When retrobulbar neuritis affects the optic nerve. It is represented by axons of the retinal ganglion. Bundles of fibers, separated by myelin, pass through the sclera of the eye, where they are surrounded by meninges and form a nerve trunk.
The optic tract approaches the subcortical centers where primary information processing takes place, visual reflexes are formed. Next go to the visual cortex.
At the base of the brain, a partial intersection occurs, thus the visual analyzers are connected with the opposite halves of the visual areas.
The functions of the optic nerve are in the ability to transmit impulses associated with the perception of objects, colors, light and shade.
With a complete defeat, the functions are not restored.
Signs of decreased visual function are associated with inflammation of the optic nerve that can occur in any part of it. If the process occurs inside the eye, they talk about papillitis, beyond its limits – about retrobulbar neuritis. There are three forms of the disease:
- Axial. Long processes – axons – are affected. It is characterized by the appearance of blind spots (en masse) in the field of view. This form is the most common.
- Peripheral. Inflammation occurs in areas of the myelin sheath of the optic nerve. It has a progressive nature, with time it spreads deeper into the trunk. Under the shell exudate accumulates, which leads to pain during movement of the eyeball. Central vision is safe, but the fields are narrowed.
- Transversal First, the periphery and axon bundle are affected, and in the future, the remaining areas, including the disk. Leads to complete loss of vision.
When retrobulbar neuritis of the optic nerve disc is affected as the disease progresses.
The etiology of visual neuritis is not fully understood. Probably one of the main factors provoking its development is a genetic predisposition contributing to the erroneous perception of myelin proteins as proteins of pathological microorganisms. As a result, T-lymphocytes accumulate in the affected area, and immune protection is activated.
The risk of getting sick at a young age of 40 years increases (the average age of the first symptoms noted at 25–28 years). Pathologies are more often exposed to women.
The range of causes that lead to visual neuritis is wide. It includes infectious and non-infectious factors.
Viral infections lead to primary inflammation: herpes, cytomegalovirus, infectious mononucleosis. Often it is caused by sinusitis, tonsillitis, otitis media, sore throat, less often – pyelonephritis. Separately distinguish inflammation of the orbit of the eyes, in particular, uveitis, chorioretinitis.
Damage to the brain leads to secondary retrobulbar neuritis. Such causes include neurosyphilis, HIV infection, inflammation of the brain and its membranes, Lyme disease. Signs of pathology develop on the background of blood diseases, diabetes, injuries, poisoning, vaccinations, autoimmune diseases, taking certain medications. Neoplasms have a squeezing effect on the vessels, the place of intersection of nerve fibers.
Two-thirds of patients with multiple sclerosis are diagnosed with secondary neuritis of the optic nerve. The reasons for this process lie in demyelination. At the same time, atrophy of the myelin sheath is not always obvious at the initial stage. His signs are not detected even on MRI. This may be due to the low resolution of the device used and fatty tissue.
Signs of myelin destruction are diagnosed in the brain. They are celebrated in all patients up to 5 years from the onset of the disease. In half of the cases, symptoms of demyelination of both visual pathways are also found in the images, more than 37% have symptoms on one side. The remaining 12% of patients have visual pathways.
The disease is acute and chronic. In the first case, signs of neuritis are observed in the first two or three days. Sharply painful, aggravated by eye movement. Vision decreases. The perception of certain colors worsens. The disease in the early stages usually affects one eye, as the inflammatory process develops, it spreads to the second. Sometimes there is swelling and hyperemia.
Chronic form is distinguished by a gradual decrease in the ability to see. Over time, atrophy of the optic nerve develops, leading to the formation of a blind spot (skopoma) in the center of the eyes. It is found in about 60% of cases. The patient notes that everything around is in the twilight. Sometimes they talk about the appearance of non-existent points, shapes. There is redness in the eyes. The patient may feel sick, sometimes he complains of pain in the head.
Symptoms of neuritis increases after a strong mental stress, heavy physical exertion.
Common symptoms are a gradual deterioration of vision, increased sensitivity of the retina, pain inside or around the eyes, photophobia. Signs manifest with varying strengths. Thus, the vision may decrease slightly, in other cases lead to possible blindness, while the person will perceive only the light. The latter is observed mainly in axial and transversal forms.
Soreness is most pronounced with peripheral neuritis. With this form of visual impairment, so-called lateral vision disappears, and visual acuity may remain intact.
Interestingly, few people indicate a violation of color perception. Most often, this feature is found when conducting research.
Symptoms largely depend on where in the area from the eyes to the visual centers a lesion of the optic nerve occurred. It is associated not only with deterioration of vision, but also with its split. The presence of signs of nystagmus (involuntary movements) in many patients is noteworthy. Sometimes the symptoms of optic neuritis are accompanied by loss of control over the position of the head in space.
