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.
– 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
Etiology of secondary atrophy of the optic nerve- The most important causes are:
- Anterior ischemic optic neuropathy.
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
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