Biomicroscopy of the eye. A safe non-contact method for examining and diagnosing the media of the eye: what is biomicroscopy? Biomicroscopy of the lens

Modern medicine offers various ways to diagnose health. One of them is eye biomicroscopy. What is this research method and what is it used for? Let's try to figure it out further.

Shulpina N.B. described in detail the biomicroscopy of the eye. back in 1966. She devoted an entire book of the same name to this type of research. Many ophthalmologists still use it to improve the quality of diagnostic, preventive, and therapeutic work. In general, the procedure looks like this:

The patient sits in a specially designated seat opposite the doctor.
The specialist directs a beam of light from a slit lamp onto the person's eye.
Thanks to high-quality lighting using a microscope, an ophthalmologist examines the visible part of the eye for various types of abnormalities and pathological changes.
If the patient has increased sensitivity of the eyes to light, then the doctor uses special drops with an anesthetic.
When the method needs to be used on a child under 3 years of age, the specialist first puts the baby into a state of sleep. The study takes place when the child is in a horizontal position.

The slit lamp is a special device used for qualitative diagnostics of eye health. With its help, it is possible to examine in sufficient detail the iris, eyelids, conjunctiva, lens, sclera, and also the cornea. The light from the slit lamp is highly focused and is adjusted by a specialist. For example, biomicroscopy of the anterior segment of the eye using a slit lamp is as painless, safe and effective as possible.

Ultrasound and its features

One of the types of eye health diagnostics is ultrasound biomicroscopy of the eye, which is abbreviated as UBM. This diagnostic method allows you to visualize with maximum accuracy the most subtle and inaccessible structures of the front part of the eye. Note that this is not available for classical biomicroscopy, as well as for gonioscopy. Let us note that with the help of this diagnosis it is quite possible to give an accurate assessment of the following anatomical features of the eye:

iris;
ciliary body;
angle of the anterior chamber of the eye;
equatorial region of the lens;
functional interaction of the listed elements with each other.

UBM as a specific diagnostic method appeared relatively recently in our country - approximately in the 90s. This is precisely the reason for the small amount of information about UBM in the domestic literature.

Common varieties

Biomicroscopy of the eye media has a number of varieties, which are mainly influenced by the type of light supplied by the slit lamp. Let's look at these varieties and their features further:

Indirect focused light. In this case, the directed beam of light is focused not where the area of interest to the specialist is directly localized, but next to it. This method allows, using the resulting contrast, to track possible changes in individual elements of the eye and assess their health.
Direct focused light. Classic diagnostic option. With it, a beam of light is directed to a specifically selected area of the eye (eyeball) by the doctor. The method provides a good analysis of the transparency of optical media, as well as detection of possible darkening or clouding in the illuminated area.
Indirect diaphanoscopic transillumination. With this type of research, using the same rays, “mirror” areas are formed in areas bordering optical media. This phenomenon occurs due to different refractive indices of light. Thanks to such diagnostics, it is possible to quickly identify the localization of changes in the eye.
Reflected light. With this method of testing, a directed beam of light is reflected from the iris. The method is used if the doctor needs to identify swelling or detect a foreign body.

The duration of exposure and study is on average the same in all these cases. After certain complaints or existing results, the doctor independently selects a diagnostic method.

Advantages of biomicroscopy

Biomicroscopy of the eye is a high-quality, time-tested diagnostic method. What advantages does it have?

Checking the health of the optic nerve.
High accuracy in determining the localization of changes in the eye.
Diagnosis of the choroid.
The ability of light to penetrate at different angles, breaking through the transparent tissues of the eye.
The ability to examine the eye even at considerable depth.
Qualitative diagnosis of pathological changes in the retina.
By using a special diverging lens, it is possible to neutralize the optical system of the eye and perform biomicroophthalmoscopy.
The ability to make a so-called optical cut due to the fact that the light can be directed both horizontally and vertically.

