Inflammation of the optic nerve

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

Perineuritis is an inflammatory process that seizes all the membranes. Morphologically small cell proliferation of connective tissue cells and endothelium is noted. In the vaginal lumen, exudate accumulates, the web of the arachnoid membrane is expanded by exudate and later replaced by a connective tissue.

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

Neuritis is a morphologically inflammatory process that has an interstitial character. In connective tissue rails proliferation, infiltration, filling with leukocytes and plasma cells occur. The connective tissue bars can be loosened. In the future, the nerve fibers are involved again, they atrophy from the compression of the proliferating connective tissue and the effects of toxins.

With neuritis of the optic nerve, the inflammatory process seizes the nipple of the optic nerve, where small-cell infiltration and proliferation of connective tissue cells occur. With a mild inflammatory process, edema predominates. With a prolonged inflammatory process and its high intensity, atrophy of the nervous substance occurs with the growth of glia and connective tissue,

Intrabulbar neuritis (capillitis) - inflammation of the intraocular part of the optic nerve (from the level of the retina to the grating plate of the sclera). This department is also called the preparation of the optic nerve. The causes of neuritis are manifold. The causative agents of inflammation can be staphylo- and streptococci, the 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., is a complication of the common infection or focal inflammation of an organ, therefore, when a neuritis of the optic nerve arises, consultation of various specialists (therapist, ENT doctor, neurologist) is always necessary.

[1],

Causes of inflammation of the optic nerve

The development of inflammation of the optic nerve can lead to:

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 optic nerve head, orbital phlegmon, periostitis and traumas of the orbit);
3. diseases of the ear, throat, nose, teeth, nasal sinuses (sinusitis, frontal sinusitis, tonsillitis, farynolaryngnt, dental caries);
4. acute and chronic infections;
5. general diseases of toxic-allergic origin.

The most common causes of optic neuritis are acute respiratory viral infection (ARVI), influenza, parainfluenza. The anamnesis of such patients is very characteristic. 5-6 days after acute respiratory viral infection or influenza accompanied by fever, coughing, runny nose, malaise, a "spot" or "fog" appears before the eye and vision decreases sharply, ie, symptoms of optic neuritis occur.

[2], [3]

Symptoms of inflammation of the optic nerve

The onset of the disease is acute. Infection penetrates through the perivascular space and the vitreous body. There are total and partial damage to the optic nerve. With total damage, vision decreases, blindness may occur. With partial damage to the optic nerve, vision can be preserved up to 1.0, but in the field of vision central and paracentral scotomes of round, oval and arco-like forms are noted. Decrease in tempo adaptation and color perception.

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

Ophthalmoscopic picture with neuritis. All pathological changes are concentrated in the region of the optic disc. The disk is hyperemic, impregnated with exudate, the tissue becomes swollen, the exudate can fill the vascular funnel of the disc. The boundaries of the disk are stilted, but there is no big prominapia, as with stagnant discs, is not observed. When the vitreous thallus is clouded, the posterior wall is not clearly visible. Hyperemia and streakiness of the disc borders are so pronounced that the optic nerve itself merges with the background of the fundus. Plasma and hemorrhages (banded and dashed) appear in the optic disc and pericapillary zone. Arteries and veins are moderately expanded.

The diagnosis of neuritis is difficult. Neuritis is usually differentiated from pseudo-neuritis, stagnant nipple, ischemic states of the optic nerve.

Features of inflammation of the optic nerve in various diseases

Rhinogenic neuritis is characterized by a decrease in vision, a decrease in central and paracentral livestock. The color perception is detuned, especially with regard to red and blue colors. There is an increase in the blind spot.

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

It is characteristic that the nipple of the optic nerve is not above the level of the surrounding retina. With the transition to secondary atrophy, hyperemia, pacifying of the nipple, vesicles become narrow, hemorrhages and exudate plaques resolve.

The flow is varied. The ocular can quickly return to normal. In other cases, a transition to secondary atrophy occurs.

Neuritis of the optic nerve with syphilis in 32.8% of cases occurs on the basis of bases or bright leg of the leytic meningitis in the early period of secondary syphilis. Changes are noted in two forms:

1. mild changes in the optic nerve disk in the form of hyperemia, washout of borders - with normal vision functions;
2. changes on the eye day, a decrease in visual function, changes in peripheral vision. With relapses of neurosyphilis, neuritis with edema should be considered as a result of insufficient treatment or provocation. Rarely does the gum of the optic nerve occur. In the vitreous humus, gross and tender opacities are noted. The disc of the optic nerve is covered with exudate of grayish-white color, which sharply protrudes into the vitreous body and passes to the retina. In the retina large and small foci, in the field of the yellow spot - the figure of the star, the vessels are not affected. Gradually, the exudate resolves, in its place a connective tissue cord is formed, which goes into the vitreous body. When syphilis is often observed as a complete and reflex motionless pupil.

Treatment is specific: bismoderol, penicillin.

Optic neuritis with tuberculosis. Ways of infection:

1. hematogenous from adjacent foci;
2. on the lymphatic perivascular spaces of the retinal vessels.

It can take the form of neuritis, perineuritis. In case of tuberculous meningitis, tuberculous osteomyelitis of the skull base bones, solitary tuberculosis of the nipple is noted - a tumor-like formation of gray-white color, partially or completely covering the optic nerve disc, transferring to the retina. The surface of this formation is flat, with small elevations.

With intensive specific treatment, a complete reverse development occurs, a thin gray film remains on the surface of the nipple.

With typhus in the third week of the disease, optic neuritis often results in atrophy.

Malaria. Optic neuritis is usually on one eye. The disc of the optic nerve is swollen, in the central artery of the retina is a clot, consisting of erythrocytes, plasmodia, pigment.

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

Antibiotics are prescribed for chlamydia, tetracycline is rarely used.

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

Fever Ku - bilateral neuritis with edema of the optic disc. 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 dilated, do not respond to light. The disc of the optic nerve is sharply edematous, veins dilated, pericapillary edema with hemorrhages. Sometimes peripheral vision suffers due to the formation of scotoma. Disturbing headache, photophobia, nausea, vomiting, paralysis of smooth muscles and limbs, changes in the heart.

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

Segmental optic neuritis. A triad of symptoms is typical:

1. edema of the optic nerve on one eye;
2. a sectoral defect of peripheral vision on this eye;
3. normal vision.

With ophthalmoscopy, edema of the optic nerve disk, scotoma associated with a blind spot, is found. After three weeks, edema leads to a partial atrophy of the optic nerve, on the disk - a sector of blanching (atrophy). The etiology is not yet known. There are single observations of optic neuritis with herpes toaster. In this case, often atrophy occurs, with sepsis, there may be inflammation of the optic nerve with the formation of abscesses in it, edema of the optic nerve disk, hyperemia, blurring of borders, hemorrhages.

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

[4], [5], [6], [7], [8]