The fundus of the eye - structure and functions. The fundus of the eye is normal in adults How is the condition of the fundus determined

Depends on the presence of capillaries. The thickness of their layer is equivalent to the thickness of the layer of nerve fibers, and therefore fine the color gradation is different: from almost red in the nasal part to pale pink in the temporal part. In young people, the color is often yellow-pink; in children under 1 year old, the color of the disc is pale gray.

In case of pathology, the optic disc can be decolorized, hyperemic, bluish-gray. Monotony of color - abnormal development of the optic disc (often with amblyopia) is observed with tapetoretinal dystrophy, in old age.

Borders.

Clear ok or obscured by pathology. The ophthalmoscopic border of the disc is the edge of the choroid. When there is an underdevelopment of the choroid, an oblique position of the disc or stretching of the posterior pole of the eye with myopia (myopic cone) - the choroid moves away from the edge of the disc.

The senile halo is a peripapillary zone of atrophy without noticeable disorders of visual functions.

Dimensions.

Note normal size (true size 1200-2000 microns), enlarged or reduced. In hypermetropic eyes, the discs are usually visually smaller, in emmetropic eyes they are larger. With age, the size of the disc does not change, but part of the supporting tissue atrophies, this atrophy is manifested by flattening of the optic disc.

Form. Normally round or slightly oval.

The central recess (vascular funnel, physiological excavation) is the place of entry and exit of retinal vessels. Formed by 5-7 years. The maximum diameter is normally 60% of the disk diameter (DD), the area is 30% of the total disk area. In some cases, excavation is absent and the central part of the disk is occupied by glial and connective tissue (Kunt's meniscus) and retinal vessels. Sometimes (in 6% of emmetropes) physiological excavation reaches the depth of the cribriform plate of the sclera and the latter is visible as a white oval with dark dots.

Pathological excavation (glaucoma) differs in size, depth, progressive course up to a breakthrough to the edge of the ONH (the ratio of diameters E / D from 0.3 to 1.0), the presence of parallax of the vessels along the edge of the disc.

Level in relation to the plane of the fundus.

Fine the nasal, upper, and lower portions of the optic disc are somewhat elevated compared to the surrounding retinal tissue (vitreous prominence), and the temporal portion is on the same level as the retina.

Atypical optic disc ("oblique disc") - occurs in 1% of cases in healthy eyes. Due to the oblique course of the ONH in the scleral canal, such a disk has a narrowed shape in the horizontal meridian, a flat position of the entire temporal side, and an undermined nasal edge of the excavation.

Edema of the optic disc:

Inflammatory (neuritis-papillitis),

Circulatory (anterior ischemic neuropathy, disc vasculitis - incomplete CVD thrombosis),

Hydrodynamic (stagnant disk).

Pseudostagnant disk- in ¼ of patients with hypermetropia, it can also be caused by drusen. The reason is the hypertrophy of glial tissue in the central depression of the disc during fetal development. The degree of expression is different. Often this is an increase in the saturation of the pink color, some blurring of the nasal, upper and lower borders in the normal state of the retinal vessels. To exclude pathology, dynamic observation is necessary with the control of visual functions, control of the size of the blind spot (not enlarged here).

Underdevelopment of the papillomacular sector of the disc: The optic disc is bean-shaped. The temporal sector is absent, pigment deposition is noted in this area.

disc entry coloboma- in the region of the disk, a wide hole 2-2.5 DD in size, surrounded by pigment, is visible. At the bottom of the hole, which is 3-4 diptries below the level of the retina, a pink disk is visible. The central vessels climb along the lateral surface of this cavity to the surface of the retina. Visual functions, as a rule, are not disturbed.

Myelin sheaths of fibers in the disc area and retina (in 0.3% of people). Normally, in humans, the border of their distribution is the cribriform plate. Ophthalmoscopically, myelin fibers with clear boundaries, coming from the depths of the disk, resemble white flames. Retinal vessels are lost in these tongues. Vision is not affected.

Disc inversion- the reverse arrangement, while the vessels of the retina are located in the temporal half of the disk, and not the nasal one.

Symptom of Kestenbaum- a decrease in the number of vessels on the disk less than 7 (symptom of optic nerve atrophy).

Disc drusen- abnormal hyaline bodies in the form of yellowish-white nodules located on the surface of the disc or in its tissue. Discs with drusen are not hyperemic, the borders can be scalloped, there is no exudate and venous stasis. Physiological excavation is smoothed, the edges are blurred, uneven. In doubtful cases, fluorescein angiography.

Evulsion- tearing out of the optic nerve from the scleral ring. Ophthalmoscopically, a hole is seen instead of a disc.

avulsion- rupture, detachment of the disc from the scleral ring. The disk remains in place. Visual acuity = 0.