Biomicroscopy of the eye was a common type of health diagnostics back in the Soviet Union. Today, slit lamps have undergone global modernization and are equipped with various advanced capabilities. Despite the high quality of diagnostics, its cost remains quite reasonable and averages about 700 rubles.

In contact with

Biomicroscopy uses a slit lamp. This ophthalmic device allows you to examine the visible structures of the eye under magnification. The procedure itself is non-invasive and is aimed at examining the conjunctiva, sclera, eyelids, lens, iris and cornea. The slit lamp is equipped with a source of narrowly directed light, and also includes a binocular microscope.

How does the diagnostic process work?

During biomicroscopy, the patient must sit opposite the doctor, after which the doctor directs a beam of light from the slit lamp directly to the eye of the patient. Through a binocular microscope, the doctor identifies the presence of any pathologies. Some patients have increased sensitivity to light and photophobia. This feature makes examination difficult, so such patients should first drip an anesthetic solution into the eye.

If it is necessary to perform biomicroscopy on a child under two years of age, the study is carried out under conditions of deep physiological sleep. The child himself is in a horizontal position to reduce the likelihood of unintentional movement.

Advantages of the biomicroscopy method

When examining the eye using a slit lamp, many diseases of the cornea, eye chambers (for example, glaucoma), and the lens (for example, cataracts) can be detected. With biomicroscopy, you can quite accurately determine the location of the area of pathological changes. When examining the anterior chamber of the eye, it is quite easy to identify the cause of glaucoma, which is accompanied by intraocular hypertension. Also, with biomicroscopy it is easy to detect pathology of the choroid, retina or optic nerve. Due to the fact that the beam of light from the slit lamp can penetrate the structures of the eye from different angles, the depth of these pathological changes can be diagnosed.

Light from a lamp can come from both vertical and horizontal planes. The advantage of a narrow directional beam is the contrast that is created between the illuminated and darkened areas of the eyeball. As a result, the doctor receives a so-called optical section. A slit lamp is also needed for biomicroophthalmoscopy. For this study, a lens with a scattering structure (power 60 diopters) is used, which is capable of neutralizing the optical system of the eyeball.

Video about slit lamp biomicroscopy

Types of research

The classification of biomicroscopy is based on the lighting option. There are four types:

Biomicroscopy with direct focused light. In this case, the beam is directed into a certain area of the eye, which makes it possible to determine the presence of areas of clouding or reduced transparency of the optical media.
Biomicroscopy in reflected light. This allows you to study the structure of the cornea using rays that are reflected from the iris. As a result, the doctor may detect tissue swelling or foreign bodies.
Indirect focused light during biomicroscopy allows you to focus the beam in close proximity to the area of pathological changes. This creates a contrast between brightly and dimly lit areas. This allows you to carefully study the area of possible pathology.
In the case of indirect diaphonoscopic transmission, mirror areas appear in the areas of transition of one optical media to another. This is due to different refractive power values. This type of biomicroscopy helps to more accurately determine the location of the pathology.

Price

Biomicroscopy can be performed as a separate study, or can be part of a comprehensive eye diagnostics.

1 200

Comprehensive diagnostic examination (visual acuity test, biomicroscopy, autorefractometry, ophthalmoscopy with a narrow pupil, pneumotonometry) - 3 500 rub.
Extended comprehensive diagnostic examination (visual acuity test, biomicroscopy, autorefractometry, ophthalmoscopy with a narrow pupil, pneumotonometry, fundus examination with a dilated pupil, OST) - 5 500 rub.

Above is the price for diagnostic services at our ophthalmology center at the time of publication of the material. You can find out the exact cost of services and make an appointment by calling the numbers listed on our website.

Modern methods of examining the visual system make it possible to identify dangerous ophthalmological pathologies even at the early stages of their development. Biomicroscopy of the eye is considered one of the most informative. It makes it possible to study in detail and with high magnification the elements of the anterior segment of the eyeball.

