What is Ischemic Neuropathy in Children?
Ischemic neuropathy is a group of eye diseases that occurs for three reasons: local changes in the walls of blood vessels, disturbances in general hemodynamics, coagulation and lipoprotein changes in the blood.
The general dynamics of the blood is usually disturbed due to hypotension, hypertension, diabetes, atherosclerosis, blood diseases, occlusive diseases of large vessels. Vascular endothelial disorders, vascular atheromatosis also affect the development of the diseases under consideration. Therefore, pathogenetic therapy is important – methods that are aimed at eliminating and preventing the development of the disease.
Two types of disease will be considered below:
- anterior ischemic neuropathy
- posterior ischemic neuropathy.
Anterior ischemic neuropathy (IDU) is an acute circulatory disorder in the intrabulbar section of the optic nerve. The reasons can be very different. This disease can be a symptom of systemic diseases in the body of the child.
Posterior ischemic neuropathy is a disease that is less common than IDUs, it consists in the development of ischemic disorders along the optic nerve behind the eyeball, in the intraorbital section.
Causes of Ischemic Neuropathy in Children
Anterior ischemic neuropathy
In a third of patients (children and adults), the cause is hypertension (high blood pressure), in about 20% the cause is generalized atherosclerosis. In a minority of patients with this diagnosis, the cause is systemic hypotension, diabetes mellitus, temporal arteritis, rheumatism.
Even less often, anterior ischemic neuropathy in children is associated with blood diseases, for example, with chronic leukemia. The cause (in extremely rare cases) may be endocrine pathology, for example, thyrotoxicosis, as well as surgical interventions – IDUs may be the result of anesthesia or cataract extraction.
Pathogenesis during Ischemic Neuropathy in Children
In the development of anterior ischemic neuropathy, an imbalance (lack of a correct, healthy ratio) between intravascular and intraocular pressure is important. When perfusion pressure drops to a certain extent, first partial and then pronounced ischemia of the prelaminar, laminar and retrolaminar parts of the optic nerve is formed in the system of the posterior ciliary arteries.
Symptoms of Ischemic Neuropathy in Children
Anterior ischemic neuropathy
For children, this disease is not characteristic. In the development of the disease, the main place is occupied by circulatory disorders in the vessels of the anterior third of the optic nerve. In most cases, the disease affects only one eye, but in a third of cases, the disease is bilateral in nature.
The second eye may not be affected immediately, but after a time – from several days to several years, the average period is from 2 to 5 years. IDUs can often be combined with such vascular lesions as posterior ischemic neuropathy, CAC occlusion, etc.
Anterior ischemic neuropathy has a sharp onset – usually after sleep, with hypotension, after lifting heavy weights. If the lesion of the optic nerve is total in nature, vision can drop to zero or almost to zero. If the lesion is partial, characteristic tapered scotomas are recorded. The explanation lies in the sectoral nature of the blood supply to the optic nerve.
Wedge-shaped prolapses in some cases can merge, a square or half prolapse forms. In most cases, the fallout is in the lower half of the field of view, but can be in the nasal or temporal half of the field of view.
Ophthalmoscopy shows a pale edematous disc of the optic nerve, wide dark veins, convoluted, are observed. In the peripapillary zone or on the disc there are small hemorrhages. When the course of the disease is severe, hemorrhagic manifestations are less pronounced, exudate is observed on the surface of the optic disc.
The acute period lasts from 4 to 6 weeks, after this period the edema becomes less, blood outflows dissolve, atrophy of the optic nerve occurs (can be expressed to a greater or lesser extent).
Posterior Ischemic Neuropathy (ZIN)
The causes and symptoms of posterior ischemic neuropathy in children are almost completely similar to those of anterior ischemic neuropathy. But to make a correct diagnosis is not so simple, since in the acute period there are no changes in the fundus. The optic nerve disc does not change color, the boundaries are clear.
4-6 weeks after the onset of the disease, disc decoloration is detected. Optic nerve atrophy is formed. Retinal vascular changes correspond to those with atherosclerosis and hypertension. With posterior ischemic neuropathy, defects in the field of view can be different: sectoral prolapse (mainly in the lower nasal region), concentric narrowing of the field of vision, paracentral scotomas, etc.
This disease most often causes damage to one eye. But after a certain period, there may be vascular disorders in the other eye. Vision drops to hundredths in almost all cases, and after treatment, in the best case, it rises by 0.1-0.2 or does not change.
Diagnosis of Ischemic Neuropathy in Children
Anterior ischemic neuropathy
It is not so easy to diagnose anterior ischemic neuropathy in children and adults, a comprehensive assessment of the general condition of the patient, the results of ophthalmoscopy, anamnestic data, the results of fluorescence angiography, and perimetric results are needed. Dopplerography of large vessels (carotid arteries, vertebrates) may also be important.
The method of ophthalmoscopy consists in examining the fundus (posterior wall of the eye) using special tools. Anamnestic data – information that may be associated with a disease – about factors that affect the pathogenesis and symptoms.
The method of fluorescence angiography is based on the intravenous administration of fluorescein sodium salt (contrast), and then on high-frequency photography of the fundus vessels using a special camera.
Treatment of Ischemic Neuropathy in Children
Posterior ischemic neuropathy
Applied complex, pathogenetic treatment, taking into account the general systemic vascular pathology.
In cases where emergency care is needed, anti-edema therapy is carried out in all cases (drugs: lasix, diacarb, glucocorticosteroids, glyceroascorbate). Further, spasmolytic agents (Cavinton, Trental, Xanthinolum, Sermion, etc.), thrombolytic agents (urokinase, fibrinolysin, hemase), anticoagulants (phenylin, heparin) are used for treatment. It is necessary to take vitamins of groups B, C, E.
Prevention of Ischemic Neuropathy in Children
It is important to timely and correctly treat common vascular and systemic diseases, promptly contacting a doctor. Remember that self-medication, especially – relating to an organ such as the eye – can harm your health without the possibility of recovery. Patients who have undergone ischemic neuropathy of the optic nerve in one eye need regular follow-up by an ophthalmologist and appropriate prophylactic therapy.