Omnubelation- periodic fogging, transient loss of vision, manifested by an increase in intracranial pressure.

In newborns, it is light yellow, corresponding in size to the area of the optic disc. By the age of 3-5 years, the yellowish background decreases and the macular area almost merges with the pink or red background of the central zone of the retina. Localization is determined mainly by the avascular central zone of the retina and light reflexes, located approximately 25 0 temporal to the ONH. The macular reflex is determined mainly up to 30 years, then gradually fades away.

Retina

Transparency.

Fine transparent (even a layer of pigment epithelium). The thickness at the optic disc is 0.4 mm, in the area of the macula 0.1-0.03 mm, at the dentate line 0.1 mm. The background of the fundus is pink. It is necessary to examine the near, middle and extreme periphery.

The first zone, otherwise - the posterior pole - a circle, the radius of which is equal to twice the distance from the optic disc to the foveola. The second - the middle zone - a ring located outward from the first zone to the nasal part of the dentate line and passing through the temporal part in the equatorial region. The third zone is the rest of the retina anterior to the second. She is the most prone to retinopathy.

Parquet fundus- uneven red color, which shows the stripes formed by the vessels and darker areas between them. This is due to a small amount of retinal pigment and a large amount of choroid pigment (normal variant).

Aspid fundus- the background is slate gray. The norm for people of the dark race.

Albinotic fundus: pale pink color (little pigment in the retinal pigment epithelium and choroid, and the sclera is visible). The vascular pattern of the choroid is clearly visible.

"Thinning of the retina"- this ophthalmological term is incorrect in principle, since even the absence of the retina does not lead to a change in the color of the fundus. If large and medium vessels of the choroid are visible through the retina, this means that the retinal pigment epithelium layer and the vascular choriocapillary layer have died.

A) caliber.

Note the state of the caliber of the vessels (arteries and veins): normal caliber, narrowed, dilated, obliterated. With narrowing of the arteries, note the arteriovenous ratio.

normal difference in the ratio of caliber A and B is most pronounced in newborns 1:2, decreases with age - in adults 2:3 and increases again in the elderly.

B) The course of blood vessels.

Note: normal, pathological tortuosity, arteriovenous chiasm.

The CAS and the CVS have 4 branches each, supplying blood to 4 quadrants of the retina - the upper and lower temporal, upper and lower nasal. Vessels pass in the layer of nerve fibers, small branches branch out to the outer mesh layer. Before the first branching, the vessels are called the vessels of the first order, from the first to the second - the vessels of the second order, etc.

To examine the fundus (retina, optic nerve head and choroid), use the method of ophthalmoscopy. The dimensions of the retina are comparable to those of a large postage stamp. Its important structures are extremely small. So, the diameter of the optic disc is 1.5 mm, and large vessels - 0.1-0.2 mm. Pronounced edema of the optic nerve head, equal to three diopters, corresponds to 1 mm of elevation.

The technique of ophthalmoscopy is as follows. After receiving a reflex from the fundus in transmitted light, a lens of 13 diopters is placed in front of the patient's eye and a reverse (inverted) image of the fundus is magnified 5 times. This examination method is called reverse ophthalmoscopy or indirect ophthalmoscopy. For indirect ophthalmoscopy, head ophthalmoscopes are also used, providing an enlarged stereoscopic image of the fundus. The illumination in them is projected by means of a mirror or prism, coinciding with the line of sight of the doctor.

Direct ophthalmoscopy (direct ophthalmoscopy) is performed using an electric ophthalmoscope. A 15 times enlarged direct image of the fundus is obtained. With electro-ophthalmoscopy, a better image of the fundus is obtained than when using a mirror ophthalmoscope.

With ophthalmoscopy of a normal fundus, the optic nerve head (OND) is pale pink in color with clear boundaries. It has a rounded or oval vertical shape. The temporal side of the ONH is usually lighter pink than the nasal side. The center of the disc may have some depression (depression), which is considered as a physiological excavation, the bottom of which may be fibrous in appearance and represent the fibers of the cribriform plate of the sclera. Normal excavation of a round shape and its parameters can vary from almost complete absence to involvement of 80% of the area of the optic nerve head.

In the presence of extensive or asymmetric excavation with the other eye, the patient is suspected of glaucoma.

With atrophy of the optic nerve, the entire disc will be pale, with papilloedema or papillitis - edematous and congestive. The size of the normal head of the optic nerve varies depending on the refraction of the patient's eye. They are small in the farsighted and large in the nearsighted. The border of the ONH is usually clearly separated (demarcated) from the retina, but may gradually merge with the surrounding tissue without a clearly defined edge. There is often a white band in the form of a scleral ring or cone, which is the exposed sclera between the choroidal vessels and the optic nerve foramen. In this zone, there may be pronounced choroidal pigmentation.