Specifics of biomicroscopy

Biomicroscopy is a non-contact method of examining the eye and its deep structures using a slit lamp. A slit lamp is a binocular microscope adapted for ophthalmological purposes, which is equipped with an illumination device that creates a beam of light. Using a slit lamp is non-contact and therefore painless.

The slit lamp makes it possible to study the structure of the eye tissues. The lamp's lighting system includes a slit-shaped diaphragm with adjustable width and color filters. Passing through the slit, a beam of light forms a slice of the optical structures of the eye, which can be viewed through a binocular microscope. To examine all the structures of the anterior region, the ophthalmologist alternately moves the light slit.

Indications for biomicroscopy

A detailed study of the elements of the anterior segment of the eye allows us to diagnose many vision pathologies. Biomicroscopy is included in the list of standard preventive examinations, along with (determination of visual acuity) and examination of the fundus. These three methods identify signs of most diseases of the visual system, and additional studies are prescribed to confirm the diagnosis.

Indications for biomicroscopy:

corneal pathology;
inflammatory processes of various nature in the conjunctiva;
tumors or cysts;
injury to the head, eyeball or eyelid;
inflammation or swelling of the eyelids;
scleritis or episcleritis;
abnormalities in the structure of the iris;
, iridocyclitis and other inflammations of the iris;
keratitis;
glaucoma;
cataract;
dystrophy of the cornea or sclera.

Also, an ophthalmological examination helps to assess the condition of the conjunctival vessels in hypertension and analyze changes in endocrine disorders. Biomicroscopy helps identify foreign bodies in the eye.

A slit lamp examination is mandatory before ophthalmological operations, as well as after the intervention. Biomicroscopy is the main method for assessing the results of treatment of the visual system, but it is not performed on patients with alcohol or drug intoxication, as well as people with mental illnesses that provoke inappropriate or aggressive behavior.

How is biomicroscopy performed?

To make it more convenient to examine the deep structures of the eye, such as the lens and vitreous body, a special drug is instilled into the eyes before the procedure to dilate the pupil. Before removing the foreign body, drops of anesthetic are instilled. This is usually lidocaine, so if you have an allergy, you need to inform your ophthalmologist.

If you want to examine the condition of the cornea for damage, inflammation and unknown pathologies, a special dye should be instilled before biomicroscopy. Then eye drops are dropped into the eye, which washes away the dye from healthy areas, leaving defects and changes in the cornea tinted for a short time, which allows them to be examined in more detail.

The study is carried out in a darkened room to provide a contrast between the unlit and lamp-lit areas of the eyeball. During biomicroscopy, the patient sits in front of a microscope. The chin and forehead need to be placed on supports. The microscope and illuminator are placed at eye level. The doctor sits opposite, adjusting the lighting and the width of the light beam. The beam is directed into the eye and the ocular structures are examined.

Biomicroscopy is painless, but due to the light, increased lacrimation and mild discomfort may occur. The manipulations take 10-15 minutes. For the study to be accurate and of high quality, it is recommended to blink rarely.

Methods of biomicroscopy according to the nature of lighting:

Direct focusing. The light beam is focused strictly on the area of the eye being examined. In this way, it is possible to evaluate the transparency of optical media and determine the localization of foci of turbidity.
Reflected light. A method of examining the cornea when light rays are reflected from the iris. This is how foreign bodies and areas of swelling are identified.
Indirect focusing. The light beam is focused near the required area. Thanks to contrast and low lighting, changes in the structures of the eye are better visible.
Indirect diaphanoscopic transillumination. At the boundary of optical media with different refractions of light, a specular reflection is formed. This allows tissue close to the reflected light exit to be examined. This is how the angle of the anterior chamber is examined.

In addition to different lighting methods, the ophthalmologist can use different biomicroscopy techniques. A sliding beam allows you to evaluate the relief of the cornea, identify newly formed vessels and infiltrates, as well as the depth of their location. Such a beam is obtained by moving a light strip along the surface in different directions. It is also possible to study structures in a mirror field. The method makes it possible to evaluate the surface topography and detect irregularities.

