Stagnant nipples of the optic nerve. Stagnant nipple optic nerve. What happens with the further development of a disease

Many patients after visiting the ophthalmologist's office are diagnosed with a "congestion of an optic nerve". This term is not always clear, which makes the patients look additional information. What is accompanied by a similar condition and what complications is fraught with? What are the main reasons for the development of stagnation? What can offer modern medicine as treatment?

What is a pathology?

To begin with, it is worth dealing with the meaning of the term. Not everyone knows that in fact this diagnosis implies swelling. Stagnation of an optic nerve - pathology, which is accompanied by an edema, and its appearance is not associated with the inflammatory process.

This condition is not an independent disease. Eugene in most cases is associated with persistent increase intracranial pressure. This problem faces not only in adulthood - often diagnosed with a stagnant eye of an optic nerve in a child. This pathology naturally affects vision and in the absence of treatment can lead to nerve atrophy and blindness. Edema can be one-sided, but, according to statistical studiesThe disease is more often striking both eyes at once.

Stagnation of optic nerve: causes

As mentioned, in most cases, swelling is developing against the background of increasing intracranial pressure. And the reasons for this can be a lot:

• Approximately 60-70% of cases, the congestion disk of the optic nerve is associated with the presence of a tumor in the brain. To date, it was not possible to determine whether there is a relationship between the size of the neoplasm and the appearance of swelling. On the other hand, it is known that the closer to the sinus of the brain there is a tumor, the faster the stagnant disk is formed and progresses.
• Inflammatory lesions (in particular, meningitis) can also provoke pathology.
• The risk factors also include the formation of an abscess.
• The stagnant disc can be developed as a result of a cranial injury or hemorrhage in the ventricles and brain fabrics.
• The same pathology is sometimes observed at hydrocephalus (the state that is accompanied by a violation of the normal outflow of the cerebral fluid and its accumulation in the ventricles).
• To the tissue edema, the presence of uncharacteristic attributes between vessels.
• Often the reason for the development of the congestion disk of the optic nerve are cysts, as well as other formations, which are gradually increasing in size.
• Such pathology can develop against the background of vessel thrombosis, providing blood circulation in the brain.
• To the other possible reasons include diabetes, chronic hypertension and other diseases, which, in the end, lead to metabolic and hypoxic lesions of brain tissues.

In fact, it is very important during the diagnosis to determine exactly the cause of the development of enemy nerve edema, since the treatment regimen and the rapid recovery of the patient depends on this.

Features of the clinical picture and symptoms of pathology

Of course, the list of symptoms is something worth familiar with. After all, the sooner this or that violation is noticed, the faster the patient will appeal to the doctor. Immediately it is worth saying that in the presence of this pathology, normal vision is preserved, and for a long time. But many patients complain about periodic headaches.

For a congestion disk of the optic nerve, a sharp deterioration in view is characterized, up to blindness. As a rule, it is short-term, and then all for a while comes back. Associated with such a spasm phenomenon blood vessels - For a moment, nervous endings cease to receive nutrients and oxygen. Some patients have similar "attacks" only occasionally, other patients suffer from vision is almost every day. You should not talk about how dangerous there may be sharply advancing blindness, especially if at this moment the person leads the car, goes the street, works with a dangerous tool.

Over time, the process is involved and the retina is involved, which is accompanied by a significant decrease in examination, the doctor may notice small hemorrhages, which is due to circulatory disorders in the structures of the eye analyzer. With such symptoms, you need to see the doctor as soon as possible.

Stages of development of ailment

It is customary to allocate several stages of development of pathology:

• At the initial stage, there is hyperemia of the disk, the narrowing of small arteries and the erochion of venous vessels.
• The pronounced stage - the stagnant disk of the optic nerve increases in size, small hemorrhages appear around it.
• On a sharply pronounced phase, the disk greatly promises to the vitreous body zone, changes in the field of yellow retinal spots are observed.
• Next follows the stage of atrophy, in which the disk is compact and acquires a dirty gray color. It is during this period that noticeable problems with vision begin to appear. First there is a partial, and then complete loss of vision.

