Basic methods for diagnosing eye diseases. Ophthalmologist (ophthalmologist, eye doctor). How is the reception and consultation carried out? What treatment does he prescribe? The membranes of the eye are washed away, an accurate diagnosis

■ Patient complaints

■ Clinical examination

External examination and palpation

Ophthalmoscopy

■ Instrumental examination methods

Biomicroscopy Gonioscopy

Echoophthalmography

Entoptometry

Fluorescein angiography of the retina

■ Examination of the organ of vision in children

PATIENT'S COMPLAINTS

With diseases of the organ of vision, patients complain of:

Decreased or changed vision;

Pain or discomfort in the eyeball and surrounding areas;

lacrimation;

External changes in the condition of the eyeball itself or its appendages.

Visual impairment

Decreased visual acuity

It is necessary to find out what visual acuity the patient had before the illness; whether the patient discovered decreased vision by chance or can he accurately indicate under what circumstances this occurred; sn-

whether vision decreased gradually or whether its deterioration occurred quite quickly in one or both eyes.

Three groups of reasons can be distinguished that lead to a decrease in visual acuity: refractive errors, clouding of the optical media of the eyeball (cornea, anterior chamber moisture, lens and vitreous body), as well as diseases of the neurosensory apparatus (retina, pathways and cortical part of the visual analyzer).

Vision changes

Metamorphopsia, macropsia And micropsies concern patients in case of localization of pathological processes in the macular area. Metamorphopsia is characterized by distortion of the shapes and outlines of objects, curvature of straight lines. With micro- and macropsia, the observed object appears to be either smaller or larger in size than it actually exists.

Diplopia(double vision) can only occur when fixating an object with both eyes, and is caused by a violation of the synchronization of eye movements and the inability to project an image onto the central fossa of both eyes, as occurs normally. When one eye is closed, diplopia disappears. Causes: disruption of the innervation of the external muscles of the eye or uneven displacement of the eyeball due to the presence of a space-occupying formation in the orbit.

Hemeralopia accompanies diseases such as hypovitaminosis A, retinitis pigmentosa, siderosis and some others.

Photophobia(photophobia) indicates inflammatory diseases or injury to the anterior segment of the eye. In this case, the patient tries to turn away from the light source or close the affected eye.

Glare(glare) - severe visual discomfort when bright light enters the eyes. It is observed with some cataracts, aphakia, albinism, cicatricial changes in the cornea, especially after radial keratotomy.

Seeing halos or rainbow circles around the light source occurs due to swelling of the cornea (for example, during a microattack of angle-closure glaucoma).

Photopsias- seeing flashes and lightning in the eye. Causes: vitreoretinal traction with incipient retinal detachment or short-term spasms of retinal vessels. Also photo

psia occur when the primary cortical centers of vision are affected (for example, by tumor).

The appearance of "flying flies" caused by the projection of the shadow of vitreous opacities onto the retina. They are perceived by the patient as points or lines that move along with the movement of the eyeball and continue to move after it stops. These “floaters” are especially characteristic of the destruction of the vitreous body in the elderly and patients with myopia.

Pain and discomfort

Unpleasant sensations in diseases of the organ of vision can be of a different nature (from a burning sensation to severe pain) and localized in the eyelid area, in the eyeball itself, around the eye in the orbit, and also manifest itself as a headache.

Pain in the eye indicates inflammatory processes in the anterior segment of the eyeball.

Unpleasant sensations in the eyelid area are observed in diseases such as stye and blepharitis.

Pain around the eye in the orbit occurs with lesions of the conjunctiva, injuries and inflammatory processes in the orbit.

Headache on the side of the affected eye is observed during an acute attack of glaucoma.

Asthenopia- unpleasant sensations in the eyeballs and orbits, accompanied by pain in the forehead, eyebrows, back of the head, and sometimes even nausea and vomiting. This condition develops as a result of prolonged work with objects located near the eye, especially in the presence of ametropia.

Tearing

Lacrimation occurs in cases of mechanical or chemical irritation of the conjunctiva, as well as with increased sensitivity of the anterior segment of the eye. Persistent lacrimation may result from increased tear production, impaired tear evacuation, or a combination of both mechanisms. Strengthening the secretory function of the lacrimal gland is reflexive in nature and occurs when the facial, trigeminal or cervical sympathetic nerve is irritated (for example, with conjunctivitis, blepharitis, and some hormonal diseases). A more common cause of lacrimation is impaired evacuation.

ation of tears along the lacrimal ducts due to pathology of the lacrimal openings, lacrimal canaliculi, lacrimal sac and nasolacrimal duct.

CLINICAL EXAMINATION

The examination always begins with the healthy eye, and in the absence of complaints (for example, during a preventive examination) - with the right eye. An examination of the organ of vision, regardless of the patient’s complaints and the doctor’s first impression, must be carried out consistently, according to the anatomical principle. An eye examination begins after a vision test, since after diagnostic tests it may worsen for a while.

External examination and palpation

The purpose of the external examination is to assess the condition of the orbital margin, eyelids, lacrimal organs and conjunctiva, as well as the position of the eyeball in the orbit and its mobility. The patient is seated facing the light source. The doctor sits opposite the patient.

First, the areas of the eyebrows, the bridge of the nose, the upper jaw, the zygomatic and temporal bones, and the area where the preauricular lymph nodes are located are examined. The condition of these lymph nodes and the edges of the orbit is assessed by palpation. Sensitivity is checked at the exit points of the branches of the trigeminal nerve, for which a point located on the border of the inner and middle third of the upper edge of the orbit is simultaneously palpated on both sides, and then a point located 4 mm below the middle of the lower edge of the orbit.

Eyelids

When examining the eyelids, you should pay attention to their position, mobility, condition of the skin, eyelashes, anterior and posterior ribs, intercostal space, lacrimal openings and excretory ducts of the meibomian glands.

Skin of the eyelidsNormally, it is thin, tender, with loose subcutaneous tissue located underneath it, as a result of which swelling easily develops in the eyelid area:

In case of general diseases (kidney and cardiovascular diseases) and allergic angioedema, the process is bilateral, the skin of the eyelids is pale;

In inflammatory processes of the eyelid or conjunctiva, the swelling is usually one-sided, the skin of the eyelids is hyperemic.

The edges of the eyelids. Hyperemia of the ciliary edge of the eyelids is observed during the inflammatory process (blepharitis). Also, the edges may be covered with scales or crusts, after removal of which bleeding ulcers are found. Reduction or even baldness (madarosis) of the eyelid, abnormal growth of eyelashes (trichiasis) indicate a chronic inflammatory process or a previous disease of the eyelids and conjunctiva.

Palpebral fissure. Normally, the length of the palpebral fissure is 30-35 mm, width 8-15 mm, the upper eyelid covers the cornea by 1-2 mm, the edge of the lower eyelid does not reach the limbus by 0.5-1 mm. Due to disturbances in the structure or position of the eyelids, the following pathological conditions arise:

Lagophthalmos, or “hare's eye”, is non-closure of the eyelids and gaping of the palpebral fissure with paralysis of the orbicularis oculi muscle (for example, with damage to the facial nerve);

Ptosis is a drooping of the upper eyelid that occurs when the oculomotor or cervical sympathetic nerve is damaged (as part of Bernard-Horner syndrome);

A wide palpebral fissure is characteristic of irritation of the cervical sympathetic nerve and Graves' disease;

Narrowing of the palpebral fissure (spastic blepharospasm) occurs due to inflammation of the conjunctiva and cornea;

Entropion is an inversion of the eyelid, usually the lower one, which can be senile, paralytic, cicatricial and spastic;

Ectropion - inversion of the eyelid, can be senile, cicatricial and spastic;

Coloboma of the eyelids is a congenital defect of the eyelids in the form of a triangle.

Conjunctiva

When the palpebral fissure is open, only part of the conjunctiva of the eyeball is visible. The conjunctiva of the lower eyelid, the lower transitional fold and the lower half of the eyeball is examined with the edge of the eyelid pulled down and the patient's gaze fixed upward. To examine the conjunctiva of the upper transitional fold and the upper eyelid, it is necessary to evert the latter. To do this, ask the subject to look down. The doctor, with the thumb and forefinger of his right hand, fixes the eyelid by the edge and pulls it down and forward, and then

with the index finger of the left hand, moves the upper edge of the cartilage down (Fig. 4.1).

Rice. 4.1.Stages of upper eyelid eversion

Normally, the conjunctiva of the eyelids and transitional folds is pale pink, smooth, shiny, with vessels visible through it. The conjunctiva of the eyeball is transparent. There should be no discharge in the conjunctival cavity.

Redness (injection) eyeball develops with inflammatory diseases of the organ of vision due to dilation of the vessels of the conjunctiva and sclera. There are three types of injection of the eyeball (Table 4.1, Fig. 4.2): superficial (conjunctival), deep (pericorneal) and mixed.