Biomicroscopy capabilities

With biomicroscopy, you can examine the condition of the conjunctiva, cornea, iris, lens, vitreous body and anterior chamber of the eyeball. Biomicroophthalmoscopy helps to examine the center of the fundus. Thanks to the slit lamp, it is possible to carry out early diagnosis of glaucoma, trachoma, cataracts and other eye pathologies.

A thin light section is obtained by narrowing and increasing the intensity of light in translucent tissues. In the optical section, you can see clouding of the cornea, new vessels, infiltrates, and deposits on the posterior surface of the membrane. The method helps not only to identify, but also to determine the depth of defects.

By examining the looped vascular network and conjunctiva, it is possible to observe the blood flow and movement of blood elements. With biomicroscopy, different zones of the lens are clearly visible (poles, cortex, nucleus, and others), as well as the anterior layers of the vitreous body. If the patient has cataracts, the study shows the localization of foci of opacification.

During biomicroscopy, the doctor can use aspherical lenses to examine the fundus of the eye and identify changes in the vitreous body and choroid. When diagnosing glaucoma, congestion, neuritis and retinal tears, focusing light on the fundus allows examination of the optic nerve head.

An improved slit lamp allows additional assessment of the thickness, specularity and sphericity of the cornea and determination of its parameters. With biomicroscopy, you can measure the depth of the anterior segment of the eye. The slit lamp shows defects in the vitreous that are not visible with other diagnostic methods. For example, fibrillar structures that indicate the presence of inflammation or dystrophy.

Recent innovations include ultrasound biomicroscopy, which has significantly expanded the capabilities of the method. The use of ultrasound makes it possible to examine the ciliary body, the lateral zones of the lens, the posterior surface and the section of the iris - many structures that are hidden behind the opaque iris during conventional biomicroscopy.

Biomicroscopy is an accessible and very informative method for diagnosing ophthalmological diseases. It is considered fundamental at the beginning of the diagnosis of any vision pathology, because with biomicroscopy one can study the structures of the anterior segment of the eye and some elements of the fundus. Biomicroscopy is available in most ophthalmology offices of public and private medical institutions.

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Biomicroscopy of the eye is a diagnostic method for examining the tissues and optical media of the eyeball by creating a sharp contrast between the unlit and illuminated areas. The examination is performed using a special device – a slit lamp.

Thanks to biomicroscopy, the ophthalmologist can evaluate the condition of the cornea, retina, anterior vitreous, lens and optic nerve head. In addition, such a study can be used to identify foreign bodies in the eyeball after injury.

In this article we will introduce you to the essence of this examination method and its varieties, indications, contraindications and methods of conducting eye biomicroscopy. This information will help you understand this diagnostic procedure, and you can ask your doctor any questions you may have.

The essence of the technique

This is what a slit lamp looks like for eye biomicroscopy.

Biomicroscopy of the eye is performed using a slit lamp. This apparatus includes a lighting device (6 V, 25 W bulb), a binocular stereoscopic microscope and a lens. To create lighting slits (vertical or horizontal), a slit diaphragm is installed in the device along the path of the lighting beam. The body of a binocular stereoscopic microscope contains an optical system that allows you to magnify the image by 5, 10, 18, 35 or 60 times. A special diverging lens (60 diopters) is installed above the microscope, which allows you to examine the fundus of the eye. The study of the structures of the eye is performed in a dark room - thus creating a significant contrast between the illuminated areas of the eyeball and the darkened areas of the eyeball.

By focusing light on the cornea through an optical section, the doctor can examine the posterior and anterior surfaces of the area being examined and its substance. If cloudiness or an inflammatory focus is detected in the cornea, the specialist can determine the depth, location and extent of the pathological focus. In the same way, the doctor can detect foreign bodies.

After focusing the light on the lens, the specialist sees its optical section in the form of a transparent biconvex body. It defines the interface zones (oval stripes). When assessing the condition of the lens, the doctor may detect clouding (a sign of incipient cataracts).