The initial stage of the disease and its features

As mentioned above, initial stages The development of pathology patient may not suspect the presence of a problem, since some pronounced violations are simply missing. During this period, the violation is possible - as a rule, it happens randomly during a planned ophthalmologic inspection.

The discs swell and increase in size, the edges of them are fuzzy and enter the area of \u200b\u200bthe vitreous body. Approximately 20% of patients pulse in small veins disappears. Despite the lack of visible symptoms, the retina also begins to swell.

What happens with the further development of the aless?

In the absence of treatment, some signs can already be seen. What complications cause a congestion disk of the optic nerve? Symptoms look pretty characteristic. Patients gradually decreases visual acuity. During the survey, you can see the expansion of boundaries

In the future, the blood stagnation is developing in veins, and the circulatory disorder, as is well known, affects the work of the optic nerve. Disk swelling is enhanced. The disease can go into the chronic phase. At this stage, visual acuity is improved, it drops sharply. In this case, it is possible to observe the narrowing of the normal field of view.

Modern diagnostic methods

The congestion disk of the optic nerve is a disease that can be diagnosed with an ophthalmologist, since with a thorough examination and testing of vision, a specialist can suspect nonlade. But since the pathology is associated with diseases nervous systemThe treatment is carried out a neurologist or neurosurgeon.

The presence of edema can be accurately installed during retinothomography. In the future, additional studies are conducted, the purpose of which is to determine the degree of development of edema and identify the main cause of the development of the disease. For this patient is sent on the optic nerve. Further conducted x-ray study skull cT scan and optical coherent tomography.

Stagnation of optic nerve: treatment

Immediately it is worth saying that therapy largely depends on the cause of development, as it is necessary to treat, first of all, the primary disease. For example, during meningitis, patients prescribe corresponding antibacterial (antifungal, antiviral) preparations. At hydrocyphalia, it is necessary to ensure the normal circulation of the liquor and so on.

In addition, the congestion disc of optic nerve requires supporting therapy in order to prevent the development of secondary atrophy. To begin with dehydration, which displays an extra liquid and reduces the edema. Patients also prescribe vasodinating drugs that normalize blood circulation in the nervous tissue, providing cells with the necessary amount of oxygen and nutrients. Part of the treatment and the reception of metabolic preparations that improve and maintain the metabol metabolism, providing normal work Spectator nerve.

When eliminating the primary cause, the congestion disk of the optic nerve disappears - the work of the brain and the visual analyzer comes back to normal. But the absence of treatment often leads to complete loss of vision. That is why in no case should not refuse therapy and neglect the advice of the doctor.

Are preventive measures?

Immediately it is worth saying that some drugs or specific means capable of preventing the development of pathology does not exist. The only thing that doctors can recommend are regular preventive inspections from an ophthalmologist. Naturally, it is worth avoiding situations that threaten brain injuries.

All infectious and inflammatory diseases, especially if we are talking about the defeats of the nervous system, must be treated, and the therapy is not stopped until the full restoration of the body. With the slightest violation of vision or appearance anxiety symptoms It is necessary to refer to an ophthalmologist or a neurologist.

Stagnation (syn. stagnation) - Nickname swelling nipple (disk, PNA) optic nerve.

In 1910, Shik (F. Schieck) suggested that the way. Pathogenesis transport theory 3. p. Chic tied development 3. p. with a delay in the outflow of the tissue fluid from eyeball According to the perioreural spaces of an axial beam, the fibers of the optic nerve caused by the oncoming current of the fluid, as far as the combustible spaces under the influence of increased intracranial pressure. but experimental studies The existence of the communication between the perinancial spaces of an axial beam of the visual nerve and the surrounding nerve of the inter-brake spaces are not confirmed. The retention theory of Baer (S. Behr, 1912) comes from the idea of \u200b\u200bthe delay of the fluid that flows out of the eyeball in the bone canal when the nerve outlet from the eyeliner into the skull cavity. However, the study of the entire move of the nerve in the bone canal using the Trachiskopic Methodology of M. A. Baron (1949) showed that no compression of the optic nerve in the bone canal at 3. s. It does not occur, the interoboral space of the optic nerve remains wide open throughout the congestion of the bone canal. The optic nerve is surrounded by cavities filled with liquid under the action of intracranial pressure. With the increase in pressure, the processes of tissue exchange in the visual nerve and its blood supply, which can lead to changes, an ophthalmoscopically expressed pattern 3 p.