Table 4.1.Distinctive features of superficial and deep injection of the eyeball

Rice. 4.2.Types of injections of the eyeball and types of vascularization of the cornea: 1 - superficial (conjunctival) injection; 2 - deep (pericorneal) injection; 3 - mixed injection; 4 - superficial vascularization of the cornea; 5 - deep vascularization of the cornea; 6 - mixed vascularization of the cornea

Chemosis of the conjunctiva - pinching of the conjunctiva within the palpebral fissure due to severe swelling.

Eyeball position

When analyzing the position of the eye in the orbit, attention is paid to the protrusion, retraction or displacement of the eyeball. In some cases, the position of the eyeball is determined using a Hertel mirror exophthalmometer. The following options for the position of the eyeball in the orbit are distinguished: normal, exophthalmos (anterior protrusion of the eyeball), enophthalmos (retraction of the eyeball), lateral displacement of the eye and anophthalmos (absence of the eyeball in the orbit).

Exophthalmos(proportion of the eye anteriorly) is observed in thyrotoxicosis, trauma, orbital tumors. To differentiate these conditions, reposition of the protruding eye is performed. For this purpose, the doctor presses the patient’s eyeballs through the eyelids with his thumbs and assesses the degree of their displacement inside the orbit. With exophthalmos caused by a neoplasm, difficulty in repositioning the eyeball into the orbital cavity is determined.

Enophthalmos(retraction of the eyeball) occurs after fractures of the orbital bones, with damage to the cervical sympathetic nerve (as part of Bernard-Horner syndrome), as well as with atrophy of retrobulbar tissue.

Lateral displacement of the eyeball can be due to a space-occupying formation in the orbit, an imbalance in the tone of the extraocular muscles, a violation of the integrity of the orbital walls, or inflammation of the lacrimal gland.

Motility disorders of the eyeball are more often the result of diseases of the central nervous system and paranasal sinuses

nose When examining the range of motion of the eyeballs, the patient is asked to follow the movement of the doctor’s finger to the right, left, up and down. They observe how far the eyeball reaches during the study, as well as the symmetry of eye movements. The movement of the eyeball is always limited towards the affected muscle.

Lacrimal organs

The lacrimal gland is normally inaccessible to our examination. It protrudes from under the upper edge of the orbit during pathological processes (Mikulich syndrome, tumors of the lacrimal gland). The accessory lacrimal glands located in the conjunctiva are also not visible.

When examining the lacrimal openings, pay attention to their size, position, and their contact with the conjunctiva of the eyeball when blinking. When you press on the area of ​​the lacrimal sac, there should be no discharge from the lacrimal openings. The appearance of tears indicates a violation of the outflow of tear fluid through the nasolacrimal duct, and mucus or pus indicates inflammation of the lacrimal sac.

Tear production is assessed using the Schirmer test: a strip of filter paper 35 mm long and 5 mm wide with one pre-curved end is inserted behind the lower eyelid of the subject (Fig. 4.3). The test is carried out with eyes closed. After 5 minutes, the strip is removed. Normally, a section of the strip more than 15 mm long is wetted with tears.

Rice. 4.3. Schirmer test

Functional patency lacrimal ducts evaluate several methods.

Tubular test. Instilled into the conjunctival sac

3% collargol solution? or 1% sodium fluorescein solution.

Normally, due to the suction function of the eye tubules,

The apple becomes discolored within 1-2 minutes (positive tubular test).

Nasal test. Before instilling the dyes into the conjunctival sac, a probe with a cotton swab is inserted under the inferior turbinate. Normally, after 3-5 minutes, the cotton swab is stained with dye (positive nasal test).

Washing the lacrimal ducts. The lacrimal punctum is expanded with a conical probe and the patient is asked to tilt his head forward. A cannula is inserted into the lacrimal canaliculus 5-6 mm and a sterile 0.9% sodium chloride solution is slowly poured in using a syringe. Normally, fluid flows out of the nose in a trickle.

Side (focal) lighting method

This method is used to study the conjunctiva of the eyelids and eyeball, sclera, cornea, anterior chamber, iris and pupil (Fig. 4.4).

The study is carried out in a darkened room. The table lamp is installed at eye level of the seated patient, at a distance of 40-50 cm, to the left and slightly in front of him. The doctor takes a +20 diopter magnifying glass in his right hand and holds it at a distance of 5-6 cm from the patient’s eye, perpendicular to the rays coming from the light source, and focuses the light on the area of ​​the eye that is to be examined. Thanks to the contrast between a brightly lit small area of ​​the eye and the unlit neighboring parts of it, changes are better visible. When examining the left eye, the doctor fixes his right hand, resting his little finger on the cheekbone; when examining the right eye, on the back of the nose or forehead.

The sclera is clearly visible through the transparent conjunctiva and is normally white. A yellow coloration of the sclera is observed in jaundice. Staphylomas may be observed - dark brown areas of protrusion of sharply thinned sclera.

Cornea. Ingrowth of blood vessels into the cornea occurs under pathological conditions. Minor defects

Rice. 4.4.Side (focal) lighting method

The corneal epithelium is detected by staining with 1% sodium fluorescein solution. The cornea may have opacities of varying location, size, shape and intensity. The sensitivity of the cornea is determined by touching the center of the cornea with a cotton wick. Normally, the patient notices the touch and tries to close the eye (corneal reflex). When sensitivity decreases, the reflex is caused only by placing a thicker part of the wick. If the corneal reflex could not be evoked in the patient, then there is no sensitivity.

Anterior chamber of the eye. The depth of the anterior chamber is assessed when viewed from the side by the distance between the light reflexes appearing on the cornea and iris (normally 3-3.5 mm). Normally, the moisture in the anterior chamber is completely transparent. In pathological processes, an admixture of blood (hyphema) or exudate may be observed in it.

Iris. Eye color is usually the same on both sides. A change in the color of the iris of one eye is called anisochromia. It is more often congenital, less often - acquired (for example, with inflammation of the iris). Sometimes iris defects are found - colobomas, which can be peripheral or complete. Severing the iris from the root is called iridodialysis. With aphakia and lens subluxation, iris trembling (iridodonesis) is observed.

The pupil is visible as a black circle in side lighting. Normally, the pupils are the same in size (2.5-4 mm in moderate lighting). Constriction of the pupil is called miosis, extension - mydriasis, different pupil sizes - anisocoria.

The reaction of the pupils to light is tested in a dark room. The pupil is illuminated with a flashlight. When one eye is illuminated, its pupil constricts (direct pupil reaction to light), as well as the pupil of the other eye constricts (cooperative pupil reaction to light). The pupillary reaction is considered “alive” if, under the influence of light, the pupil quickly narrows, and “sluggish” if the pupil reaction is slow and insufficient. The pupil may not react to light.

The reaction of the pupils to accommodation and convergence is checked when moving the gaze from a distant object to a close object. Normally, the pupils constrict.

The lens is not visible in lateral lighting, except in cases of clouding (total or anterior).

Transmitted light examination

This method is used to assess the transparency of the optical media of the eye - the cornea, anterior chamber moisture, lens and vitreous body. Since the transparency of the cornea and the moisture of the anterior chamber can be assessed with lateral illumination of the eye, a study with transmitted light is aimed at analyzing the transparency of the lens and vitreous body.

The study is carried out in a darkened room. The lighting lamp is placed to the left and behind the patient. The doctor holds an ophthalmoscopic mirror in front of his right eye and, directing a beam of light into the pupil of the eye being examined, examines the pupil through the opening of the ophthalmoscope.

The rays reflected from the fundus (mainly from the choroid) are pink. With transparent refractive media of the eye, the doctor sees a uniform pink glow of the pupil (pink reflex from the fundus). Various obstacles in the path of the light beam (that is, clouding of the eye media) delay some of the rays, and dark spots of different shapes and sizes appear against the background of the pink glow. If, when examining the eye in lateral illumination, opacities in the cornea and anterior chamber aqueous are not detected, then the opacities visible in transmitted light are localized either in the lens or in the vitreous body.

Ophthalmoscopy

The method allows you to assess the condition of the fundus (retina, optic nerve head and choroid). Depending on the technique, ophthalmoscopy is distinguished in reverse and direct form. This study is easier and more effective to carry out with a wide pupil.

Reverse ophthalmoscopy

The study is carried out in a darkened room using a mirror ophthalmoscope (a concave mirror with a hole in the center). The light source is placed to the left and behind the patient. With ophthalmoscopy, a uniform glow of the pupil is first obtained, as in a transmitted light study, and then a +13.0 diopter lens is placed in front of the eye being examined. The lens is held with the thumb and index finger of the left hand, resting on the patient's forehead with the middle finger or little finger. Then the lens is moved away from the eye being examined by 7-8 cm, gradually achieving image magnification

pupil so that it occupies the entire surface of the lens. The image of the fundus during reverse ophthalmoscopy is real, enlarged and inverted: the top is visible from below, the right part is visible from the left (that is, the opposite, which explains the name of the method) (Fig. 4.5).

