Features of the clinical course of optic neuritis due to sphenoiditis

Background. Optic neuritis is the most common cause of optic nerve damage in young people and is characterized by a variety of etiological factors, including infectious, autoimmune, and demyelinating diseases. Objective: to determine the features of the clinical course of optic neuritis due to sphenoiditis. Materials and methods. We examined 35 patients aged 18 to 52 years with a diagnosis of optic neuritis, their average age was 31.2 ± 15.7 years. Patients were randomized into two groups. The first group of 27 patients (27 eyes) received systemic anti-inflammatory, immunosuppressive, desensitizing therapy, electrophoresis of antibacterial substances. In the second group of 8 patients (8 eyes), who were diagnosed with inflammation of the optic nerve on the background of sphenoiditis, in addition to the indicated therapy, endonasal electrophoresis of an antibacterial, antiseptic agent was conducted, using corticosteroid and antihistamine drugs. A general ophthalmic examination was done along with determination of visual acuity, visual fields, ophthalmoscopy, computed tomography, anterior and posterior rhinoscopy, pharyngoscopy, fluoroscopy in direct and targeted lateral projections, endoscopy. Results. In patients with optic neuritis on the background of sphenoiditis, the inflammatory symptoms of the disease (headache, pain when pressing in the nose area disappeared, nasal breathing and smell improved) were relieved, visual acuity increased (p < 0.02) and the total visual field expanded (p < 0.05) following general anti-inflammatory therapy. More often, patients complained of headache in the temple and occipital area and when tilting the head forward, difficulty breathing and nasal discharge, weakness, fever and deterioration of vision. Conclusions. One of the clinical differential indicators in the diagnosis of optic neuritis on the background of sphenoiditis can be headaches, pain when pressing in the nose area, deterioration of nasal breathing and smell. Diagnosis of optic neuritis should be performed by an ophthalmologist in conjunction with an otorhinolaryngologist, using radiological methods, rhinoscopy, pharyngoscopy. It is recommended to use vacuum lavage of the nasal cavities and endonasal electrophoresis of antibacterial, antiseptic and desensitizing drugs against the background of general anti-inflammatory therapy for the management of patients with optic neuritis due to sphenoiditis.