Etiology

Pathological anatomy

In the pathologist examination, the eye draws attention to a significant increase in the size of the optic nerve disk, which sometimes sputs above the retinal level by 2 mm and more. Due to the increment of the disk diaper, its retinal fabric turns out to be displaced. For microscopic examination There is a pronounced non-agitative swelling of the disk and the stem of the optic nerve. Nervous fibers spread to a liquid accumulated between them, penetrating also between gliose fibers and connecting interlayers on the disk. Blood vessels of the disk and retinal are noticeably expanded. There are hemorrhages. The connective tissue lattice plate is often arcuated with a pressure of swollen tissues (color. Fig. 1-4). Gradually, the disk swelling regnets, the nerve fibers are replaced with a newly formed gliose cloth. Sometimes there is a progressive atrophy of nerve fibers.

Clinical manifestations

3. p. usually happens bilateral in initial stages It does not cause obvious visual disorders, so it is often revealed by chance when examining persons who applied to the oculist on a different occasion. Quite often, these are patients directed by the therapist or a neuropathologist to explore the eyebound in connection with uncertain complaints about frequent headaches or on sudden binding of vision with a sharp change of the position of the body (for example, with a rapid upside down from bed).

With a long existence 3. p. In the patient, there are often certain visual disorders - then violations of the fields of view, then the formation of cattle, which indicates some local effect on the stem of the optic nerve (or the pressure on a certain section of the nerve barrel of the basal tumor or shifted by it elements of the brain, or That limited basal inflammatory process). If visual disorders are associated with the coming atrophy of the nerve fibers, they may be irreversible.

Diagnosis

The diagnosis is made on the basis of the data of ophthalmoscopy and functional studies of the eye.

Ophthalmoscopic picture In pronounced cases 3. p. It is quite characteristic (color. Fig. 6-10). The stainedness of the optic nerve disk, the fuzziness of its boundaries, the pronounced convolutions of the blood vessels and the expansion of their caliber is noted. In the process of development 3. p. In the area of \u200b\u200bthe optic nerve disk, hemorrhages often appear; The vessels of the retina, especially Venuly, are sharply expanded, form wide loops. The tissue of the retina around the disk of the optic nerve sharply, which indicates the change in its color and the blurry of the pattern. In the pronounced stage, there is a protrusion into the vitreous body, a sharp swelling of the optic nerve disk with severe hemorrhages and a significant expansion and convulsion of the retina. In the later stages, the peripapillary edema is less pronounced, the disk of the optic nerve seems to be pale, with uneven, as if from the edges.

• Changes in the eye bottom in sorry diseases of the visual nerve

Final Stage 3. with. It is atrophy of the optic nerve (see the eye bottom, optic nerve).

Ophthalmchromoscopic research Allows you to very early to catch the manifestations of edema. Refractometric and campimetric methods provide the ability to measure as a degree of surrender 3. s. Forward, in the vitreous body, and the expansion of its diameter (see Campimimetry, Refractometry). Great importance As in the clarification of the diagnosis 3. (s. and in the study of its pathogenesis and the clinic has a method of fluorescent retinal angiography (see ophthalmoscopy), which allows you to trace the move and the state of all the blood vessels of the retina right up to the capillary network. With suspected 3. p. Mandatory neurol, examination of the patient and x-ray, study of the skull.

Differential diagnosis

When establishing a diagnosis 3. s., Especially on early stagesThere is a need for a differential diagnosis with the neuritude of the optic nerve. Famine diagnostics Functional eye research. So, with neurutic, already at an early stage there are visual disorders (decrease in visual acuity, the appearance of livestock, the restriction of the field of view), whereas at 3. s. summary functions Long remain normal.

