Disease Index Eyes and Vision

Optic Atrophy

Optic atrophy, or degeneration of the optic nerve, can develop spontaneously or can follow inflammation or edema of the nerve head.Atrophy of the optic nerve is classified according to its morphology and pathogenesis. There is not medical/surgical treatment available for optic atrophy. However, the underlying cause when treated may help in preserving some vision in patients with partial optic atrophy.

Optic atrophy, or degeneration of the optic nerve, can develop spontaneously (primary) or can follow inflammation or edema of the nerve head (secondary). Some forms of this condition may subside without treatment, but degeneration of the optic nerve is irreversible.

Morphology and pathologic classification of optic atrophy

Atrophy of the optic nerve is classified according to its morphology and pathogenesis. The following forms are distinguished on the basis of ophtalmoscopic findings:

  • Primary atrophy of the optic nerve
  • Secondary atrophy of the optic nerve
  • Glaucomatous atrophy of the optic nerve

Forms of primary atrophy of the optic nerve can be further classified according to their pathogenesis:

  • Ascending atrophy in which the lesion is located anterior to the lamina cribrosa in the ocular portion of the optic nerve or retina.
  • Descending atrophy in which the lesion is located posterior to the lamina cribrosa in retrobulbar or cranial location.

Etiology of optic atrophy

Etiology of primary atrophy of the optic nerve:

The most important causes are as follows:

  • Ascending atrophy (after 2-4 weeks).

–      Usually vascular, such as central retinal artery occlusion or anterior ischemic optic neuropathy.

  • Descending atrophy (after 4-6 weeks).

–      Compressive, such as from an orbital or intracranial mass or hydrocephalus.

–      Traumatic, such as avulsion, compression of the optic nerve in a fracture, or hematoma in the optic nerve sheath.

–      Inflammatory, such as retro-bulbar optic neuritis, arachnoiditis of the optic chiasm, or syphilis.

  • Toxic

–      Chronic abuse of low-grade tobacco and alcohol in tobacco and alcohol amblyopic.

–      Lead, arsenic, or thallium

–      Methyl alcohol

–      Medications, such as Ethambutol, chloramphenicol, gentamicin, isoniazid, vincristine, penicillamine, etc.

  • Congenital or hereditary.

–      Infantile hereditary optic atrophy (an autosomal-dominant disorder with slow progressive loss of visual acuity, color vision defects, and visual filed defects.

–      Juvenile hereditary optic atrophy (similar to the infantile form, only the onset is usually later, in the second decade of life).

–      Leber’s optic atrophy.

–      Behr infantile recessive optic atrophy.

  • Systemic disorders.

–      Hemorrhagic anemia or pernicious anemia

–      Leukosis

Etiology of secondary atrophy of the optic nerve- The most important causes are:

  • Papilledema
  • Anterior ischemic optic neuropathy.
  • Papillitis

The etiology of any atrophy of the optic nerves should be determinate to exclude possible life threatening Intracerebral causes such as a tumor.

What are the symptoms of optic atrophy?

The symptoms of optic atrophy relate to a change in vision, specifically:

  • Blurred vision
  • Difficulties with peripheral (side) vision
  • Difficulties with color vision
  • A reduction in sharpness of vision

DIFFERENTIAL DIAGNOSIS OF OPTIC ATROPHY

Pallor of optic disk seen in partial optic atrophy must be differentiated from other causes o pallor disk which may be non-pathological and pathological.

Non-pathological pallor of optic disk may be seen in axial myopia, infants, and elderly people with sclerotic changes. Temporal pallor is often associated with large physiological cup. Pathological causes of pallor disk other than optic atrophy include hypoplasia, congenital pit and coloboma.

INVESTIGAIONS IN A CASE OF OPTIC ATROPHY

Following investigations should be done in a case presenting with optic atrophy.

  • Blood investigations include total and differential count, ESR, blood VDRL tests and blood sugar (fasting and PP).
  • Complete visual fields examinations (both peripherals and central fields or vision). On Goldmann or automated perimeter and tangent screen scotometry to reveal concentric contractions.
  • Radiography of skull and CT scan (skull if needed) to rule out intracranial lesions).
  • Complete ocular examination including visual acuity status, color vision test distant direct ophthalmoscopy and fundus photography.

Treatment of optic atrophy

There is not medical/surgical treatment available for optic atrophy. However, the underlying cause when treated may help in preserving some vision in patients with partial optic atrophy. However, once a complete optic atrophy sets in, the vision cannot be recovered or restored or saved.

Homeopathic treatment of optic atrophy- Homeopathy is one of the most popular holistic systems of medicine. The selection of remedy is based upon the theory of individualization and symptoms similarity by using holistic approach. This is the only way through which a state of complete health can be regained by removing all the sign and symptoms from which the patient is suffering. The aim of homeopathy is not only to treat optic atrophy but to address its underlying cause and individual susceptibility. As far as therapeutic medication is concerned, several remedies are available to cure optic atrophy that can be selected on the basis of cause, sensations and modalities of the complaints.  For individualized remedy selection and treatment, the patient should consult a qualified homeopathic doctor in person. There are following remedies which are helpful in the treatment of optic atrophy:

Agaricus, Argentum Nitricum, Nux Vomica, Phosphorous, Syphillinum, Tabacum, Arsenic Album, Conium, Stramonium, Strychininum and many other medicines

Reference:

Lippincott Williams & Wilkins- Professional guide to diseases; 2008; 682

Gerhard K. Lang- Ophthalmology: a pocket textbook atlas; 2006; 393 &94

Sunita Agrawal, Athiya Agrawal, David J Apple- Textbook of Ophthalmology, Volume 2

About the author

Ashish Sharma

Ashish Sharma

Leave a Comment

4 Comments

  • hi
    my daughter has swallen eye nerve related to head presur because there is excess liquid in the head pressing on the eye nerve , so is the coconut oil useful in her case? and is there since approve wepsite for it , and if there is another natural remedy for this please tel me about it . thanks
    asma

  • 23 yrs nephew meet Sever road accident on 20.01.2015 and was in coma for aroun 90 days (oxanal head injury) now he is fit.mind body as usal working but he lost his eye sight.Doctor has declared that he is suffering from optic atrophy and no any chance to recover eye sight.Kindly help me and suggest any medicine or way.
    Thanks.

  • Dear Sir,

    My son 6 months old is suffering from Temporal Pallor of Optical Disc .Doctors said optic nerves are very weak , consult Neuro Physician . Neuro Physician said will perform Flash VPE test to know the exact position of nerves Can u tell us any medicine is available for temporal pallor