Rice. 4.5.Indirect ophthalmoscopy: a) using a mirror ophthalmoscope; b) using an electric ophthalmoscope

An examination of the fundus is carried out in a certain sequence: they start with the optic nerve head, then examine the macular region, and then the peripheral parts of the retina. When examining the optic disc of the right eye, the patient should look slightly past the doctor’s right ear; when examining the left eye, at the doctor’s left earlobe. The macular area is visible when the patient looks directly into the ophthalmoscope.

The optic disc is round or slightly oval in shape with clear boundaries, yellowish-pink in color. In the center of the disc there is a depression (physiological excavation), caused by bending of the optic nerve fibers.

Fundus vessels. Through the center of the optic disc, the central retinal artery enters and the central retinal vein exits. Once the main trunk of the central retinal artery reaches the surface of the disc, it divides into two branches - superior and inferior, each of which branches into the temporal and nasal. The veins follow the course of the arteries; the ratio of the caliber of arteries and veins in the corresponding trunks is 2:3.

The macula looks like a horizontal oval, slightly darker than the rest of the retina. In young people, this area is bordered by a strip of light - the macular reflex. The central fovea of ​​the macula, which has an even darker color, corresponds to the foveal reflex.

Direct ophthalmoscopy used for detailed examination of the fundus using a hand-held electric ophthalmoscope. Direct ophthalmoscopy allows you to examine small changes in limited areas of the fundus at high magnification (14-16 times, while with reverse ophthalmoscopy the magnification is only 4-5 times).

Ophthalmochromoscopy allows you to examine the fundus of the eye using a special electroophthalmoscope in purple, blue, yellow, green and orange light. This technique allows you to see early changes in the fundus.

A qualitatively new stage in the analysis of the condition of the fundus is the use of laser radiation and computer image assessment.

Measuring intraocular pressure

Intraocular pressure can be determined using indicative (palpation) and instrumental (tonometric) methods.

Palpation method

During the examination, the patient's gaze should be directed downward, eyes closed. The doctor fixes the III, IV and V fingers of both hands on the patient’s forehead and temple, and places the index fingers on the upper eyelid of the eye being examined. Then, alternately with each index finger, the doctor performs light pressing movements on the eyeball several times. The higher the intraocular pressure, the denser the eyeball and the less its walls move under the fingers. Normally, the wall of the eye collapses even with light pressure, that is, the pressure is normal (short notation T N). Eye turgor may be increased or decreased.

There are 3 degrees of increase in eye turgor:

The eyeball is crushed under the fingers, but for this the doctor applies more force - intraocular pressure is increased (T+ 1);

The eyeball is moderately dense (T+ 2);

Finger resistance has been dramatically increased. The doctor's tactile sensations are similar to those felt when palpating the frontal area. The eyeball almost does not fall under the finger - intraocular pressure is sharply increased (T+ 3).

There are 3 degrees of reduction in eye turgor:

The eyeball feels softer to the touch than normal - intraocular pressure is reduced (T -1);

The eyeball is soft, but retains its spherical shape (T -2);

During palpation, no resistance to the wall of the eyeball is felt at all (as when pressing on the cheek) - intraocular pressure is sharply reduced. The eye does not have a spherical shape, or its shape is not preserved upon palpation (T -3).

Tonometry

There are contact (applanation using a Maklakov or Goldman tonometer and impression using a Schiotz tonometer) and non-contact tonometry.

In our country, the most common tonometer is Maklakov, which is a hollow metal cylinder 4 cm high and weighing 10 g. The cylinder is held with a grip handle. Both bases of the cylinder are expanded and form platforms onto which a thin layer of special paint is applied. During the examination, the patient lies on his back, his gaze is fixed strictly vertically. A local anesthetic solution is instilled into the conjunctival cavity. The doctor widens the palpebral fissure with one hand, and with the other sets the tonometer vertically on the eye. Under the weight of the load, the cornea flattens, and at the point of contact of the platform with the cornea, the paint is washed away with a tear. As a result, a circle devoid of paint is formed on the tonometer platform. An imprint of the area is made on paper (Fig. 4.6) and the diameter of the unpainted disc is measured using a special ruler, the divisions of which correspond to the level of intraocular pressure.

Normally, the level of tonometric pressure ranges from 16 to 26 mmHg. It is higher than the true intraocular pressure (9-21 mm Hg) due to the additional resistance provided by the sclera.

Topographyallows you to assess the rate of production and outflow of intraocular fluid. Intraocular pressure is measured

Rice. 4.6.Flattening of the cornea with the Maklakov tonometer platform

for 4 minutes while the sensor is on the cornea. In this case, a gradual decrease in pressure occurs, as part of the intraocular fluid is forced out of the eye. Based on tonography data, one can judge the cause of changes in the level of intraocular pressure.

INSTRUMENTAL METHODS OF EXAMINATION

Biomicroscopy

Biomicroscopy- This is intravital microscopy of eye tissue using a slit lamp. The slit lamp consists of an illuminator and a binocular stereomicroscope.

Light passing through the slit diaphragm forms a light slice of the optical structures of the eye, which is viewed through a slit lamp stereomicroscope. By moving the light slit, the doctor examines all structures of the eye with a magnification of up to 40-60 times. Additional observational, photo- and tele-recording systems, and laser emitters can be introduced into the stereomicroscope.

Gonioscopy

Gopioscopy- a method of studying the angle of the anterior chamber, hidden behind the limbus, using a slit lamp and a special device - a gonioscope, which is a system of mirrors (Fig. 4.7). Van Beuningen, Goldmann and Krasnov gonioscopes are used.

Gonioscopy allows you to detect various pathological changes in the angle of the anterior chamber (tumors, foreign bodies, etc.). Especially

It is important to determine the degree of openness of the anterior chamber angle, according to which wide, medium width, narrow and closed angles are distinguished.

Rice. 4.7. Gonioscope

Diaphanoscopy and transillumination

Instrumental examination of intraocular structures is carried out by directing light into the eye through the sclera (with diaphanoscopy) or through the cornea (with transillumination) using diaphanoscopes. The method makes it possible to detect massive hemorrhages in the vitreous body (hemophthalmos), some intraocular tumors and foreign bodies.

Echoophthalmoscopy

Ultrasound research method structures of the eyeball are used in ophthalmology to diagnose retinal and choroidal detachment, tumors and foreign bodies. It is very important that echoophthalmography can also be used in cases of opacification of the optical media of the eye, when the use of ophthalmoscopy and biomicroscopy is impossible.

Doppler ultrasound allows you to determine the linear speed and direction of blood flow in the internal carotid and orbital arteries. The method is used for diagnostic purposes for eye injuries and diseases caused by stenotic or occlusive processes in these arteries.

Entoptometry

An idea of ​​the functional state of the retina can be obtained by using entoptic tests(Greek ento- inside, orto- I see). The method is based on the patient’s visual sensations, which arise as a result of the influence of adequate (light) and inadequate (mechanical and electrical) stimuli on the retinal receptive field.

Mechanophosphene- the phenomenon of feeling a glow in the eye when pressing on the eyeball.

Autoophthalmoscopy- a method that allows you to assess the safety of the functional state of the retina in opaque optical environments of the eye. The retina functions if, with rhythmic movements of the diaphanoscope along the surface of the sclera, the patient notices the appearance of visual patterns.

Fluorescein angiography of the retina

This method is based on serial photography of the passage of sodium fluorescein solution through the retinal vessels (Fig. 4.8). Fluorescein angiography can be performed only in the presence of transparent optical media of the ocular

Rice. 4.8.Retinal angiography (arterial phase)

apple In order to contrast the retinal vessels, a sterile 5-10% sodium fluorescein solution is injected into the cubital vein.

VISUAL EXAMINATION IN CHILDREN

When conducting an ophthalmological examination of children, it is necessary to take into account their rapid fatigue and the inability to fix their gaze for a long time.

An external examination in young children (up to 3 years old) is carried out with the help of a nurse who fixes the child’s arms, legs and head.

Visual functions in children under one year of age can be assessed indirectly by the appearance of tracking (end of the 1st and beginning of the 2nd month of life), fixation (2 months of life), danger reflex - the child closes his eyes when an object quickly approaches the eye (2-3 months life), convergence (2-4 months of life). Starting from the age of one year, children's visual acuity is assessed by showing them toys of different sizes from different distances. Children aged three years and older are examined using children's optotype tables.

The boundaries of the visual field in children aged 3-4 years are assessed using an approximate method. Perimetry is used from the age of five. It should be remembered that in children the internal boundaries of the visual field are somewhat wider than in adults.

Intraocular pressure in young children is measured under anesthesia.

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What happens at an appointment with an ophthalmologist?

Where does the ophthalmologist see?

