Centres of Excellence -> Ophthalmology -> Treatment of diseases of the optic nerve

Treatment of diseases of the optic nerve

There are various diseases that affect the optic nerve, called optic neuropathies. In everyday clinical practice, the most common are optic neuritis (inflammation of the optic nerve) and ischemic optic neuropathy.

What is acute optic neuritis?

Acute optic neuritis is an inflammation of the optic nerve and most often affects young adults, more often women. The leading symptoms are blurring of vision followed by pain behind or around the eye, which is aggravated by the movements of the eyeball. People who have acute optic neuritis most often complain that they see unclearly, have a black spot in the central field of vision, that the colors are washed out and of pain that occurs when moving the eye.

Diagnosis and treatment of optic neuritis

The diagnosis of optic neuritis is established by a complete eye examination, which includes testing of the visual field, color vision, contrast sensitivity and visual evoked potentials. Although spontaneous recovery is possible, patients are treated with corticosteroid infusions or pulse steroid therapy in order to accelerate vision recovery and achieve a better prognosis. In order to discover the cause of optic neuritis and possible connection with systemic diseases, it is necessary to do additional diagnostic work in cooperation with a neurologist and an otorhinolaryngologist. For prognosis, treatment and monitoring of the disease it is necessary to perform magnetic resonance imaging of the brain, spine and eye cavity.

What is anterior ischemic optic neuropathy?

Anterior ischemic optic neuropathy is damage to the optic nerve head caused by interruption of circulation in the blood vessels of the optic nerve, which leads to permanent visual impairment. There are two main clinical forms: non-arteritic and arteritic. The non-arteritic form is manifested by painless blurring of vision, which is usually noticed in the morning after waking up. People older than 50 are most often affected. Risk factors are arterial hypertension, diabetes mellitus, nocturnal hypotension (drop in blood pressure at night), smoking, sleep apnea and other conditions.

The arteritic form is caused by inflammation of blood vessels (temporal arteries) and along with blurred vision, headache, tingling sensation on the scalp (head surface) and face, pain in the muscles and joints and more often affects people over 70 years old.

Diagnosis and treatment of anterior ischemic optic neuropathy

The diagnosis of this disease of the optic nerve is made after a complete ophthalmological examination, visual field testing, laboratory results of a complete blood tests, with special reference to erythrocyte sedimentation, C-reactive protein and platelet count. In case of suspicion of the arteritic form, it is necessary to perform ultrasonography and biopsy of the temporal artery and extracranial imaging of blood vessels.

There is currently no known proven successful therapy for the non-arteritic form of optic neuropathy, but treatment with corticosteroids can stop further visual impairment. The arteritic form of anterior ischemic optic neuropathy is treated with high doses of corticosteroids in infusion in the acute phase and then in oral form in small doses to prevent involvement of the other eye.

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