Synonyms
(Opticus = optic nerve; atrophy = decrease in cell size, decrease in cell count) Death of the optic nerve, optic nerve atrophy
Definition Optic atrophy
Optic atrophy is the loss of nerve cells in the optic nerve. The nerve cells either decrease in size or in number. Both are possible.
Atrophy can have various causes. Optic atrophy describes a loss of nerve cells in the optic nerve. The nerve cells that transmit the visual impressions from the retina along the visual path towards the brain (visual cortex) decrease in number or size.
This atrophy can have various causes. Some of them are: inflammation of the optic nerve, increased intracranial pressure, alcohol or tobacco poisoning. The symptoms range from small, unnoticed central deficits to large-area visual field deficits that restrict everyday life.
The ophthalmologist‘s examination of the back of the eye is the most important factor in making a diagnosis. The treatment of optic atrophy is more difficult, since the cause must be treated in each case. Prophylaxis is equally difficult.
The prognosis also depends strongly on the different causes and can therefore range from good to bad.
- Optic nerve (nervus opticus)
- Cornea
- Lens
- Anterior eye chamber
- Ciliary muscle
- Glass body
- Retina (retina)
The complaints reported by the patients range from small central failures in the visual field to large-area failures of the visual field which are very restrictive in everyday life. The symptoms depend on the cause of the optic nerve damage.
In a special hereditary form (liver ́sche optic atrophy), for example, large central failures in the visual field are irreversible. In optic atrophy caused by tumor pressure, color vision is the most affected at the beginning of the symptoms, while visual acuity improves again after adequate therapy. In the diagnosis of optic atrophy, the reflection of the fundus of the eye performed by the ophthalmologist is particularly important.
Here the papilla (exit of the optic nerve) appears pale. Here too, the diagnosis varies in ease or difficulty from cause to cause. The papilla shows different impressive changes.
As the resolution of the MRI improves, the representation of the optic nerve in the MRI plays an increasingly important role. MRI has become more and more established in ophthalmology, particularly for assessing the course of the nerve behind the retinal ocular fundus. The therapy of optic atrophy usually depends on the cause.
In most cases, however, the therapy is not very promising and there is no improvement of the symptoms. Especially in cases of traumatic damage to the optic nerve, treatment is hardly possible. Although cortisone is used to try to reduce the nerve swelling, complete recovery of vision is very often not possible.
If the nerve is compressed by a tumor, it is relatively easy to find a treatment by relieving the nerve, i.e. removing the tumor. In order to diagnose optic atrophy and to better assess its course, it may be necessary to perform magnetic resonance imaging (a so-called MRI scan). This involves using electromagnetic radiation to make the structures inside the body visible.
Due to its molecular composition, an MRI is particularly well suited for imaging soft tissue structures, which is very helpful in assessing the likewise “soft” optic nerve. This enables the treating physician to assess how far degeneration has already progressed and whether other space-consuming processes may underlie the whole process and also whether the disease process can be slowed down by the therapy or not. In most cases, optic atrophies occur in the context of or as a consequence of previous diseases of the eye.
It is divided into primary and secondary causes:
- Inherited optic atrophy
- Optic atrophy due to poisoning (tobacco, alcohol, lead)
- Papillitis (inflammation of the optic disc)
- Retrobulbar neuritis (inflammation of the optic nerve behind the eye)
- Congestive papilla (in case of increased intracranial pressure)
- Primary causes: This includes all optic atrophies that are not caused by another disease. The optic disc, the point where the optic nerve exits the eye (blind spot), is sharply defined.The following causes are possible: inherited optic atrophy Optic atrophy due to poisoning (tobacco, alcohol, lead)
- Inherited optic atrophy
- Optic atrophy due to poisoning (tobacco, alcohol, lead)
- Secondary causes: Secondary causes are usually a disease of the retina or the optic nerve itself, e.g. glaucoma. In most cases the optic nerve exit is swollen in these cases.
Optic atrophy often occurs after the following diseases: Papillitis (inflammation of the optic disc) Retrobulbar neuritis (inflammation of the optic nerve behind the eye) Congestive papilla (in case of increased intracranial pressure)
- Papillitis (inflammation of the optic disc)
- Retrobulbar neuritis (inflammation of the optic nerve behind the eye)
- Congestive papilla (in case of increased intracranial pressure)
Optic atrophy can only be prevented by preventing the cause. Prophylaxis is more or less difficult depending on the circumstances. Hereditary optic atrophy cannot be prevented, whereas optic nerve atrophy caused by alcohol or tobacco can be avoided.
Optic atrophy is a degenerative deterioration of the optic nerve, which usually progresses slowly. The individual nerve cells along the optic nerve gradually degenerate, so that the affected person can expect to be completely blind at the end of the disease. In children and adolescents, this process is generally much faster than in patients who only became ill at an advanced age.
According to the current state of science, once nerve cells have died, they cannot be restored, so that early detection and thus the earliest possible treatment of optic atrophy is of great importance. The first symptoms that are noticed by those affected are partial visual field loss and an increasing loss of central visual acuity. Night vision and color perception during the day can also be impaired.
In imaging procedures, such as ophthalmoscopy, progressive fading and discoloration of the optic nerve papilla is observed at the back of the eye. In order to better assess the damage that has already occurred, further diagnostic procedures such as MRI and VECP are indicated. The earlier the diagnosis of optic nerve atrophy can be made, the earlier an appropriate therapy can be initiated and thus the progression of the disease slowed or even stopped.
Untreated, however, the disease ultimately leads to complete blindness of the affected eye in almost all cases. The prognosis depends on the cause of the optic nerve damage. If there is a traumatic cause, experience shows that the result is poor.
In contrast, in the case of temporary optic nerve damage caused by tumor pressure, the optic nerve recovers surprisingly quickly and well after relief, so that visual acuity is soon restored. In hereditary optic atrophies, the loss of vision is irreversible, i.e. irreparable. Optic atrophy in babies and small children can have various causes, including, for example, a congestive papilla, hydrocephalus, meningioma, retinitis pigmentosa, multiple sclerosis, inflammation of the optic nerve, traumatic processes and many more.
In Germany, therefore, the eyes of newborns are routinely examined for possible incipient pathological changes so that a diagnosis can be made as early as possible and appropriate treatment can be provided. For this purpose, the doctor uses special eye drops that dilate the baby’s pupil and thus enable him to examine and assess the ocular fundus. He pays particular attention to clouding and the like.
The first signs of discomfort in the child are the inability to fix objects and persons and a conspicuously strong reaction of the child to light stimuli. If the parents observe this behaviour, a visit to the doctor is recommended. The so-called Lebersche Optikusatophie is inherited mitochondrially from generation to generation.
This means that the mother alone is responsible for passing on the defective genes, which is why this is also called “maternal heritability”. Nevertheless, Leber’s optic atrophy is less frequent in women themselves. Furthermore, optic atrophy can also be inherited in the context of other syndromes, such as Behr syndrome I, limb belt dystrophy 20, motor sensitive neuropathy VI or Cohen syndrome.In each case, the cause is malfunction in the eye at the subcellular level of the tissue.