Examination by an ophthalmologist

An examination by an ophthalmologist includes:

• Checking visual acuity. Allows you to evaluate the ability of the eye to clearly see two different points located at a certain distance from each other. Primary impairment of visual acuity can occur with myopia, farsightedness, astigmatism and other pathologies.
• Study of the refractive structures of the eye. Allows you to determine the functional state of the refractive system of the eye, that is, the ability of the cornea and lens to focus the image directly on the retina.
• Visual field examination. Allows you to examine peripheral vision, which may be impaired due to glaucoma and other pathologies.
• Fundus examination. Allows you to study the vessels of the fundus and the retina, damage to which may cause decreased visual acuity, narrowing of the visual fields and other defects of the visual analyzer.
• Measuring intraocular pressure. It is the main test in the diagnosis of glaucoma.
• Checking color perception. Allows you to determine whether a person can distinguish different colors from each other. This function of the visual analyzer may be impaired in some people suffering from color blindness.

Ophthalmologist's chart for checking visual acuity

The essence of the study is as follows. The patient sits on a chair located at a distance of 5 meters from a well-lit table mounted on the wall. The doctor gives the patient a special flap and asks him to cover one eye with it, but not to close it completely ( that is, do not close your eyelids). The patient should look at the table with his other eye. Next, the doctor begins to point to the letters in various rows of the table ( first to larger ones, then to smaller ones), and the patient must name them. The result is considered satisfactory when the patient easily ( without squinting) will be able to read letters from 10 ( above) table row. In this case, we are talking about one hundred percent vision, which the ophthalmologist records in the patient’s chart. Next, he asks to cover the other eye with a shutter and repeats the procedure in the same way.

When examining young children ( who can't read yet) tables with images of animals, plants and other objects are used. At the same time, for the examination of deaf and mute patients, instead of letters, the tables depict circles with a cutout on one side ( right, left, top or bottom). During the examination, the patient must indicate to the doctor which side the notch is located on.

An ophthalmologist's device for examining the fundus of the eye

The essence of the procedure is as follows. The bright lights in the room are turned off, and the patient sits on a chair opposite the doctor. The doctor brings an ophthalmoscope to the patient's eye ( a device consisting of a light source and a magnifying lens) and directs light through the pupil into the eye being examined. Light rays hit the fundus of the eye and are reflected from it, as a result of which the doctor, through a magnifying glass, can observe various structures in this area - the retina, fundus vessels, optic nerve head ( the place in the fundus of the eye where nerve fibers of photosensitive cells leave the eyeball and travel to the brain).

Fundus examination helps in diagnosing:

• Glaucoma. Characteristic of this pathology is the so-called excavation of the optic nerve head, which is “squeezed out” as a result of increased pressure inside the eyeball.
• Retinal angiopathy. During ophthalmoscopy, the doctor identifies modified, irregularly shaped and sized blood vessels in the fundus.
• Retinal detachments. Under normal conditions, the retina is attached to the wall of the eyeball very weakly, supported mainly by intraocular pressure. For various pathological conditions ( for eye injuries, wounds) the retina can become detached from the wall of the eye, which can lead to deterioration or complete loss of vision. During ophthalmoscopy, the doctor can determine the location and severity of the detachment, which will allow planning further treatment tactics.

What does an ophthalmologist put in your eyes to dilate your pupils?

It is worth noting that these drugs cannot be used if you have glaucoma, since pupil dilation can lead to blockage of the outflow tract of intraocular fluid and provoke an increase in intraocular pressure. The doctor must also inform the patient that for a certain time after the procedure the patient may experience pain or burning in the eyes when exposed to bright light, and will also not be able to read books or work at the computer. The fact is that the drugs used to dilate the pupil also temporarily paralyze the ciliary muscle, which is responsible for changing the shape of the lens when viewing closely spaced objects. As a result of this, the lens is flattened as much as possible and fixed in this position, that is, a person will not be able to focus vision on a nearby object until the effect of the drug wears off.

Ophthalmologist instruments for measuring IOP

To measure IOP, the ophthalmologist uses a special tonometer - a cylindrical weight weighing 10 grams. The essence of the study is as follows. After instilling a local anesthetic solution into the patient's eyes ( a drug that temporarily “turns off” the sensitivity of the eyes, as a result of which they will not respond to the touch of foreign objects to the cornea) the patient lies down on the couch face up, directing his gaze strictly vertically and fixing it on some point. Next, the doctor tells the patient not to blink, after which he places the surface of the cylinder on his cornea ( tonometer), which was previously coated with special paint. Upon contact with wet ( moisturized) the surface of the cornea washes off some of the paint from the tonometer. After a few seconds, the doctor removes the cylinder from the patient’s eye and presses its surface onto special paper, on which a characteristic imprint in the form of a circle remains. At the end of the study, the doctor uses a ruler to measure the diameter of the resulting circle-imprint, based on which he establishes the exact intraocular pressure.

Checking color perception ( pictures of an ophthalmologist for drivers)

To check color perception, the ophthalmologist uses special tables. Each of them depicts numerous circles of various sizes, colors ( mostly green and red) and shades, but similar in brightness. Using these circles, a certain image is “masked” in the picture ( number or letter), and a person with normal vision can easily see it. At the same time, for a person who does not distinguish colors, recognizing and naming an “encrypted” letter will be an impossible task.

How else does an ophthalmologist check vision?

If necessary, the ophthalmologist may prescribe:

• Biomicroscopy of the eye. The essence of this study is that, using a special slit lamp, a narrow strip of light is directed into the patient’s eye, illuminating the cornea, lens and other transparent structures of the eyeball. This method allows you to identify various deformations and damage to the structures under study with high accuracy.
• Study of corneal sensitivity. To assess this parameter, ophthalmologists usually use a thin hair or several threads from a bandage, which they touch the cornea of ​​the eye being examined ( first in the center and then along the edges). This makes it possible to identify a decrease in the sensitivity of the organ, which can be observed in various pathological processes.
• Study of binocular vision. Binocular vision is the ability of a person to clearly see a specific image with both eyes at the same time, ignoring the fact that each eye is looking at an object from a slightly different angle. To test binocular vision, ophthalmologists use several methods, the simplest of which is the so-called Sokolov experiment. To carry out this experiment, you should take a sheet of paper, roll it into a tube and bring it to one eye ( both eyes must remain open during the entire examination). Next, you need to place your open palm on the side of the paper tube ( its edge should be in contact with the tube). If the patient has normal binocular vision, when the hand is raised to the paper, the effect of the so-called “hole in the palm” will appear, through which what is visible through the paper tube will be visible.

What tests can an ophthalmologist prescribe?

An ophthalmologist may prescribe:

• General blood analysis– to determine the cellular composition of the blood and identify signs of infection in the body.
• Microscopic studies– to identify microorganisms that cause infectious and inflammatory damage to the eye, eyelids or other tissues.
• Microbiological examination– to identify and identify the causative agent of an eye infection, as well as to determine the sensitivity of the infectious agent to various antibiotics.
• Biochemical blood test– to determine glucose levels ( Sahara) in the blood if diabetic retinal angiopathy is suspected.

Selection of glasses and lenses from an ophthalmologist

Using glasses or contact lenses you can correct:

• Myopia ( myopia). As mentioned earlier, with this pathology, light rays passing through the cornea and lens are refracted too strongly, as a result of which they are focused in front of the retina. To correct this disease, the doctor selects a diverging lens, which “shifts” the focal length somewhat posteriorly, that is, directly to the retina, as a result of which a person begins to clearly see distant objects.
• Hypermetropia ( farsightedness). With this pathology, light rays are focused behind the retina. To correct the defect, the ophthalmologist selects a converging lens that shifts the focal length anteriorly, thereby eliminating the existing defect.
• Astigmatism. With this pathology, the surface of the cornea or lens has an uneven shape, as a result of which light rays passing through them hit different areas in front of and behind the retina. To correct the defect, special lenses are made that correct existing irregularities in the refractive structures of the eye and ensure that the rays are focused directly on the retina.

Does an ophthalmologist prescribe computer glasses?

Medical examination and certificate from an ophthalmologist

It is also worth noting that a certificate from an ophthalmologist may be needed in some other circumstances ( for example, to obtain a permit to carry a firearm, to obtain a driver's license, etc.). In this case, an examination by an ophthalmologist does not differ from that during a regular medical examination ( the doctor evaluates visual acuity, visual fields and other parameters). If during the examination the specialist does not identify any abnormalities in the patient’s organ of vision, he will issue an appropriate conclusion ( certificate). If the patient is diagnosed with a decrease in visual acuity, a narrowing of the visual fields, or any other deviation, the doctor may prescribe appropriate treatment for him, but in the conclusion he will indicate that this person is not recommended to engage in activities that require one hundred percent vision.

Are ophthalmologist services paid or free?

It is worth noting that free ophthalmologist services under the compulsory medical insurance policy ( compulsory health insurance) are found only in state medical institutions ( clinics and hospitals). All ophthalmologist consultations and visual analyzer examinations performed in private medical centers are paid.

When is a follow-up appointment with an ophthalmologist indicated?

