Inflammation of the optic nerve

Inflammation of the optic nerve (neuritis) can develop both in its fibers and in the membranes. According to the clinical course, two forms of inflammation of the optic nerve are distinguished: intrabulbar and retrobulbar. Inflammatory processes in the optic nerve affect the trunk and membranes (perineuritis and neuritis).

Perineuritis is an inflammatory process that affects all membranes. Morphologically, small-cell proliferation of connective tissue cells and endothelium is observed. Exudate accumulates in the vaginal lumen, the arachnoid membrane crossbars are pushed apart by exudate and are later replaced by connective tissue.

From the pia mater, the inflammation moves to the brain substance. In later stages, obliteration of the vaginal space occurs, but there is no complete obliteration, since with neuritis the inflammatory process is not diffuse.

Neuritis is a morphologically inflammatory process, interstitial in nature. In the connective tissue crossbars, proliferation, infiltration, filling with leukocytes and plasma cells occur. Connective tissue crossbars can be loosened. Later, nerve fibers are involved secondarily, they atrophy from compression by proliferating connective tissue and exposure to toxins.

In optic neuritis, the inflammatory process involves the optic nerve papilla, where small-cell infiltration and proliferation of connective tissue cells occur. With a mild inflammatory process, edema predominates. With a long-term inflammatory process and its high intensity, atrophy of the nerve substance occurs with proliferation of glia and connective tissue,

Intrabulbar neuritis (capillitis) is an inflammation of the intraocular part of the optic nerve (from the level of the retina to the cribriform plate of the sclera). This section is also called the optic nerve preparation. The causes of neuritis are varied. The causative agents of inflammation can be staphylococci and streptococci, causative agents of specific infections (gonorrhea, syphilis, diphtheria, brucellosis, toxoplasmosis, malaria, smallpox, typhus, etc.).

The inflammatory process in the optic nerve is always secondary, i.e. it is a complication of a general infection or focal inflammation of any organ, therefore, when optic neuritis occurs, consultation with various specialists (therapist, ENT doctor, neurologist) is always necessary.

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Causes of inflammation of the optic nerve

The development of inflammation of the optic nerve can be caused by:

1. inflammatory diseases of the brain and its membranes (encephalitis, meningitis, arachnoiditis);
2. inflammatory diseases of the eyeball and orbit (keratitis, iridocyclitis, choroiditis, uveopapillitis, inflammation of the vascular tract and head of the optic nerve, orbital phlegmon, periostitis and orbital trauma);
3. diseases of the ear, throat, nose, teeth, nasal sinuses (sinusitis, frontal sinusitis, tonsillitis, pharynolaryngitis, dental caries);
4. acute and chronic infections;
5. common diseases of toxic-allergic genesis.

The most common causes of optic neuritis are acute respiratory viral infection (ARVI), flu, parainfluenza. The anamnesis of such patients is very typical. 5-6 days after ARVI or flu, accompanied by fever, cough, runny nose, malaise, a "spot" or "fog" appears in front of the eye and vision is sharply reduced, i.e., symptoms of optic neuritis occur.

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Symptoms of optic nerve inflammation

The onset of the disease is acute. The infection penetrates through the perivascular space and the vitreous body. A distinction is made between total and partial damage to the optic nerve. With total damage, vision is reduced, and blindness may occur. With partial damage to the optic nerve, vision may be preserved up to 1.0, but central and paracentral scotomas of round, oval and arched shapes are noted in the visual field. Tempo adaptation and color perception are reduced.

The acute period lasts 3-5 weeks. The inflammatory process can be of varying severity. Mild forms of neuritis quickly pass under the influence of treatment, the optic disc becomes normal, and visual functions are restored. In more severe cases of neuritis, the process can end with partial or complete atrophy of the optic nerve, which is accompanied by a significant and persistent decrease in visual acuity and narrowing of the visual field. Thus, the outcome of neuritis is a range from complete recovery to absolute blindness.

Ophthalmoscopic picture in neuritis. All pathological changes are concentrated in the area of the optic nerve head. The disc is hyperemic, saturated with exudate, the tissue becomes swollen, the exudate can fill the vascular funnel of the disc. The boundaries of the disc are blurred, but there is no large prominapia, as in stagnant discs. With clouding of the vitreous thalamus, the posterior wall of the eye, the fundus is not clearly visible. Hyperemia and blurring of the disc boundaries are so pronounced that the optic nerve itself merges with the background of the fundus. Plasmorrhages and hemorrhages (striated and striated) appear in the optic nerve head and pericapillary zone. Arteries and veins are moderately dilated.

Diagnosis of neuritis is difficult. Neuritis is usually differentiated from pseudoneuritis, congestive papilla, and ischemic conditions of the optic nerve.