By focusing light on the fundus of the eye, the condition of the retina and optic nerve head is studied. In this way, signs of nipple congestion, breaks in the central part of the retina and optic neuritis can be detected.

When studying the vitreous body, the doctor can identify signs of inflammatory and dystrophic processes in the form of fibrillar structures. In addition, during the study, the conjunctiva and iris are examined.

Objectives of the study

Using eye biomicroscopy, a doctor can evaluate:

condition of the eyelids and conjunctiva;
condition of the cornea: its thickness, structure, nature and area of location of identified pathological changes;
the condition of the fluid located in the anterior chamber of the eye (between the iris and cornea);
anterior chamber depth parameters;
condition of the iris;
condition of the lens;
condition of the anterior part of the vitreous: its transparency, opacities, presence of blood or deposits.

Varieties

To perform eye biomicroscopy, various lighting options can be used:

direct focused light - to assess the transparency of optical media and identify areas of turbidity;
reflected light - to identify foreign bodies or detect edema;
indirect focused light - for a more detailed examination of the various detected changes;
indirect diaphanoscopic transillumination - to determine the exact localization of pathological changes.

Indications

This research method has no age restrictions.

Biomicroscopy of the eye can be used to diagnose the following pathologies:

diseases of the conjunctiva of various origins (cysts or tumors caused by inflammatory processes);
inflammation, trauma, swelling and tumors of the eyelids;
scleral pathologies: structural anomalies, keratitis, corneal dystrophy, scleritis, etc.;
inflammatory processes and structural abnormalities of the iris;
glaucoma;
corneal foreign bodies;
various injuries;
, giving complications to the organs of vision.

In addition, eye biomicroscopy is performed to assess the effectiveness of treatment, prepare for surgical operations and analyze the results of already performed interventions.

Contraindications

Biomicroscopy of the eye has virtually no contraindications. Such a study cannot be performed only in the following cases:

severe forms of mental illness;
alcohol or drug intoxication.

How the research is carried out

Biomicroscopy of the eye can be performed in a specially equipped office of an ophthalmologist. Preparing the patient for such a study is not required.

Depending on the purpose of the examination, the patient may undergo the following procedures:

If necessary, study the condition of the lens or vitreous body. 15 minutes before the procedure, to maximize pupil dilation, Tropicamide solution is instilled into the eyes (adults - 1%, children under 6 years old - 0.5% solution).
When examining the cornea. A fluorescein dye solution is instilled into the eye being examined. After this, the dye is washed off with drops and an inspection is carried out. If the integrity of the cornea is violated, residues of the dye solution are detected in areas of its damage.
If necessary, remove a foreign body. To perform surgery, a solution of local anesthetic (Lidocaine) is instilled into the eye before the examination. Before carrying out such operations, the doctor must make sure that there is no allergic reaction to the drug used.

The eye biomicroscopy procedure is performed in the following sequence:

The patient sits opposite the doctor and places his chin on a special stand, and rests his forehead against a special bar. During the examination, he must remain still and try to blink as little as possible. If the examination is carried out for a child under 3 years of age, then the procedure is recommended in a state of deep sleep or in a horizontal position.
The specialist sets up a slit lamp and examines the necessary structures of the eye. The required lighting option is used for each part of the eyeball.

The duration of eye biomicroscopy is about 10 minutes.

Which doctor should I contact?

Biomicroscopy of the eye can be prescribed by an ophthalmologist for various eye diseases, to remove a foreign body or evaluate the effectiveness of treatment. If necessary, the doctor may recommend other diagnostic procedures:

measurement of intraocular pressure;
ophthalmoscopy;
gonioscopy;
OCT (optical coherence tomography), etc.

Biomicroscopy of the eye is a simple, accessible and non-invasive research method that allows you to diagnose many ophthalmological pathologies. Thanks to this technique, the doctor can study in detail the condition of the cornea, lens, retina, optic nerve, vitreous body, eyelids, conjunctiva and iris. In addition, this diagnostic method helps ophthalmologists remove foreign bodies from the cornea. The examination takes no more than 10 minutes and does not require special preparation of the patient.