The reason for a medical check-up with an ophthalmologist may be:

• Cataract– clouding of the lens, for which it is recommended to visit an ophthalmologist 2 times a year.
• Glaucoma– increased intraocular pressure, which requires visiting a doctor at least 4 times a year.
• Retinal detachment and other lesions– consultation with an ophthalmologist is required at least 2 times a year ( if complications occur, an unscheduled consultation is indicated).
• Damage to the refractive system of the eye ( myopia, farsightedness, astigmatism) – examination by an ophthalmologist 2 times a year ( provided that before this a full diagnosis was carried out and corrective glasses or contact lenses were selected).
• Eye injury– regular ( weekly or monthly) examination by an ophthalmologist until complete recovery.
• Retinal angiopathy– you need to visit a doctor at least 1–2 times a year ( depending on the cause of the disease and the severity of retinal vascular damage).

When can an ophthalmologist admit you to the hospital?

The reason for hospitalization may be the severe course of the patient’s disease ( for example, retinal detachment in several places) or development of complications of the underlying disease ( for example, retinal hemorrhage, penetrating injury to the eyeball with damage to adjacent tissues, and so on). In this case, the patient is placed in a hospital, where he will be under constant medical supervision throughout the entire period of treatment. Before the operation, all studies necessary for an accurate diagnosis and determination of the surgical plan are performed. After surgical treatment, the patient also remains under the supervision of doctors for several days, which allows timely identification and elimination of possible complications ( for example, bleeding).

After discharge from the hospital, the doctor gives the patient recommendations regarding further treatment and rehabilitation, and also sets dates for follow-up consultations, which will allow monitoring the recovery process and identifying possible late complications.

How to get a sick leave certificate from an ophthalmologist?

Is it possible to call an ophthalmologist at home?

At home, an ophthalmologist can perform:

• external examination of the eye;
• assessment of visual acuity;
• visual field examination ( approximately);
• fundus examination;
• measurement of intraocular pressure.

When an ophthalmologist refers you to other specialists for consultation ( oncologist, endocrinologist, ENT specialist, allergist, neurologist, cardiologist)?

The ophthalmologist may refer the patient for consultation:

• To an oncologist– if there is a suspicion of tumor diseases of the eye or adjacent tissues.
• See an endocrinologist– when detecting diabetic retinal angiopathy.
• To the ENT ( otorhinolaryngologist) – when identifying diseases of the nose or paranasal sinuses that could be complicated by eye damage.
• See an allergist– in case of allergic conjunctivitis ( lesions of the mucous membrane of the eye).
• To a neurologist– if there is suspected damage to the optic nerve or brain ( visual center) and so on.
• See a cardiologist– with retinal angiopathy caused by hypertension ( persistent increase in blood pressure).

What treatment can an ophthalmologist prescribe?

Vitamins for eyes

• Vitamin A– to improve the condition of the retina.
• Vitamin B1– improves metabolism in nervous tissue, including the retina and nerve fibers of the optic nerve.
• Vitamin B2– improves metabolism at the cellular level.
• Vitamin E– prevents tissue damage during various inflammatory processes.
• Lutein and zeaxanthin– prevent damage to the retina when exposed to light rays.

Eye drops

For therapeutic purposes, an ophthalmologist may prescribe:

• Antibacterial drops– for the treatment of stye, chalazion, bacterial conjunctivitis and other infectious eye diseases.
• Antiviral drops– for the treatment of viral conjunctivitis and other similar diseases.
• Anti-inflammatory drops– to eliminate the inflammatory process in infectious and inflammatory eye diseases.
• Antiallergic drops– with allergic conjunctivitis.

Eye surgeries

Surgical treatment in ophthalmology may be required:

• for diseases of the cornea;
• for lens transplantation;
• for treatment

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Diagnosis of eye diseases. What symptoms of eye diseases help to correctly identify the causes of the pathology?

Signs of eye disease identified during a traditional consultative examination

However, in many cases, combinations of this kind are as nonspecific as individual symptoms. In particular, complaints of blurred visual fields in combination with a gradual painless decrease in visual function may indicate diseases of such different nature as cataracts, open-angle glaucoma, optic nerve atrophy, etc.

Therefore, a diagnostic search for eye diseases can be quite difficult and require the use of special equipment. To save time, money and nerves, it is better for the patient to prepare for a visit to the ophthalmologist by preparing answers to the most popular questions, such as:
1. When did the symptoms of eye disease first appear (in cases where the pathology develops gradually, it is often not so easy to remember the first minor symptoms - quickly appearing eye fatigue, spots before the eyes, eyelids sticking together in the morning, etc.);
2. What measures were taken to eliminate unpleasant symptoms, and was there any improvement;
3. Did any of your relatives suffer from eye diseases or eye-related diseases (hypertension, atherosclerosis, diabetes mellitus, increased thyroid function, etc.);
4. Is the patient’s work associated with occupational hazards due to vision;
5. What eye diseases and eye surgeries have you undergone?

After collecting detailed information, the ophthalmologist proceeds to examine the patient. The examination begins with the healthy eye. In cases where both eyes are affected by the pathological process, they traditionally start with the right one.

The doctor pays attention to the mobility of the eyes, the condition of the palpebral fissure, the position of the eyelids, then, slightly pulling the lower eyelid, examines the mucous membrane of the conjunctival cavity.

A standard examination aimed at identifying eye diseases is carried out in daylight. Consultation with an ophthalmologist, as a rule, includes the well-known procedure for determining visual acuity using special tables (Golovin-Sivtsev table or children's visometric tables). If necessary, more complex examination methods are prescribed.

What methods do ophthalmologists use to diagnose eye diseases?

• biomicroscopy (study of the optical media of eye tissues, such as the cornea, iris, anterior chamber of the eye, vitreous body, using a slit lamp);
• gonioscopy (examination of the angle of the anterior chamber of the eye formed by the inner surface of the cornea and the outer surface of the iris and ciliary body);
• intraocular pressure examination;
• assessment of corneal sensitivity (carried out in the “old-fashioned” way by carefully touching a cotton swab to the surface of the membrane covering the pupil in the center and four places around the periphery);
• conifocal intravital microscopy of the cornea (examination of corneal tissue using a specially adapted microscope);
• studies of tear production and tear drainage, which help determine the uniformity of tear distribution, the total amount of tear fluid production, and the patency of the tear ducts;
• diaphanoscopy and transillumination of the eye (widely used for penetrating wounds and tumor processes of the eye, assessment of the condition of the internal structures and membranes of the eyeball using diaphanoscopes that direct light through the sclera (diaphanoscopy) or the cornea (transillumination of the eye));
• ophthalmoscopy (standard method of objective examination of the fundus);
• study of the central and peripheral visual fields (study of the photosensitivity of the retina by establishing the boundaries of the visual fields and determining the usefulness of vision (absence/presence of blind spots in the visual field));
• the study of color vision, which is carried out using a special anomaloscope device, and/or special color tables and tests;
• assessment of binocular vision (friendly work of the eyes), which is used in professional selection (pilots, drivers, etc.), routine examinations, as well as in pathology of the oculomotor system (strabismus, occupational ophthalmopathy, etc.);
• ultrasound examination of the eye;
• fluorescein angiography of the fundus, which allows a detailed examination of the condition of the choroid of the eye by introducing a special substance fluorescein into the blood;
• optical coherence tomography (OCT) is a modern method of studying the optical structures of the eye, allowing one to obtain information at the microscopic level;
• Heidelberg retinal tomography, which uses laser scanning to obtain ultra-precise information about the condition of the optic nerve head and the retina as a whole;
• laser polarimetry is the newest method for objectively studying the condition of the optic nerve head;
• electrophysiological methods, which are the study of the activity of the visual analyzer based on changes in bioelectric potentials that arise in the cells of the cerebral cortex in response to light stimulation of the retina.

Treatment of eye diseases

How can eye diseases in people be treated?
Treatment of eye diseases with folk remedies and methods
official medicine (surgical,
physiotherapy, medication)

Mostly, surgical methods are used to heal congenital malformations of the eye, correct age-related changes (surgery to replace the lens for cataracts, surgical treatment of senile ptosis, entropion and eversion of the eyelids), restore normal circulation of intraocular fluid in glaucoma, eliminate many malignant tumors, etc.

However, most eye diseases can and should be treated without resorting to a scalpel. So the need for surgery in many cases indicates untimely intervention or inadequate treatment of pathology (infectious eye diseases, “eye” complications of diabetes mellitus, etc.).

The main methods of conservative treatment of eye diseases are medications and physiotherapy. The medicinal method refers to the treatment of eye diseases with the help of local medications (special eye drops and ointments) and, much less frequently, general action (drugs for oral administration and injections). Physiotherapeutic treatment is the fight against an illness using physical factors (heat, electric current, magnetic field, etc.).

Modern medicine allows and welcomes the use of so-called folk remedies (beaver stream, honey, etc.) in the complex treatment of eye diseases. However, they should be used on the recommendation and under the supervision of the attending ophthalmologist.

What drugs are there to treat eye diseases?

