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 the skull cavity (to the optic nerve is 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 intrabulbar neoplasm. Infection joins 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 latticed adnexal nasal cavities, damage. There are also frequent cases of retrobulbar neuritis arising from common intoxications. Methyl (or wood) alcohol selectively affects the optic nerve, followed by its atrophy and complete incurable blindness. From the use of even 30 grams of wood alcohol a person can not only blind, but also die!

Retrobulbaric neuritis with central scotoma can arise from chronic nicotine intoxication (excessive smoking of tobacco).

Symptoms of retrobulbar neuritis

With the course of retrobulbar neuritis can be acute and chronic. The first is characterized by an acute onset, pain in the eye socket and eyeball movements, rapid drop in vision, functional impairment (narrowing of the field of vision, especially green, decrease in central vision) are often noted.

With a chronic course, these phenomena increase gradually. The process fades slowly.

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

In the peripheral form, the inflammatory process begins with the membranes of the optic nerve and spreads through the septa to the tissue. The inflammatory process has an interstitial character. Exudate accumulates in the subdural and subarachnoid spaces of the optic nerve. Central vision is not disturbed, peripheral vision is narrowed. Functional tests can be within normal limits.

With the axial form, which is observed most often, the inflammatory process develops in the axial bundle. With this form, central vision sharply decreases, central scotoma appears in the field of vision. Functional tests are significantly reduced.

The transversal form is the heaviest form. Inflammatory process captures the entire tissue of the optic nerve. Significantly reduced vision, until complete blindness, Functional tests are very low.

Ophthalmoscopic symptoms from the fundus 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, the blanching of his disc is revealed.

A decisive role in the diagnosis of retrobulbar neuritis belongs to the study of eye function. There is a slight decrease in visual acuity, narrowing of the visual fields, especially red and green colors, the appearance of central cattle.

The outcome of retrobulbar neuritis, as well as intrabulbar, varies from full recovery to absolute blindness of the affected eye.

With multiple sclerosis, retrobulbar neuritis in 13-15% (in children in 70%) cases is acute, vision rarely falls to blindness, the attacks of retrobulbar neuritis last from one to three months. Vision is reduced with physical stress, fatigue, while eating. With multiple sclerosis there may be an abrupt disturbance of vision: that of depression, then restoration.

The consequences are a simple atrophy of the optic nerve.

Treatment - intravenously administered urotropine, glucose, nicotinic acid, prescribe corticosteroids (dexone) to remove the edema.

Retrobulbaric neuritis with meningitis (Devin's disease) is a bilateral optic nerve disease with acute myelitis, which starts suddenly, accompanied by a decrease in vision. On the eye day - the phenomenon of neuritis. Peripheral vision is characterized by narrowing, the appearance of cattle, temporal hemiakogic defects.

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

With tuberculosis, the peptobulbar neuritis occurs even more rarely.

When fasting, beriberi B6, B12, PP, neuritis can also develop. The need for vitamins increases with pregnancy, lactation, severe physical nagugki, alcoholism. With avitaminosis B6 ("beriberi" disease), retrobulbar neuritis may occur.

Avitaminosis B12 - retrobulbar neuritis, bright red tongue and lips, cracks on the lips, seborrhea in the area of 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. To this end, appoint:

1. antibiotics of a wide spectrum (streptomycin is not recommended);
2. sulfanilamide preparations;
3. antihistamines;
4. intravenous dexazone, 40% urotropine solution, 40% glucose solution with 5% solution of ascorbic acid, 1% solution of nicotinic acid;
5. vitamins of troupe B;
6. with retrobulbar neuritis prescribe dexazone, which should be alternated with heparin, intravenously injected haemodes, polyglucin, reopolyglucin;
7. desensitizing therapy (dimedrol, suprastip, etc.), dehydra and ion therapy (novorit, lasix, mannitol), corticosteroids are prescribed (prednisolone 30-40 mg per day), hemodynamics (trental, nikverip, compilamin);
8. shows electrophoresis with calcium chloride;
9. with rhinogenic 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, reflexotherapy,

In the late stages of the onset of symptoms of optic atrophy, antispasmodics acting on microcirculation (trental, sermion, xanthinol) are prescribed. The expedient appointment of magnetotherapy, laser stimulation.