Features of inflammation of the optic nerve in various diseases

Rhinogenous neuritis is characterized by decreased vision, a decrease in central and paracentral scotomas. Color perception is disturbed, especially in relation to red and blue colors. An increase in the blind spot is noted.

Ophthalmoscopy reveals that the optic nerve disk is hyperemic, the borders are blurred due to edema. Very early, the vascular membrane is filled with exudate, as a result of exudate seeping into the tissue of the optic nerve, its striation disappears due to edema. Often, hemorrhages and white spots of sweating appear on the optic nerve papilla.

Characteristically, the optic nerve papilla does not protrude above the level of the surrounding retina. During the transition to secondary atrophy, hyperemia and papilla pallor decrease, the vessels become narrow, hemorrhages and exudate plaques are absorbed.

The course is varied. The fundus can quickly return to normal. In other cases, there is a transition to secondary atrophy.

Optic neuritis in syphilis in 32.8% of cases occurs on the basis of basil yar noga luetic meningitis in the early period of secondary syphilis. Changes are noted in two forms:

1. mild changes in the optic nerve head in the form of hyperemia, blurred boundaries - with normal visual functions;
2. changes in the fundus, decreased visual function, changes in peripheral vision. In case of relapses of neurosyphilis, neuritis with edema should be considered as a result of insufficient treatment or provocation. Gumma of the optic nerve is rare. Rough and soft opacities are observed in the vitreous body. The optic disc is covered with a grayish-white exudate, which sharply protrudes into the vitreous body and goes to the retina. In the retina there are large and small foci, in the area of the macula - a star figure, the vessels are not affected. Gradually, the exudate is absorbed, in its place a connective tissue strand is formed, protruding into the vitreous body. In syphilis, both complete and reflex immobility of the pupil is often observed.

Treatment is specific: bismoverol, penicillin.

Optic neuritis in tuberculosis. Routes of infection:

1. hematohegge from adjacent foci;
2. through the lymphatic perivascular spaces of the retinal vessels.

It can occur as neuritis, perineuritis. In tuberculous meningitis, tuberculous osteomyelitis of the bones of the base of the skull, solitary tuberculosis of the papilla is observed - a tumor-like formation of a gray-white color, partially or completely covering the optic nerve disk, passing to the retina. The surface of this formation is smooth, with small elevations.

With intensive specific treatment, complete regression occurs, leaving a thin grey film on the surface of the nipple.

In typhus, in the third week of the disease, optic neuritis often ends in atrophy.

Malaria. Optic neuritis, usually in one eye. The optic disc is swollen, there are thrombi in the central retinal artery, consisting of erythrocytes, plasmodia, and pigment.

Brucellosis, chlamydia - hyperemia of the optic nerve, narrowing of peripheral vision to white. In case of brucellosis neuritis, treatment is carried out with a specific vaccine: 100-200-500 thousand microbial bodies are administered at intervals of initially 2-3 days, then 4-7 days. The dose is increased to 4-5 million. Antibiotics and salicylates are also used.

For chlamydia, antibiotics are prescribed; tetracycline is rarely used.

In flu, measles, optic neuritis is a manifestation of serous meningitis, arachnoiditis, measles encephalitis. Treatment: antibiotics, y-globulin, glucocorticoids, vitamin B,.

Q fever - bilateral neuritis with optic disc edema. Treatment - tetracycline.

In other diseases, neuritis of the intracranial part of the optic nerve develops. It is believed that it is caused by a virus.

Clinic: pupils are dilated, do not react to light. The optic disc is sharply swollen, veins are dilated, pericapillary edema with hemorrhages. Sometimes peripheral vision suffers due to the formation of scotoma. Headache, photophobia, nausea, vomiting, paralysis of smooth muscles and limbs, changes in the heart are disturbing.

Treatment is surgical (removal of the inner wall of the bone canal and incision of both optic nerves).

Segmental optic neuritis. A triad of symptoms is characteristic:

1. swelling of the optic nerve in one eye;
2. sector-shaped defect of peripheral vision in this eye;
3. normal vision.

Ophthalmoscopy reveals optic disc edema, scotoma associated with the blind spot. Three weeks later, the edema leads to partial atrophy of the optic nerve, on the disc - a sector of pallor (atrophy). The etiology is still unknown. There are isolated observations of optic neuritis in herpes toaster. In this case, atrophy often occurs. In sepsis, there may be inflammation of the optic nerve with the formation of abscesses in it, edema of the optic disc, hyperemia, blurred boundaries, hemorrhages.

Inflammation of the optic nerve is possible with severe burns to the body.

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