Anti-infective drugs are used to treat inflammatory processes caused by exposure to microorganisms. This large group of drugs includes the following types of drugs:

• Antiseptics or disinfectants are drugs that do not penetrate the inner layers of the skin and mucous membrane, but have a powerful local anti-infective and anti-inflammatory effect. The most popular are Vitabact eye drops, combination preparations containing boric acid, silver salts, etc.;
• Antibiotics are substances of biological origin, as well as their synthetic analogues, that have a pronounced antimicrobial effect. For the treatment of infectious eye diseases, antibiotics from the group of chloramphenicol (chloramphenicol eye drops 0.25%), aminoglycosides (tobramycin eye drops (Tobrex)) and the newest broad-spectrum antibiotics fluoroquinolones (Tsipromed eye drops (ciprofloxacin)) are most often used.
• Sulfonamides are one of the groups of chemotherapy drugs that are effective against most types of bacterial infection. In ophthalmological practice, sulfonamides are represented by such a well-known drug as Albucid eye drops (sodium sulfacyl).
• As antifungal drugs for the treatment of eye diseases, as a rule, drugs intended for oral administration (Nystatin tablets, etc.) are used.
• Antiviral drugs used to treat eye diseases are divided into antiviral chemotherapeutic agents that directly eliminate viruses (for example, 3% Acyclovir ointment) and immune drugs that activate the body's defenses (the drug for intramuscular injections Cycloferon).

A distinction is made between steroidal anti-inflammatory drugs, for example, dexamethasone drops, and non-steroidal anti-inflammatory drugs, such as eye drops containing 0.1% diclofenac sodium solution.

In addition, there are combination drugs with anti-infective and anti-inflammatory effects. This type of medicine includes Sofradex, Tobradex and Maxitrol drops, which are successfully used for infectious and inflammatory eye diseases with an allergic component.

Antiallergic drugs are intended for the treatment of eye diseases of allergic origin and include medications of several groups. First of all, these are so-called membrane-stabilizing drugs that prevent the release of inflammatory mediators from mast cells responsible for the development of the allergic process (Lecrolin and Ketatifen eye drops).

Dacryocystitis is an inflammation of the lacrimal sac, a special cavity for collecting tear fluid located at the inner corner of the eye.

Tear fluid performs a vital function, protecting the mucous membranes of the organ of vision from drying out and the development of dangerous infectious and degenerative eye diseases. Tears are produced by a specialized lacrimal gland located in the superolateral part of the orbit.

The tear fluid is evenly distributed in the cavity of the conjunctiva, while excess tears are removed through the lacrimal canaliculi, the mouths of which open on the conjunctiva of the inner corner of the eye below.

Through the lacrimal canaliculi, the lacrimal fluid enters the lacrimal sac, which ends blindly at the top, and downwards passes into the nasolacrimal canal, which opens into the nasal cavity.

During fetal development, the opening of the nasolacrimal duct is closed, so that normally it opens with the first loud cry of the newborn. In cases where the thin film blocking the nasolacrimal duct remains intact, there is a real threat of developing dacryocystitis in newborns.

The fact is that tear fluid is a good breeding ground for microorganisms that begin to multiply intensively in the overcrowded lacrimal sac, causing an inflammatory reaction.

Symptoms of dacryocystitis in newborns are in many ways similar to the symptoms of conjunctivitis: the affected eye begins to fester, increased lacrimation is observed, and by the morning the eyelashes may stick together.

Such characteristic symptoms as damage to only one eye and an increased amount of tears in the conjunctival sac will help to suspect dacryocystitis in newborns.

Finally, you can verify the presence of inflammation in the lacrimal sac by lightly pressing on the area of ​​its projection (the side surface of the nose at the inner corner of the eye) - in this case, droplets of pus and/or blood will appear from the lacrimal openings, which are the mouths of the lacrimal canaliculi.

Dacryocystitis of newborns is an infectious eye disease that should not be treated with antimicrobial agents. After all, purulent inflammation is only a consequence of pathological obstruction of the nasolacrimal duct.

So the most adequate treatment for dacryocystitis in newborns is massage of the lacrimal sac, which promotes the opening of the nasolacrimal duct. This is a simple procedure, a video of which can be easily found on the Internet. With clean hands, the mother carefully presses the projection of the lacrimal sac from top to bottom.

In the vast majority of cases, with the help of regularly repeated simple manipulation, it is possible to get rid of the film covering the mouth of the nasolacrimal duct. As soon as the tear fluid stops accumulating in the lacrimal sac, the infectious process is spontaneously eliminated.

In cases where a week-long course of massage of the lacrimal sac does not lead to success, the patency of the nasolacrimal duct is restored by surgical methods (probing and washing of the lacrimal ducts, which is carried out under general anesthesia).

Eye diseases in premature babies. Retinopathy (pathology of the retina) of premature babies: causes, symptoms, treatment

A typical eye disease of children born prematurely is retinopathy of prematurity - a severe pathology that often leads to irreparable loss of vision.

The immediate cause of retinopathy of prematurity is the immaturity of the vascular network of the retina - the inner lining of the eyeball, responsible for light perception itself.

The retinal vasculature begins to develop only at the 17th week of development. Moreover, by the 34th week of pregnancy (gestational age is calculated from the first day of the last menstruation), the formation of the vessels located at the nasal part of the retina is completed, so that the optic disc and macula (the part of the retina responsible for best vision) are already normally supplied with blood, but the temporal part the retina is still extremely poor in blood vessels. The formation of retinal vessels is completed only by the last – 40th week of gestation.

If a child is born prematurely, his still immature retina begins to be affected by many unfavorable external and internal factors that can cause the main manifestation of retinopathy of prematurity - a disruption of the normal formation of retinal vessels, expressed in their growth inward into the vitreous body of the eye.

As a result, hemorrhages form in the vitreous body, and pathological tension of the retina by improperly growing vessels leads to its local or even complete detachment, ruptures and other irreversible changes.

Retinopathy of prematurity as an eye disease of varying severity develops in 76% of children born at 24-25 weeks of gestation, and in 54% of children born at 26-27 weeks of gestation. At the same time, retinopathy of prematurity, which threatens retinal detachment, occurs in 5% of children born before 32 weeks of pregnancy, and the risk of developing this dangerous complication in children born at 24-25 weeks reaches 30%.

It should be noted that retinopathy of prematurity also occurs in children born at term. This occurs in cases where the fetus is immature and/or exposed to extremely aggressive factors in the first hours and days of life.

• those born at less than 32 weeks of pregnancy;
• born at any stage weighing less than 1500 g;
• those born between 32 and 36 weeks of pregnancy and receiving oxygen for more than 3 days;
• all premature infants with episodes of complete apnea (lack of breathing requiring emergency resuscitation measures).

• cicatricial changes after retinal ruptures and detachment;
• moderate or high myopia;
• clouding and/or displacement of the lens;
• glaucoma (increased intraocular pressure);
• subatrophy of the eyeballs;
• corneal dystrophy with subsequent formation of a cataract.

In the case of a real threat of detachment, ruptures or tears of the retina in this eye disease, either cryotherapy (cauterization of sprouting vessels with cold) is performed, which reduces the risk of irreversible blindness by half, or laser therapy (laser exposure to abnormal vessels), which is just as effective, but significantly less painful.

What to do with dacryocystitis in a child - video

Prevention of eye diseases in adults and children

Primary and secondary prevention of eye diseases in humans

Secondary prevention is measures taken for the timely detection and treatment of eye pathology (routine examinations by an ophthalmologist, refusal of self-medication, strict adherence to all doctor’s instructions). Thus, if primary prevention is powerless, adequate treatment of timely identified pathology allows one to avoid serious consequences for the organ of vision and the body as a whole.

Prevention of eye diseases in children

It is necessary to adhere to a daily routine so that children's eyes are well rested during sleep. Rational lighting and teaching your child the rules of reading and writing hygiene will help protect against eye diseases.

Many children like to read while lying down, as well as while riding in public transport, often using material on electronic media, which puts a significant strain on the visual organs. Parents should warn their offspring that this behavior, as well as the use of material with small fonts and poor contrast, can lead to the development of serious eye diseases.

School hygiene provides for fairly long breaks between lessons, during which it is strongly recommended to provide complete rest to the eyes. After attending school, children should walk outdoors or indoors, and do homework only after a sufficient break (at least 2 hours).

Many parents ask about when watching television and working on a computer may pose a risk of eye disease. It all depends on the overall load on the organ of vision. Of course, if a student is forced to spend a lot of time studying textbooks, it is better for him to choose another type of entertainment (active games, sports clubs, walks, etc.).

Secondary prevention of eye diseases in children consists of timely completion of routine examinations by an ophthalmologist and timely seeking specialized medical care if any alarming signs appear in the visual organ.

Prevention of eye diseases in adults. How to prevent computer eye disease from developing

The most common eye disease associated with new human living conditions is computer syndrome, manifested by the following symptoms:

• rapid eye fatigue;
• feeling of “sand” in the eyes;
• soreness of the eyeballs;
• pain when moving the eyes;
• redness of the eyes;
• color vision disturbances;
• slow refocusing of the eyes from distant objects to near ones and vice versa;
• the appearance of blurred vision, double vision, headaches when working with a computer for a long time.