The appearance of the first symptoms of visual impairment, pain in the eye area is the basis for referring to an ophthalmologist. During the examination, he will ask what concerns the patient, clarify the symptoms of inflammation of the optic nerve, and prescribe treatment.
When signs of optic neuritis change blood pressure and temperature, consultation of a neurologist is appointed.
The following studies are recommended:
- Perimetry. Dynamic allows you to clarify whether there is a violation of peripheral vision, the presence of cattle, their appearance. With static, the ability to perceive changing brightness is examined.
- Magnetic resonance imaging of the brain. Typically, this type of examination allows you to see signs of demyelination of the brain. Neurology recommends diagnosis to rule out multiple sclerosis.
- Electrophysiological study. The goal is to assess the features of the functioning of the optic nerve, retina, and areas of the brain that are responsible for recognizing visual images.
- Optical coherent tomography. Allows you to measure the diameter of the optic nerve.
- Fundoscopic study. The main purpose is to see the fundus.
- Blood test. An additional method that allows you to see non-specific signs of inflammation.
- Research liquor. Allows to detect neuroinfections.
For neuritis, which has become chronic, an ophthalmoscopy is performed with special drops. Before the examination, medicine is buried in the eye. The specialist examines the fundus through the pupil. This allows you to see the disk, detect swelling, redness.
Fluorescein angiography is also performed. A special preparation is inserted into the vein that illuminates the vessels.
The last two methods are effective only if the inflammatory process has gone far enough and hit the disc. In the initial stages of the disease, they are not informative.
To assess the vision, its acuity, changes, and the presence of an ensemble, additional methods are carried out: metamorpopsia, hemianopsia, captimetry, control method of research. For their implementation do not need any devices.
Treatment tactics depend on the cause of the disease. If it is not possible to find out, complex therapy is carried out. The patient is hospitalized. In the hospital, the doctor will be able to monitor the patient’s condition, correct the treatment of inflammation of the nervous tissue.
When a viral infection is prescribed, antiviral agents (Amixin) are prescribed, and bacterial ones are treated with a wide range of antibiotics. In parallel, shows the use of antihistamine drugs. The consequences of poisoning are removed with detoxifying preparations. Used gemodez.
Glucocorticosteroids (Prednisolone, Dexamethasone) are used to reduce inflammation and edema. With a significant violation of the visual function, the drugs are injected with a syringe into the eyeball.
Actovegin, Trental contribute to the improvement of nutrition, the normalization of oxygen supply to the brain and tissues of the optic nerve. Vitamins PP, B1, B6 normalize metabolism.
To improve the transmission of nerve impulses, cholinesterase inhibitors are prescribed, for example, Neuromidin.
If optic neuritis is accompanied by multiple sclerosis, interferons (Ekstavia, Betaferon), Glatiramer acetate, and immunosuppressors are used.
During the recovery period, the use of traditional medicine is recommended. A few leaves of aloe are cut and placed in the refrigerator. Three days later, they are peeled, finely chopped. Add 5 g of medicinal eyebright, the color of cornflower field, as well as 200 g of honey. Pour the resulting mixture with 700 ml of dry red wine, mix, put in a water bath for 40 minutes, decant. Drink one tablespoon before meals.
In acute retrobulbar neuritis and properly selected therapy, vision can be restored in some cases. The disease, which arose against the background of multiple sclerosis, more often becomes chronic, accompanied by exacerbations and atrophy of the nerve.
In the case of an optic neuritis, the prognosis is poor.
The main way to detect the development of pathology in time is to undergo regular examinations by an ophthalmologist. The methods that this doctor uses are painless. They will allow you to quickly assess visual acuity, its features, measure the thickness of the optic nerve.
If possible, avoid injury to the eyes. All infections, diseases should be treated in a timely manner, preventing their transition to pathological forms and avoiding complications. Shows smoking cessation and alcohol.
When retrobulbar neuritis of the optic nerve there is deterioration of vision, a decrease in its sharpness, color perception. Diagnosis of the disease is carried out by an ophthalmologist based on the observed symptoms and using special methods of research. Tactics of treatment and the consequences depend on the cause of the pathology.
The following sources were used to prepare the article:
Nugumanova A.M., Khamitova G.Kh. Peculiarities of retrobulbar neuritis course in multiple sclerosis (clinical case) // Practical Medicine Journal – 2013.
Ignatov Yu. N., Smagina I. V., Gridina A. O., Sidorenko V. A., Popovtseva A. V., Smirnova O. V., Elchaninova S. A., Fedyanin A. S. Retrobulbar neuritis patients with multiple sclerosis // Journal Bulletin of Siberian medicine – 2009.
Kukhtik S. Yu., Popova M. Yu., Tantsurova KS Retrobulbar optic neuritis // Journal of the Council of young scientists and specialists of the Chelyabinsk region – 2016.