Eyeball atrophy is a condition in which the eyeball is deformed and reduced in size with a significant decrease in visual functions. The main causes of the development of atrophy of the eye are severe injuries of the visual organ, prolonged inflammation, retinal detachment. Symptomatically, atrophy of the eyeball is manifested by a lack of vision, a decrease in the size of the eye. For diagnostics, both basic techniques are used – ultrasound of the eye, ophthalmoscopy, biomicroscopy, tonometry, and additional ones – radiography, CT or MRI of the orbits, electroretinography. There is no treatment for atrophy that has already occurred; preventive (surgical and medical) measures are aimed at preserving the eye as an organ.
Eyeball atrophy is a pathological condition that occurs as a complication of severe injuries or inflammation, in which the eyeball decreases in size and completely loses its functions. Due to the constant growth of domestic and criminal injuries of the visual organ, the number of cases of disability as a result of the development of eyeball atrophy is also increasing. Hypotension of the eye resulting from damage is the main mechanism of atrophy and occurs in 25% of cases with penetrating wounds and in half of cases after contusion of the eye. In addition, eyeball atrophy is one of the leading causes of removal (enucleation) of the eye. More often, the pathology develops in men, mainly of working age.
The most common causes of the development of eyeball atrophy are eye injuries with damage to its membranes, severe inflammatory process (uveitis, neuroretinitis), total retinal detachment.
The pathogenetic mechanism of eye atrophy in uveitis or retinal detachment is based on the development of hypotonic syndrome. There is a violation of the work of the ciliary muscle, a decrease in secretory ability, an increase in uveoscleral outflow. Pronounced and persistent suppression of the secretion of watery moisture contributes to the expansion of retinal vessels, increased capillary permeability and fluid outflow from the vascular bed – all this leads to a violation of the normal trophic tissues. As a result of a violation of the nutrition of the structures of the eye, pronounced degenerative changes occur in the retina, the optic nerve disk, and the cornea. The eyeball gradually decreases in size, vision disappears, eyeball atrophy develops.
Eye injuries are divided into industrial, domestic, agricultural, children’s and received in combat conditions. Occupational injuries of the visual organ are often found in the mining and chemical industries. They are characterized by a severe course with frequent subsequent development of eyeball atrophy. In agriculture, injuries to the organ of vision are injuries caused by the horn or hoof of domestic animals, a tool. Considering that this type of injury is combined with infection with soil or fertilizers, adverse outcomes occur much more often than with other types of injuries.
Domestic eye injuries are associated with non-compliance with safety regulations when performing household or household chores. Most of the domestic injuries are received in a state of alcoholic intoxication. Children get an eye injury more often at school age. Damaging factors can be pencils and ski poles, hockey sticks, wire, etc. Combat injuries of the visual organ have a particularly severe nature of damage and almost always an unfavorable outcome. Despite the variety of eye injuries and their causes, any of them can lead to changes in ophthalmotonus, secondary inflammatory and degenerative processes with an outcome in atrophy of the eyeball.
Symptoms of eyeball atrophy
Based on the size of the anteroposterior axis (APA) and changes in the structures of the eye in ophthalmology, the following stages of eyeball atrophy are distinguished:
- the initial stage (APA exceeds 18 mm) – there are dystrophic changes in the cornea, the presence of traumatic cataracts, minor turbidity in the vitreous, retinal detachment in one quadrant.
- the developed stage (APA is less than 17 mm) – atrophy of the cornea and iris occurs. Mooring lines are formed in the vitreous body, retinal detachment spreads to several quadrants.
- the far–advanced stage (APA is less than 15 mm) – at this stage, an eyesore forms on the cornea; retinal detachment in all quadrants.
With the development of atrophy, visual acuity, as a rule, remains at the level of light perception, in the final stages the eye completely goes blind. Visually, there is a decrease in the size of the eye compared to a healthy one, clouding of the cornea. Given that the atrophy of the eyeball is the final stage of injury or inflammation, then the accompanying symptoms depend on the initial disease. With injuries, complaints of severe pain, a feeling of a foreign body, blepharospasm are noted. In inflammatory diseases, there may be a decrease in vision, photophobia, pain in the eyelid area. With retinal detachment, patients often complain of photopsias (flashes in the eye), the appearance of flies or the sudden appearance of a dark veil in front of the eyes.
The main method of pathology diagnosis is ultrasound of the eyeball, which is performed by an ophthalmologist. During the study, the length of the anteroposterior axis is determined, changes in the internal structures of the eye are examined. With all pathologies potentially dangerous in terms of the development of eyeball atrophy, a detailed survey is conducted to clarify the moment of occurrence of complaints. Ophthalmoscopy is performed (allows you to assess the degree and nature of changes in the vitreous body, sometimes examine the retina, detect a foreign body); biomicroscopy of the eye (reveals the localization of trauma, changes in the cornea and iris); tonometry (intraocular pressure in acute cases is determined by palpation, in the long term — instrumentally).
The list of other diagnostic methods depends on the primary disease. In case of injuries to the eyeball, radiography is additionally performed (to determine the localization of X-ray contrast foreign bodies), CT of orbits (detection of metal, glass, plastic foreign bodies) and magnetic resonance imaging (diagnosis of organic foreign bodies, clarification of damage to the scleral capsule and soft tissues, eye muscles, optic nerve).
Electrophysiological examination (electroretinography) provides important information about the state of the retina. Especially informative for the prediction of visual functions is the determination of the threshold of electrical sensitivity of the retina and the lability of the optic nerve. If the fundus is not visualized, and the threshold of electric phosphene is very high (exceeds 600 µA), then one can think of severe and possibly irreversible changes in the internal parts of the retina and the ineffectiveness of surgical treatment.
Treatment of eyeball atrophy
There is no treatment for the atrophy of the eyeball that has already occurred. An important task of an ophthalmologist is to prevent the progression of diseases or injuries of the eye to atrophy.
For this, both conservative and surgical techniques are used.
Conservative treatment is carried out for inflammatory eye diseases. It includes anti-inflammatory, antibacterial, immunosuppressive therapy, the use of cytostatics. In case of injuries, an integrated approach is used, which consists in the prevention of infectious and post-traumatic complications (antibacterial therapy with broad-spectrum drugs, anti-shock therapy, tetanus prevention), as well as primary surgical treatment, and then secondary surgical treatment of eye wound treatment. During primary surgical treatment, the extent of the wound is determined by revision of all quadrants of the eyeball. Secondary surgical treatment is carried out after 2 weeks. The main purpose of secondary processing is to improve visual acuity. To do this, the formed cataract and hemophthalmos (blood in the vitreous body) are removed.
With retinal detachment, various surgical methods of treatment are used, aimed at bringing the retinal layers closer together, restoring its integrity. Removal (enucleation) of the eyeball is carried out only with very severe damage and in the absence of prospects for restoring vision.
Measures to reduce injuries of the visual organ in children and adults are aimed at preventing the development of eyeball atrophy. Thus, in order to reduce injuries at work, automation of technical processes with a restriction of manual labor is necessary, provision of a high-quality lighting and ventilation system in workshops, regular verification of safety knowledge among workers. In everyday life, it is necessary to comply with all safety requirements when working with power tools, sharp knives. To prevent childhood injuries, adult supervision is necessary both on the street and at home. It is required to conduct a sanitization work by ophthalmologists in the form of lectures, where the most common causes of injuries in children and measures to prevent them are explained to adults in an accessible way.
Secondary prevention of eyeball atrophy includes the provision of timely ophthalmological care, the detection of inflammatory changes or signs of retinal detachment in the eyeball in the early stages and the appointment of a full-fledged competent treatment.