Retrobulbar neuritis.

Inflammation of the optic nerve can occur not only in the part that is located within the eyeball and in close proximity to the eye, but also in the part that is behind the eye and even in the cranial cavity (the optic nerve includes part of the visual pathway to the plasma).

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What causes retrobulbar neuritis?

The causes of retrobulbar neuritis are the same as those of intrabulbar neuritis. Infection joins in a descending way with diseases of the brain and its membranes. The most common causes of retrobulbar neuritis are influenza, typhus, multiple sclerosis, diseases of the main and ethmoid paranasal cavities, injuries. Cases of retrobulbar neuritis that arise as a result of general intoxication are also common. Methyl (or wood) alcohol selectively affects the optic nerve with subsequent atrophy and complete incurable blindness. From the internal use of even 30 g of wood alcohol, a person can not only go blind, but also die!

Retrobulbar neuritis with central scotoma may occur from chronic nicotine intoxication (excessive tobacco smoking).

Symptoms of retrobulbar neuritis

Retrobulbar neuritis can be acute or chronic. The first is characterized by an acute onset, often accompanied by pain in the eye socket and when moving the eyeball, rapid loss of vision, functional impairment (narrowing of the visual field, especially for green, decreased central vision).

In chronic cases, these phenomena increase gradually. The process fades slowly.

There are three forms of retrobulbar neuritis: peripheral, axial, and transversal.

In the peripheral form, the inflammatory process begins with the optic nerve sheaths and spreads to the tissue along the septa. The inflammatory process is interstitial in nature. Exudate accumulates in the subdural and subarachnoid spaces of the optic nerve. Central vision is not impaired, peripheral vision is narrowed. Functional tests may be within normal limits.

In the axial form, which is observed most often, the inflammatory process develops in the axial bundle. In this form, central vision is sharply reduced, and central scotomas appear in the visual field. Functional tests are significantly reduced.

The transversal form is the most severe form. The inflammatory process affects the entire tissue of the optic nerve. Vision is significantly reduced, up to complete blindness. Functional tests are very low.

Ophthalmoscopic symptoms from the fundus of the eye are absent at the beginning of the acute period of the disease, and only in the late period, after 3-4 weeks, when atrophic changes develop in the fibers of the optic nerve, is pallor of its disk detected.

The decisive role in the diagnosis of retrobulbar neuritis belongs to the study of the eye function. Some decrease in visual acuity, narrowing of the visual fields, especially for red and green colors, and the appearance of central scotomas are noted.

The outcome of retrobulbar neuritis, as well as intrabulbar neuritis, ranges from complete recovery to complete blindness of the affected eye.

In multiple sclerosis, retrobulbar neuritis is acute in 13-15% of cases (70% in children), vision rarely deteriorates to blindness, attacks of retrobulbar neuritis last from one to three months. Vision decreases with physical exertion, fatigue, and during meals. Multiple sclerosis may cause intermittent visual impairment: sometimes deterioration, sometimes recovery.

The consequences are simple atrophy of the optic nerve.

Treatment: intravenous administration of urotropin, glucose, nicotinic acid, and corticosteroids (dexon) to relieve swelling.

Retrobulbar neuritis in meningitis (Devin's disease) is a bilateral disease of the optic nerve with acute myelitis, which begins suddenly and is accompanied by decreased vision. On the fundus - neuritis. Peripheral vision is characterized by narrowing, the appearance of scotomas, temporal hemiacogical defects.

Retrobulbar neuritis in syphilis is rare, more often one eye is affected. The course is acute, combined with lesions of the oculomotor apparatus.

In tuberculosis, retrobulbar neuritis occurs even less frequently.

With starvation, vitamin deficiencies B6, B12, PP, neuritis may also develop. The need for vitamins increases during pregnancy, lactation, heavy physical exertion, alcoholism. With vitamin deficiency B6 (beriberi disease), retrobulbar neuritis may occur.

Avitaminosis B12 - retrobulbar neuritis, bright red tongue and lips, cracked lips, seborrhea in the nasolabial folds, dry tongue.

Avitaminosis PP - retrobulbar neuritis, pellagra, dermatitis, diarrhea.

Treatment of retrobulbar neuritis

The main direction in the treatment of intra- and retrobulbar neuritis is the elimination of the cause of the disease. For this purpose, the following is prescribed:

1. broad-spectrum antibiotics (the use of streptomycin is undesirable);
2. sulfonamide drugs;
3. antihistamines;
4. intravenous dexazone, 40% solution of urotropin, 40% solution of glucose with 5% solution of ascorbic acid, 1% solution of nicotinic acid;
5. B vitamins;
6. for retrobulbar neuritis, dexazone is prescribed, which should be alternated with heparin; hemodez, polyglucin, and rheopolyglucin are administered intravenously;
7. desensitizing therapy (diphenhydramine, suprastip, etc.), dehydra and ion therapy (novurit, lasix, mannitol) are carried out, corticosteroids (prednisolone 30-40 mg per day), hemodynamics (trental, nikoverip, compalamin) are prescribed;
8. electrophoresis with calcium chloride is shown;
9. in rhinogenous neuritis:
   • cocaine, adrenaline;
   • tamponade of the middle nasal passages;
   • puncture and suction of pus from the paranasal sinuses;
10. pyrogenal according to the scheme;
11. oxygen therapy;
12. ultrasound, reflexology,

In the later stages, when symptoms of optic nerve atrophy appear, antispasmodics affecting microcirculation (trental, sermion, xanthinol) are prescribed. It is advisable to prescribe magnetic therapy and laser stimulation.