Based on an ophthalmoscopic picture 3. p. Sometimes it is possible to take for a pseudo-nipple nipple, which is observed with an anomaly for the development of a disk of the optic nerve and vessels going on the surface of the disk, or during the druses of the disk (see eye, pathology). The presence of atypical vessels in the area of \u200b\u200bthe optic nerve disk with anomalies, a hillous view of the disc with festral edges and unchanged vessels with a disk druses also testify in favor of a pseudo-stall nipple. Druses are particularly clearly visible at ophthalmochromoscopy in red light. In people of elderly and senile age 3. p. It can be taken for the ischemic swelling of the optic nerve disk, arising in connection with the obliteration of vessels that feed the visual nerve. However, the absence of arc reflex near the disk with ischemic edema allows you to put the correct diagnosis.

Sometimes 3. s. It is necessary to differentiate with the obstruction of the central artery and the retina veins. The presence in the macular region of the retina of the bright red spots of round or oval shape with the obstruction of the central artery of the retina and a large number of The hemorrhages propagating radiances in the course of branches Wesull retina helps in diagnosis. In addition, with the obstruction of the central artery and the retina veins, there is a sudden loss of vision, which is not observed at 3. s.

Sometimes hypermetrops of the edge of the optic nerve disk may appear fuzzly contigated, which can also give reason to suspect the beginning 3 p. Such hypermmetropics are often complaining of persistent headaches (see Asthenopia), which can be attributed by increasing intracranial pressure. However, the stability of an ophthalmoscopic picture of the disk of the optic nerve in this case makes it possible to exclude 3. p.

Treatment

The regression of stagnation of stagnation in a visual nerve can be achieved by treating the underlying disease.

Forecast

After normalizing intracranial pressure (as a result of a decompressive operation or tumor removal, etc.), the output of the disk is usually reduced soon, but its diameter has long remains enlarged. Changes in the eye bottom can completely disappear in the early stages. When eliminating the reason that caused 3. p., The boundaries of the optic nerve disk and in more late time It remains uneven, blood vessels are narrowed, why the disk itself becomes pale, anemic. At the same time, a decrease in visual acuity is noted. Long existing 3. s. It can lead to atrophy of the optic nerve and a sharp decrease in visual functions.

Bibliography: Averbach M. I. The main forms of changes in the visual nerve, M., 1944; Bing R. and Trunkner R. Brain and Eye, Per. with him., L., 1959; Volkov V. V. and Nikitin I. M. Eye Symptomatics in Eponima, L., 1972, Bibliogr.; Samoilov A. Ya. Experience in dynamic study of stagnant nipples in brain tumors, in the book: Vhibr, Neurophthalm., Ed. E. J. Thron?, S. 31, L., 1958; Trone E. J. Diseases of the visual path, p. 57, L., 1968, bibliogr.; C O G A N D. Neurology of The Visual System, Springfield, 1967, Bibliogr.; Medical Ophthalmology, ED. By F. C. Rose, L., 19,76; Neurophthalmologie, HRSG. v. R. Sachsenweger, LPZ., 1975, BIBLIOGR.

A. Ya. Samoilov.

The optic nerve disc is a special structure that is noticeable on the eye day when it is studied using an ophthalmoscope. Visually, this area looks like a pink or orange oval area. It is not in the center of the eyeball, and closer to the nasal part. The position is vertical, that is, in height, the drive is slightly more than in width. In the middle of this area in each of the eyes are noticeable notes, which are called eye bowls. Through the center of the cups in the eyeball, blood vessels comes - central eye artery and vein.

Nipple or disk - this is the place of formation of the optic nerve by the process of retinal cells

The characteristic view of the optic nerve disk and its sharp difference from the surrounding retina is due to the fact that in this place there are no photosensitive cells (sticks and colums). Such a feature makes this area "blind" in relation to the ability to perceive the image. This blind area does not interfere with the vision in general, because the size of the optic nerve disk is only 1.76 mm per 1.92 mm. Although the eye is this place, it can not "see", but it provides other features of the optic nerve disk, namely the collection and transfer of nerve pulses from the retina optical nerve and further visual cores of the brain.