The central retinal artery emerges from the center of the disc and the central retinal vein enters, which on its surface and in the retina are divided into multiple branches. The pattern of dichotomous branching of arteries and veins varies from person to person. Arteries are red, veins are cherry. The ratio of their caliber is 2:3. Because of the thicker wall, the arteries have a central luminous reflex stripe. Through the transparent walls, a column of blood flowing in the vessel is visible. With ophthalmoscopy, it is necessary to evaluate the transparency of the vessels, the presence of compression effects (such as compression of the veins by the arteries (neck formation), where the vessels cross each other), to identify focal narrowing of the arterioles, as well as an increase in tortuosity and expansion of the venules, the formation of hemorrhages and exudates around the vessels.

In the center of the fundus is the macula (yellow spot) - an important functional part of the retina, which looks like a dark red oval. The macular area is located 2 disc diameters (DD) temporal to the optic disc, darker than the surrounding retina, and in young people it has a shiny yellowish dot in the center, corresponding to the location of the central fovea - fovea centralis. The brightness of the foveal reflex weakens with age.

The periphery of the fundus can be examined by moving the ophthalmoscope in various directions, as well as by moving the eye along the quadrants vertically and horizontally. Through the dilated pupil, it is possible to examine the periphery of the fundus with a direct ophthalmoscope, not reaching 1.5 mm before the attachment of the retina at the dentate line.

With experience, the physician becomes familiar with the great variety of normal appearances of the retina and optic nerve. Vessels are especially variable. They can appear from the temporal half of the optic disc and pass into the macular region. These are cilioretinal vessels that originate from the vascular circle of Zinn behind the head of the optic nerve and are formed by branches of the posterior short ciliary arteries. They represent an anastomosis between the choroidal (ciliary) and retinal circulations.

Sometimes bundles of connective tissue pass from the head of the optic nerve from the temporal side and extend forward into the vitreous body. They represent the embryonic remnants of the hyaloid artery located in the cloquet canal surrounding it. If they are localized near the edge of the ONH, then the borders of the disk may look fuzzy and even be raised.

Myelinated optic nerve fibers are another variation of the normal fundus. They are visible as cotton-like combed white threads emanating from the disk and spreading to various distances to the periphery of the retina. In areas of myelin fibers, defects in the PP are sometimes found.

Fundus changes are measured using the optic disc diameter (DD) parameter as the baseline measurement. For example, a retinal scar can be described as having a size of 3 DD and located 5 DD from the ONH on the 1st hour meridian. The degree of elevation (elevation) of the lesions is expressed by the difference between the power of the lens, which examines the normal area of the retina, and the power of the lens, which gives a clear focus at the top of the focus. A difference of 3 diopters is approximately equivalent to 1 mm of elevation.

If the intraocular media (moisture chambers, lens and vitreous body) are transparent, you can examine the posterior pole through a non-dilated pupil. However, the periphery of the fundus is best viewed through a dilated pupil in a darkened room.

Inspection in transmitted light and ophthalmoscopy of the fundus is carried out after medical dilation of the pupil.

For optimal pupil dilation, mydriatic agents such as 0.5% cyclopentolate solution or 1% tropicamide solution are often used, 2.5% phenylephrine solution can be used (but with caution in patients with cardiovascular diseases); 1% solution of homatropine dilates the pupil for 8 hours, 0.25% solution of scopolamine - for 2-3 days, 1% solution of atropine - for 7 days.

Mydriatics are not instilled if the patient has a narrow anterior chamber of the eye. You can set the depth of the anterior chamber by illuminating it sideways with the light of a slit lamp. If the iris appears to be too close to the cornea, pupillary dilation is contraindicated due to the risk of provoking an attack of acute angle-closure glaucoma. A relative contraindication to pupil dilation is an anterior chamber depth less than four times the thickness of the cornea when viewed with a slit lamp. Finally, gonioscopy allows you to set the parameters of the angle of the anterior chamber. In patients over 40 years of age, before dilating the pupil, it is imperative to measure intraocular pressure. The pupil can be dilated in patients who do not have glaucoma. In patients with glaucoma, the pupil is also dilated, but with short-acting drugs with the parallel administration of medications that reduce the formation of intraocular fluid. After examination, the patient is medically narrowed the pupil.

