The eyes are the windows to the soul, through which the beauty outside the window passes, along the optic nerve and through the long optic canal inside the orbital bone to our brain. Without the transmission of the optic nerve, even the most beautiful scenery would slip past our bright eyes. To make matters worse, the optic nerve is different from the nerves that innervate our fingers and toes – once it is necrotic, it cannot regenerate! Optic nerve atrophy is not the name of a disease, but a formative change in any disease that causes lesions in the retinal ganglion cells and their axons, resulting in a thinning of the entire optic nerve, a term commonly used in pathology. Optic nerve atrophy is the end result of optic nerve damage. It is characterized by degeneration and loss of optic nerve fibers, conduction dysfunction, changes in visual field, and loss of visual acuity. Optic nerve atrophy symptoms 1, primary optic nerve atrophy: primary optic nerve atrophy is due to damage to the orbital, intracanalicular and intracranial segments of the optic nerve after the sieve plate, as well as the optic cross, optic bundle and lateral geniculate body, so it is also known as downstream optic nerve atrophy. The fundus changes in downgradient optic nerve atrophy are limited to the optic disc, which appears grayish in color with extremely neat borders. Due to atrophy of the optic nerve fibers and loss of its myelin sheath, the physiological depression appears slightly larger and deeper in the shape of a shallow dish, and small gray-blue dotted sieve plates are visible. The retina and retinal vessels were normal. Careful visual field analysis must be performed in each case of primary optic atrophy. It is often seen that patients with pituitary tumors are first diagnosed in ophthalmology due to visual acuity loss, which is misdiagnosed or missed due to the ophthalmologist’s neglect of visual field examination, resulting in patients missing the time for treatment. 2.Secondary optic nerve atrophy: Secondary optic nerve atrophy is caused by long-term optic disc edema or severe optic discitis. The lesions are mostly confined to the optic disc and its adjacent areas, so the fundus changes are also limited to the optic disc and its adjacent retina. The optic disc is white due to gliosis, and the boundaries of the optic disc are indistinct. The physiological depressions are filled with gliosis, so the physiological depressions disappear and the sieve plate cannot be detected. The retinal arterioles near the optic disc may be thin or have white sheaths, and the retinal veins may be slightly thick and curved. Some unresolved hemorrhage and hard exudate may remain in the posterior pole of the retina. In secondary optic nerve atrophy, most of the patients have completely lost their vision, and in the few patients with partial vision, the visual field is also significantly reduced centripetally. 3, episodic optic nerve atrophy: episodic optic nerve atrophy is due to extensive lesions of the retina or choroid, causing damage to the retinal ganglion cells and resulting in optic nerve atrophy, so also known as retinal optic nerve atrophy or continuous optic nerve atrophy. Almost all extensive retinal choroidal lesions can cause episodic optic nerve atrophy. Examples include central retinal artery blockage, retinitis pigmentosa, severe retinal choroidal inflammation and metaplasia, and advanced glaucoma. The fundus of episcleral optic nerve atrophy is characterized by a waxy yellow optic disc with clear borders; the retinal vessels are mostly thin, and some pigmentation is visible in the fundus. In addition, patients may also have primary lesions of the retina, choroid or retinal vessels. Diagnostic tests for optic nerve atrophy The diagnosis of primary optic nerve atrophy should be made with caution and should not be made solely on the basis of fundus examination finding pale optic discs. Because of individual differences in normal individuals, the color of the optic disc can appear pale, but the visual function is completely normal. The diagnosis of primary optic nerve atrophy must be made in conjunction with visual acuity, visual field and visual electrophysiology findings, and after excluding other ocular diseases and refractive errors. Laboratory tests: mainly for the primary cause of optic nerve atrophy, to clarify the cause of the disease. Other auxiliary examinations: 1, visual field examination visual field changes vary according to the location of the optic nerve damage: optic neuritis near the segment of the eye, there is a huge central dark spot in the visual field; lesions of the optic nerve slightly distant from the eye can be manifested as a limited defect or centripetal narrowing of the visual field; optic cross lesions can be bilateral temporal hemianopia; unilateral lateral geniculate or optic bundle lesions, both eyes on the opposite side of the lesion appears ipsilateral hemianopia The visual electrophysiological examination can reveal the following 2. Visual electrophysiological examination may reveal characteristic abnormal changes. Treatment options for optic nerve atrophy In the treatment of primary optic nerve atrophy, we should first actively search for the cause and treat its primary disease. The majority of optic nerve atrophy caused by pituitary tumors can often recover well after surgery, even though the visual impairment is already very severe. Optic nerve atrophy caused by post-traumatic fracture of the optic nerve canal can also receive better results if early surgery is performed to decompress and remove the compression of the fracture fragment on the optic nerve. For the treatment of inflammatory, ischemic and other causes of optic nerve atrophy, the main treatment is etiology. If the diagnosis is made in time, the cause can be removed and a targeted treatment plan can be used as early as possible to preserve or restore some of the vision. Therefore, if the diagnosis of optic nerve atrophy is clear, it must be actively treated, and early symptomatic treatment is of great significance. Treatment from the perspective of improving circulation and repairing the nerve is a relatively direct and effective method. However, for optic nerves that have been atrophied for a long time, it is difficult to restore their function even with treatment. There is usually no effective treatment for secondary optic nerve atrophy. Active treatment of optic discitis and early release of intracranial hypertension may have some therapeutic effect if treated early in the course of the disease, but there is no therapeutic effect in late stages. There is no specific treatment for episodic optic nerve atrophy. Prognosis of optic nerve atrophy Prognosis: Optic nerve atrophy is the final outcome of severe damage to the optic nerve, and the prognosis of vision is generally very poor. However, the majority of patients with downstream optic nerve atrophy caused by pituitary tumor compression of the optic cross can have amazing recovery of vision after surgical removal of pituitary tumor.