Characteristic of hellish

The congestive disk of the optic nerve (ZDZHN) is a state characterized by a violation of its functionality due to the occurrence of non-inflammatory edema.

The reasons for the stagnant disc lie in the violation of the venous and lymphatic outflow from the mesh eye shell with an increase in intracranial pressure.

This indicator may increase for many reasons: intracranial tumors, brain injury, intracranial hematoma, infectious inflammation and swelling of shells or brainstatons, hydrocephalus, vessel arthritis, diseases spinal cord, Tuberculle, echinococcosis, orbit diseases.

The smaller the distance from the volumetric formation to the cerebral sinus, the more pronounced intracranial pressure and the faster the congestion disk of the optic nerve develops.

The symptoms of the edema of the disc: there is an increase in size, the stainedness of the borders, the protrusion (disk prominency) into the vitreous body. The state is accompanied by hyperemia - the central artery is narrowed, and veins, on the contrary, expanded and more convoluted than normal. If stagnation is greatly pronounced, then hemorrhage is possible in its fabric.

Glaucoma is the cause of damage to the optic nerve in the form of its excavation and stagnation

When glauer or intraocular hypertension, the disk of the optic nerve occurs, that is, an increase in the deepening of the central "eye bowl". Also constant pressure intraocular fluid Mechanically disrupts blood microcirculation in the nipple nerve, the result of this is the development of stagnation and partial atrophy. On the film of the Eye DNA marks the paletting of the nipple. With complete atrophy, it is gray, since the vessels are as narrowed as much as possible.

Causes of atrophy of this type:

• syphilis;
• tumors in the brain;
• neuritis, encephalitis, multiple sclerosis;
• traumatic brain damage;
• intoxication (including methyl alcohol);
• some diseases (hypertension, atherosclerosis, diabetes mellitus);
• ophthalmologic - tombosis of the central artery when you get infectious diseases retina.

If the nipple edema is maintained for a long time, then it also develops processes leading to secondary atrophy, which leads to a loss of vision.

Visually atrophy characterizes decoloration (loss of conventional color intensity). The discoloration process depends on the localization of atrophy, for example, when the papillo-macular beam is damaged, the temporal area is pale, and the entire area of \u200b\u200bthe disk is uniformly.

Driving nerve disc with elevated intracranial pressure at various stages of the disease. There is a gradual increase in diameter, erasing boundaries, disappearance of color and severity of the vascular network

The defeat may be one-sided or develop in both eyes. Also, the defeat of one visual nerve of the tumor at the base of the brain (primary atrophy) may be accompanied by the development of secondary atrophy in another disk due to the overall increase in intracranial pressure (with phoster-Kennedy syndrome).

Violations associated with the nipple of the optic nerve are reflected on the quality of vision. The sharpness is reduced, the areas of partial field loss appear. With a deterioration of the state, when the size of the disk increases, the blind spot is increasing proportionally. In some patients, these phenomena may not have enough long time. Sometimes there is a sudden loss of vision during a sharp spasm of the vessels.

Similar disease

At the rate of reduction of visual acuity (visa), the distinctive diagnosis of ZDZN from the neuritis is founded. With inflammation of the visual nerve, the vision falls immediately sharply at the beginning of the disease, and the development of edema is expressed in its gradual decline.

Also requires differential diagnosis Pseudo-shrouded disk of optic nerve. This pathology has genetic conditionality and bilateral nature. The nerves are increased, have a gray-pink color and significantly protrude above the retinal surface. The boundaries are blurred, have a different look, blood vessels radially diverge from them, the veins are enlarged. The formation of a pattern of pseudo stagnation is due to the congenital growth of embryonic clay tissue and the formation of the friends, including calcium particles. These inclusions are closer to the internal (from the nose) edge of the disk. With a pseudo-frost, the appearance of small hemorrhages is also noted, since the vessels are injured about the dresses. In the absence of friends, visual acuity may be normal, but their presence almost always leads to its decline, the emergence of central cattle.

