceftriaxone).
In addition, the standard treatment regimen for optic neuritis
|Drug group||Why is it prescribed?||How to apply?||The most common representatives|
|Glucocorticosteroids||Used to reduce inflammatory reactions: edema
nerve / optic disc and damaging processes.
If the patient has retrobulbar neuritis, it may be local
In the intrabulbar form, mainly used
|Detoxification drugs||Used as an intravenous infusion (drip)||
|Vitamins||Improve metabolism in the nervous tissue. Slightly
stimulate the transmission of nerve impulses.
|In the hospital are usually used in the form of intramuscular
injections. On an outpatient basis, you can use tablets.
PP (nicotinic acid);
Neyrobion is a combination drug.
|Drugs that improve microcirculation||Improve the nutrition of nervous tissue||Used mainly after an acute period of illness
with a marked decrease in visual functions.
Also, therapy may be supplemented with drugs that improve
impulse transmission along nerves. These include: Neuromidine, Nivalin and
etc. It should be noted that to decide on the need for such
treatment can only be a neurologist.
In addition to drug treatment may assign
physiotherapy. The need for it may arise when expressed
visual impairment after illness. The most common ways are
magnetic and electrotherapy, laser eye stimulation.
Since nerve damage occurs only when there are other
diseases, the only measure to prevent neuritis is
timely treatment of infections. Particular attention should be paid
eye diseases that are often spread by
surrounding tissues to the nerve trunk or optic disc.
Optic neuritis can lead to irreversible decline
eye functions or one-sided blindness. Prevent these
states with high probability, you can timely refer to
the doctor, suspecting the characteristic symptoms. In a medical facility
an additional survey will be conducted that will allow
make a final diagnosis. After this is assigned
complex treatment of several groups of drugs for 4-6 weeks and
if necessary, physiotherapy.