Ophthalmologist Yakovleva Yu. V. talks about eye biomicroscopy:

Slit lamp biomicroscopy - how to do it:

The human organ of vision is a complex and delicate mechanism. Therefore, if pathologies occur in rare cases, an ophthalmologist can make a diagnosis only by visual examination of the patient’s eyes. In most cases, the specialist uses special techniques that are based on the use of instruments and devices. One of these methods is biomicroscopy. Let's find out about it in detail.

Possibilities of the diagnostic procedure

Biomicroscopy is a diagnostic method for examining the environment of the eye using a special device - a slit lamp. It combines a powerful light source and a microscope. This combination allows the ophthalmologist to perform the following tasks:

Inspect the conjunctiva and eyelids.
Examine the structure of the cornea of the eye, the thickness of this element, diagnose the localization and nature of pathologies in it.
Determine the moisture state of the anterior chamber of the eye, that is, the space between the iris and cornea.
Determine the depth of this chamber.
Perform a detailed examination of the iris.
Examine the lens, determining the presence and localization of opacities in it.
Examine the anterior half of the vitreous body and identify blood, opacities, and deposits of various origins in it.

The beam of a slit lamp allows the ophthalmologist to examine the structures of the organ of vision in a section. And this, in turn, allows you to accurately localize various pathologies.

Indications for biomicroscopy and contraindications

The procedure is not always used to examine the organ of vision. The doctor uses it in the following situations:

Presence of eyelid pathologies. This refers to injuries, tumors, inflammation of the eyelids, their swelling, and other anomalies.
Various diseases of the conjunctiva, including cysts, tumors, allergic and inflammatory diseases.
Pathologies of the sclera and cornea. These are scleritis, keratitis, abnormalities of the cornea, sclera, as well as dystrophies of various etiologies.
Pathology of the iris, including abnormalities of its structure and inflammatory diseases.
Cataract and glaucoma.
Eye injuries.
Presence of a foreign body in the cornea.
Diseases of the endocrine system.
Postoperative and preoperative examination.
Evaluation of treatment effectiveness.

In addition to the wide range of indications for the procedure, there are also limitations in its implementation. Among the contraindications to biomicroscopy are the state of drug or alcohol intoxication of a person, his inappropriate behavior due to severe mental illnesses of the body.

Carrying out manipulation

Biomicroscopy as a method of diagnostic examination does not require preliminary preparation of the patient. If the ophthalmologist’s goal is to examine the lens and vitreous body, then 15-20 minutes before the manipulation it is necessary to instill a tropicamide solution into the eyes. When the eye doctor's patient is under six years old, a 0.5% solution of this medicinal substance is used. Adults usually take a one-percent medicine.

When there are inflammatory diseases of the cornea or injuries that violate its integrity, preliminary staining of the organ of vision with a solution of rose bengal or fluorescein is mandatory. For this purpose, the doctor instills the substance into the conjunctival cavity, then rinses it with eye drops. This treatment allows the paint to be washed off from undamaged areas and the areas with damaged epithelium to become colored.

If biomicroscopy is performed before removing a foreign body, then a lidocaine solution is instilled into the eye.

A prerequisite for this diagnostic procedure is darkness in the room. The slit lamp is placed on a special table that has a headrest. The patient places his selection in it. He presses his forehead tightly against the crossbar. The ophthalmologist sits on the other side of the device, placing it in the correct position, adjusting the width of the light beam and its brightness. Using different types of lighting, the doctor reveals the most minor changes in the tissues of the eye. The patient's head must remain motionless. As for blinking, it is not prohibited, but it is advisable to do it less often.

The duration of biomicroscopy is no more than ten minutes. She has no complications. The only thing to consider is the possibility of allergic reactions to medications used in the preliminary preparation of the eyes.