Prevention of eye diseases

Amblyopia

Amblyopia is a visual impairment that has a functional origin. It cannot be treated with various lenses and glasses. Vision deterioration progresses irreversibly. There is a violation of contrast perception and accommodation capabilities. Such changes can occur in one, and sometimes in both eyes. In this case, no pronounced pathological changes in the visual organs are observed.

The symptoms of amblyopia are as follows:

• blurred vision in one or both eyes;
• problems with visualizing three-dimensional objects;
• difficulties in measuring the distance to them;
• problems in learning and receiving visual information.

Astigmatism

Astigmatism is an ophthalmological disease that involves impaired perception of light rays by the retina. With corneal astigmatism, the problem lies in the irregular structure of the cornea. If pathological changes occur in the lens, the disease may be of the lenticular or lenticular type.

Symptoms of astigmatism are as follows:

• blurry visualization of objects with jagged and unclear edges;
• double vision;
• the need to strain your eyes to better visualize an object;
• headaches (due to the fact that the eyes are constantly under tension);
• constant squinting.

Blepharitis

Blepharitis is a common inflammatory eye infection that affects the eyelids. There are many types of blepharitis. Most often the course is chronic, it is difficult to treat with medication. Blepharitis may be accompanied by other ophthalmological diseases, such as conjunctivitis and ocular tuberculosis. Purulent lesions of the eyelids and loss of eyelashes may occur. Treatment requires serious antibiotic therapy and identification of the root causes of the pathology.

Symptoms of blepharitis:

• swelling in the eyelid area;
• burning sensation, sand in the eyes;
• severe itching;
• loss of eyelashes;
• feeling of dry skin in the eye area;
• peeling on the eyelids;
• the appearance of crusts and ulcers;
• loss of vision;
• photophobia.

Myopia or nearsightedness

Myopia is an ophthalmological disease associated with refractive error. With the disease, it becomes impossible to clearly see objects located at a great distance. The pathology consists in a violation of the fixation of rays on the retina - they lie not in the retinal zone itself, but in front of it. This causes image blur. Most often, the problem lies in the pathological refraction of rays in the visual system.

Symptoms of myopia:

• blurriness of objects, especially those located at long distances;
• pain in the frontal and temporal areas;
• burning in the eyes;
• inability to clearly focus the gaze on distant objects.

Glaucoma

Glaucoma is an ophthalmological disease that has a chronic form. It is based on a pathological increase in intraocular pressure, which leads to damage to the optic nerves. The nature of the damage is irreversible. Ultimately, there is a significant deterioration in vision, and its complete loss is also possible. The following types of glaucoma are distinguished:

• open angle;
• closed angle.

The consequences of the disease depend on the stage of its progression. In acute glaucoma, sudden and irreversible loss of vision can occur. Treatment of the disease should be carried out by an ophthalmologist together with a neurologist.

Symptoms of glaucoma:

• the presence of dark objects in front of the eyes;
• deterioration of lateral vision;
• loss of vision in the dark;
• differences in clarity;
• the appearance of “rainbow” tints when looking at a light source.

Farsightedness

Farsightedness is an ophthalmological disease in which refractive error occurs, due to which light rays are fixed not on the retina, but behind it. At the same time, the ability to distinguish objects located nearby is significantly deteriorated.

Symptoms of farsightedness:

• fog before the eyes;
• asthenopia;
• strabismus;
• deterioration of fixation during binocular vision.
• Rapid eye fatigue.
• Frequent headaches.

Cataract

Cataract is a disease that is associated with increasing clouding of the lens of the eye. This disease can affect one or both eyes, developing on part of the lens or completely affecting it. Due to clouding, light rays cannot pass to the retina, inside the eye, resulting in reduced visual acuity, and in some cases, possible loss of vision. Older people often lose their sight. The youth category may also be susceptible to this disease. The cause may be previous somatic illnesses or eye injuries. Congenital cataracts also occur.

Symptoms of cataracts:

• vision becomes blurry;
• its severity is actively reduced;
• there is a need to regularly replace glasses; the optical power of new lenses is constantly increasing;
• very poor visibility at night;
• increased sensitivity to bright light;
• the ability to distinguish colors decreases;
• difficulties with reading;
• in some cases, double vision appears in one eye when the other is closed.

Keratoconus

Keratoconus is a degenerative disease of the cornea. When thinning of the cornea occurs, due to the influence of intraocular pressure, it protrudes forward, taking the shape of a cone, while the norm is a spherical shape. This disease often appears in young people; during the course of the disease, the optical properties of the cornea change. Because of this, visual acuity deteriorates significantly. At an early stage of the disease, vision correction with glasses is still possible.

Symptoms of keratoconus:

• sudden deterioration of vision in one eye;
• the outlines of objects are not clearly visible;
• when looking at bright light sources, halos appear around them;
• there is a need to regularly change glasses with enhanced lenses;
• development of myopia is observed;
• eyes get tired quickly.

Keratitis is a disease during which the cornea of ​​the eyeball becomes inflamed, causing blurred vision. The most common cause of this disease is a viral infection or injury to the eye. Inflammation of the cornea can also spread to other areas of the eye.

There are three forms of keratitis:

• light;
• moderate;
• heavy.

Considering the cause of keratitis, it is classified into:

• exogenous (the inflammatory process began due to an external factor);
• endogenous (the cause of inflammation is internal negative changes in the human body).

Symptoms of keratitis:

• fear of light;
• frequent tearing;
• reddened lining of the eyelid or eyeball;
• blepharospasm (the eyelid contracts convulsively);
• there is a feeling that something has got into the eye, the natural shine of the cornea is lost.

Computer vision syndrome

Computer vision syndrome is a set of pathological vision symptoms caused by working at a computer. To one degree or another, computer vision syndrome occurs in approximately 60% of users. This happens mainly due to the specifics of the image on the monitor. Incorrect ergonomics of the workplace, as well as non-compliance with the recommended computer work schedule, contribute to the occurrence of these symptoms.

Symptoms of computer vision syndrome:

• There may be a decrease in visual acuity;
• increased eye fatigue;
• problems focusing on distant or close objects;
• split image;
• photophobia.

Pain, stinging, burning, hyperemia (redness), tearing, and dry eyes are also possible.

Conjunctivitis

Conjunctivitis is an inflammation of the conjunctiva (mucous membrane) covering the outer surface of the eyeballs, as well as the surface of the eyelids in contact with them. Conjunctivitis can be viral, chlamydial, bacterial, fungal or allergic. Some types of conjunctivitis are contagious and are quickly transmitted through household contact. In principle, infectious conjunctivitis does not pose a threat to vision, but in some cases it can lead to serious consequences.

Symptoms of conjunctivitis vary depending on the type of the disease: Hyperemia (redness) and swelling of the eyelids.

• discharge of mucus or pus;
• tearfulness;
• itching and burning.

Macular degeneration (AMD)

The macula is a small area located in the center of the retina of the eye, responsible for clarity of vision and accuracy of color perception. Macular degeneration is a chronic degenerative disease of the macula that exists in two forms: one is wet, the other is dry. Both cause a rapidly increasing decline in central vision, but the wet form is much more dangerous and is fraught with complete loss of central vision.

Symptoms of macular degeneration:

• a cloudy spot in the middle of the visual field;
• inability to read;
• distortion of lines and contours of the image.

Floaters in the eyes

“Floaters” in the eyes - this phenomenon is also called destruction of the vitreous body. Its cause is local disturbances in the structure of the vitreous body, leading to the appearance of optically opaque particles perceived as floating “flies”. Destruction of the vitreous body occurs quite often; there is no threat to vision from this pathology, but psychological discomfort may occur.

Symptoms of destruction of the vitreous body: appear mainly in bright lighting in the form of extraneous images (dots, small spots, threads) smoothly moving in the field of view.

Retinal disinsertion

Retinal detachment is a pathological process of detachment of the inner layer of the retina from the deep pigment epithelial tissue and choroid. This is one of the most dangerous diseases that can be found among other eye diseases. If immediate surgical intervention is not performed during detachment, the person may completely lose the ability to see.

The main symptoms of this ophthalmic disease

• frequent occurrence of glare and sparkles in the eyes;
• a veil before the eyes;
• deterioration of sharpness;
• visual deformation of the appearance of surrounding objects.

Ophthalmic rosacea

Ophthalmic rosacea is a type of dermatological disease that is better known as rosacea. The main manifestations of this disease are slight irritation and dryness of the eyes, blurred vision. The disease reaches its climax in the form of severe inflammation of the surface of the eyes. Against the background of ophthalmic rosacea, keratitis may develop.