Significantly diagnose pathology helps optical coherent tomography or tomography retina. These studies are able to layerly to assess the structure of the nipple of the nerve and determine in it pathological changes, their degree, visualize choriocapillary, hidden edema, scarring, inflammatory foci and infiltrates - education that cannot be seen with the naked eye.

Result of the scanning of the optic nerve disk with optical coherent tomography

Oct allows you to determine the final diagnosis and control the response to the therapy conducted.

Congenital anomalies

The congenital diseases inherited by autosomal dominant type, also includes the coloboma of the optic nerve disk, in which many small grooves filled with retinal cells are formed throughout its region. The cause of such formations is the incorrect fusion of cells at the end of embryonic development. Opening nerve disk purchases largerThan in the norm, a spherical excavation with clear boundaries of silver-white color is also formed by its edge. The defeat may be one-sided or bilateral. Clinically manifested by a high degree of myopia (myopia) and myopic astigmatism, as well as the squint.

Koloboma disk optic nerve

The presence of congenital colobromas increases the likelihood of a bursting of the macula, its bundle with further retinal detachment.

Since pathology is genetically determined, it is found in combination with other violations that are manifested in children from birth:

• epidermal nevus syndrome;
• focal goltz leather hypoplasia;
• down syndrome.

Another disease that has a congenital character - the hypoplasia of the disk of the optic nerve. It is characterized by underdevelopment of long processes nerve cells Networks against the background of the normal formation of support cells. Inadequately developed axons with difficulty form the nipple of the optic nerve (it is pale pink or gray, is surrounded by a radial depigmentation section).

Pathology of nervous tissue is reflected on appearance and the functionality of the organs of view, they will be:

• defects of fields of view;
• violation of color perception;
• afferent pupil defect;
• yellow spots hypoplasia;
• microfthalm (reducing the size of the eyeball);
• strabismus;
• nistagma.

In the photo of Aniridia (eye without iris) - congenital pathologywhich is often combined with the nipple of the nipple of the optic nerve

The causes of congenital hypoplasia are the violation of the development of nervous tissue in the intrauterine period under the influence of the following factors:

• genetic violation of cell division,
• small amount of accumulating waters;
• ionizing radiation;
• intoxication of the parent organism chemicals, medicines, nicotine, alcohol, drugs;
• systemic diseases in mothers, such as diabetes;
• infections and bacterial diseases.

Unfortunately, the hypoplasia (small number of nerve fibers) is almost impossible to cure. With one-sided damage, the treatment is aimed at training the functions of a weak nerve by using occlusal dressings on a stronger eye.

Treatment

Treatment of a stagnant disk depends on the cause of its occurrence.

First of all, it is necessary to eliminate volumetric formations in the cranial box - tumors, edema, hematoma.

Usually, corticosteroids (prednisone) and the introduction of hyperosmotic agents (solution of glucose, calcium chloride, magnesium sulfate), diuretics (diakarb, hypothiazide, triampur, furosemide) are used to eliminate edema. They reduce extravasive pressure and restore normal perfusion. To improve microcirculation, cavinton and nicotinic acid intravenously, mexidol (in / m and in retrobulbar space is an eye injection), a nootropic drug is prescribed inside. If stagnation occurs against the background of hypertensive disease, the treatment is aimed at treating the main disease (hypotensive therapy).

Sometimes it is possible to reduce intracranial pressure only by cerebrospinal puncture.

The consequences of stagnation require improved tissue trophics - vitamin and energy tools:

• a nicotinic acid;
• group vitamins (in 2, in 6, in 12);
• aloe extract or vitreous body in injecting form;
• riboxin;

The stagnation disc of the optic nerve can not yet manifest itself, but have catastrophic consequences, therefore, with the aim of prevention, it is necessary to survey in an ophthalmologist annually to the timely detection of the disease.