Symptoms of ophthalmic rosacea:

• increased dry eyes;
• redness;
• feeling of discomfort;
• fear of light;
• swelling of the upper eyelid;
• white particles on eyelashes in the form of dandruff;
• barley;
• loss of eyelashes;
• blurred vision;
• repeated infectious eye diseases, swelling of the eyelids.
• terigum

Pterygum

Pterygum is a degenerative eye disease that affects the conjunctiva of the eyeball and, as it progresses, can reach the center of the cornea. In its acute form, the disease threatens to infect the central optical zone of the cornea, which can subsequently lead to a decrease in the level of vision, and sometimes to its complete loss. An effective method of treating the disease is surgery.

Symptoms of pterygum at the initial stage of the disease are completely absent. If the disease progresses, there is a decrease in the level of visual acuity, fog in the eyes, discomfort, redness, itching and swelling.

Dry eye syndrome

Dry eye syndrome is quite common these days. The main causes of the syndrome are impaired lacrimation and evaporation of tears from the cornea of ​​the eyes. Very often, the disease can cause progressive Sjögren's syndrome or other diseases that have a direct effect on reducing the amount of tears, and can also cause infection of the lacrimal glands.

Dry eye syndrome can occur due to eye burns, the use of certain medications, cancer or inflammatory processes.

Symptoms of dry eye syndrome:

• large lacrimation or, on the contrary, a complete absence of tears;
• redness of the eyes;
• discomfort;
• fear of light;
• blurred images;
• burning in the eyes;
• decreased visual acuity.

Chalazion

A chalazion is a tumor-like inflammation of the meibomian gland. The disease can occur due to blockage of the sebaceous glands or their swelling. Swelling may occur due to the accumulation of a large amount of opalescent fluid. This disease occurs in people of any age. In its shape, the tumor is similar to a small ball, but during the course of the disease it can increase in size, and therefore put pressure on the cornea and distort vision.

Symptoms of chalazion: at the initial stage, chalazion manifests itself in the form of swelling of the eyelids and slight pain. At the next stage, slight swelling of the eyelid occurs, which does not cause any discomfort or pain. Gray and red spots may also appear on the inside of the eyelid.

Chemical burns to the eyes

Chemical burns to the eyes are one of the most terrible injuries to the eyeball. They appear due to the contact of acid or alkali on apples. The severity is determined by the type, amount, temperature and time of exposure of the chemicals, as well as how deep they penetrate into the eye. There are several degrees of burns, ranging from mild to severe.

Eye burns can not only reduce vision, but also lead to disability. If chemicals come into contact with your eyeballs, you should immediately seek medical help.

Symptoms of chemical burns:

• Pain in the eyes;
• redness or swelling of the eyelid;
• sensation of a foreign body in the eye;
• inability to open eyes normally.

Electroophthalmia

Electroophthalmia occurs due to exposure of the eye to ultraviolet rays. The disease can develop if you do not use eye protection while observing bright light. You can be exposed to ultraviolet rays while relaxing at the seaside, walking through mountainous snow-covered areas, or when looking at a solar eclipse or lightning. This disease also occurs from artificially generated UV rays. This could be reflection from electric welding, solarium, quartz lamps, reflection of light from a photo flash.

Symptoms of electroophthalmia:

• redness and soreness of the eyes;
• discomfort;
• lacrimation;
• blurred vision;
• nervousness;
• photosensitivity of the eyes.

Endocrine ophthalmopathy

Graves' ophthalmopathy, or endocrine ophthalmopathy, is an autoimmune disease that leads to dystrophic infection of orbital and periorbital tissues. This disease most often occurs against the background of problems with the thyroid gland, but it can also occur independently.

Symptoms of endocrine ophthalmopathy: a feeling of constriction and pain in the eyes, increased dryness, color blindness, bulging of the eyeball forward, swelling of the conjunctiva, swelling of the periorbital part of the eye.

Episcleritis

Episcleritis is an inflammatory disease that affects the episcleral tissue of the eye, located between the conjunctiva and the sclera. This disease begins with redness of some parts of the sclera, most often located near the cornea. A large swelling occurs at the site of inflammation. There are simple and nodular episcleritis. The disease most often heals on its own, but relapses are also possible.

Symptoms of episcleritis:

• slight or severe discomfort in the eye area;
• their redness;
• acute reaction to light;
• clear discharge from the conjunctival cavity.

Barley is an inflammatory process of the membomian gland of a purulent nature. It occurs on the ciliary edge of the eyelid or on the hair follicle of the eyelashes. There are internal and external forms. Styes are caused by a bacterial infection, often due to Staphylococcus aureus. There are cases when the disease can become chronic (chalazion).

Symptoms of stye:

• redness along the edge of the eyelid;
• itching and swelling of the edge of the eyelid;
• painful sensations when touched.

In addition, tear discharge may form, discomfort is felt, sometimes headaches, soreness in the body and fever, and general weakness.

The eye is a very important and at the same time vulnerable organ. Therefore, ophthalmological diseases are one of the most common diseases. Most of them are inflammatory diseases.

If you experience redness of the eyes, watery eyes, swelling, pain, discharge from the eyes, or decreased vision, you should consult an ophthalmologist as soon as possible. Often these symptoms indicate development of the inflammatory process in one of the parts of the eyeball or nearby tissues. Without the participation of a qualified ophthalmologist who will accurately diagnose and prescribe timely (and in some cases emergency) treatment, eye inflammation can become chronic and cause such unpleasant problems as eyelid closure (blepharospasm), purulent inflammation, uveitis and others. , which pose a serious threat, including complete loss of vision.

Ophthalmological center ON CLINIC provides a full range of services for the diagnosis and treatment of inflammatory eye diseases.

ON CLINIC ophthalmologists have modern diagnostic equipment, time-tested and proprietary methods of complex eye treatment in their arsenal, allowing to achieve positive results.

What inflammatory eye diseases are treated at ON CLINIC?

Experienced doctors at the ON CLINIC Ophthalmological Center provide effective treatment for various inflammatory eye diseases. Including viral and infectious nature, autoimmune eye diseases such as iridocyclitis, uveitis, chorioretinitis and others.

Inflammatory eye diseases vary depending on the area affected. In particular, inflammation of the following eye structures is distinguished:

• eyelids (stye, blepharitis, demodicosis of the eyelids, chalazion, etc.);
• conjunctiva (conjunctivitis of bacterial, viral nature, acute, chronic, etc.);
• lacrimal organs (canaliculitis, dacryoadenitis, etc.);
• corneas (viral, fungal, etc. keratitis);
• blood vessels of the eye (iritis, iridocyclitis, endophthalmitis, etc.);
• orbits (exophthalmos, thrombophlebitis of the orbit, etc.).

Thanks to the introduction of modern equipment and extensive practical experience of doctors at the Ophthalmological Center ON CLINIC, it is possible to carry out high-precision diagnosis of inflammatory eye diseases and timely initiation of treatment to prevent the development of unpleasant complications.

There are many reasons for the development of eye inflammation:

• infection from the external environment or blood;
• toxins and allergens;
• working at the computer for long periods of time, watching TV for many hours;
• injuries;
• systemic connective tissue diseases;
• foci of chronic infection;
• exposure to ultraviolet radiation, etc.

As a rule, there are several factors that provoke the development of eye inflammation, which requires careful diagnosis.

The administrator will contact you to confirm your appointment. IMC "ON CLINIC" guarantees complete confidentiality of your request.

Diagnosis of inflammatory eye diseases

An examination allows you to prescribe the most effective treatment package. First, ON CLINIC ophthalmologists carefully examine and study the condition of the patient’s eyes and collect anamnesis.

If we are talking about an inflammatory eye disease, then a set of laboratory tests, which are prescribed individually in each case, allows us to identify the agent or pathogen (bacteria, virus, fungus, mite, etc.).

Differential diagnosis is of particular importance in the examination process, since many eye diseases have similar symptoms. In any case, it is necessary to carry out complete diagnosis of inflammatory eye diseases, which may include the following studies:

ON CLINIC has its own clinical diagnostic laboratory, which provides the opportunity to conduct comprehensive laboratory and instrumental examination for inflammatory eye diseases.

Treatment of inflammatory eye diseases at ON CLINIC

In some cases, inflammatory eye damage can develop against the background of a general systemic disease. Thanks to the versatility of the ON CLINIC medical center, our patients have the opportunity to undergo not only an ophthalmological examination, but also general diagnostics with consultation with a specialist doctor.

Treatment of inflammatory eye diseases is always complex. The patient may be prescribed:

• effective medications (antibacterial, antiviral, etc.) that can destroy the infectious agent;
• specific immunotherapy and allergy therapy;
• special eyelid massage;
• ozone therapy (intravenous infusions and/or irrigation of the conjunctival cavity);
• physiotherapeutic methods, in particular magnetic stimulation, color therapy, etc.;
• in case of complications development – ​​gentle microsurgical intervention, etc.

Ophthalmologists at ON CLINIC have in their arsenal all types of modern high-precision diagnostic methods, which allow you to recognize the disease at an early stage, effectively eliminate its cause and painful manifestations, and restore the joy of a full and vivid perception of the world around you. Contact us!

ON CLINIC – comprehensive diagnosis and effective treatment of inflammatory eye diseases!

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