With a rigid pupil and in patients with glaucoma, short-term expansion can be caused by an injection under the conjunctiva of a 1% solution of mezaton or, in more rare cases, a 0.1% solution of adrenaline. At the same time, it is necessary to take into account the presence of cardiovascular diseases in the patient, since the use of these drugs can lead to an increase in blood pressure and an attack of angina pectoris.

Visual inspection of the anterior chamber angle requires a contact lens, focal illumination, and magnification. The contact lens eliminates the curvature of the cornea and allows light to bounce off the corner so that its structures are visible in detail. This study is carried out using a gonioscope, which deflects light rays into the angle of the anterior chamber. The procedure is performed under local anesthesia using lenses of Goldman, Zeiss and others, which have periscope mirrors, with which the angle is examined with reflected light.

The technique is most useful for determining various forms of glaucoma, such as open-angle, narrow-angle, angle-closure, secondary angle-closure glaucoma, allowing to assess the width of the angle (the distance from the root of the iris to the trabecular meshwork) and study the tissues of the angle in the glaucomatous eye at various stages of the disease. It is also used in other pathologies, such as an intraocular foreign body hidden in the recess of the angle, with tumors of the iris or cysts of the iris, to assess traumatic damage in the area of the angle.

T. Birich, L. Marchenko, A. Chekina

"Examination of the fundus, ophthalmoscopy" article from the section

Ophthalmoscopy - examination of the fundus with the help of special instruments (ophthalmoscope or fundus lens), which allows you to evaluate the retina, optic nerve head, fundus vessels. Determine various pathologies: places of retinal breaks and their number; identify thinned areas that can lead to the emergence of new foci of the disease.

Studies can be carried out in various ways: in direct and reverse, with a narrow and wide pupil.

Ophthalmoscopy is included in the standard examination of an ophthalmologist and is one of the most important methods for diagnosing eye diseases.

In addition to eye diseases, ophthalmoscopy helps in the diagnosis of pathologies such as hypertension, diabetes, and many others, because. it is with this study that one can visually assess the state of human vessels.

Fundus examination

An ophthalmologist, by changing the position of the eye relative to the eye of the subject and forcing him to move his gaze in different directions, can also examine the rest of the fundus.

With the maximum dilated pupil, only a small area of the fundus at the limbus 8 mm wide remains inaccessible to research. The general color of the fundus is made up of the color shades of the rays emerging from the examined eye and mainly reflected by the retinal pigment epithelium, the choroid, and partly by the sclera.

1 - uniform coloring of the fundus;
2 - parquet fundus;
3 - fundus with a small amount of pigment

The normal retina, when examined in achromatic light, reflects almost no rays and therefore remains transparent and invisible. Depending on the pigment content in the pigment epithelium and in the choroid, the color and general pattern of the fundus noticeably changes. Most often, the fundus appears uniformly colored red with a lighter periphery. In such eyes, the pigment layer of the retina hides the pattern of the underlying choroid. The more pronounced the pigmentation of this layer, the darker the fundus looks.

The pigment layer of the retina may contain little pigment and then the choroid appears through it. The fundus appears bright red. It shows choroidal vessels in the form of densely intertwined orange-red stripes converging to the equator of the eye. If the choroid is rich in pigment, then its intervascular spaces take the form of elongated spots or triangles. This is the so-called spotty, or parquet, fundus (fundus tabulatus). In cases where there is little pigment in both the retina and the choroid, the fundus of the eye, due to the stronger translucence of the sclera, looks especially bright. Against this background, the optic nerve papilla and retinal vessels are more sharply contoured and appear darker. The choroidal vessels are clearly visible. The macular reflex is poorly expressed or absent.

Weakly pigmented fundus is most common in albinos, which is why it is also called albino. It is similar in color to the albino eye fundus of newborns. But their optic papilla is pale gray with indistinct contours. The veins are wider than usual. Macular reflex is absent. From the second year of life, the fundus of the eye of children almost does not differ from the fundus of adults.

Pathological changes in the vascular and retinal membranes are distinguished by considerable diversity and can manifest themselves in the form of diffuse opacities, limited foci, hemorrhages and pigmentation.

Diffuse opacities of larger or smaller sizes give the retina a dull gray color and are especially pronounced in the region of the optic nerve papilla.

Localized retinal lesions may vary in shape and size and may be light white, light yellow, or bluish yellow in color. Located in the layer of nerve fibers, they take a dashed shape; in the region of the yellow spot form a figure resembling a star.

The round shape and pigmentation of the foci are observed when the process is localized in the outer layers of the retina. Fresh focal changes in the choroid are darker than retinal and less clearly defined. As a result of the subsequent atrophy of the choroid, the sclera is exposed in these areas and they take on the appearance of white, sharply limited foci of various shapes, often surrounded by a pigmented rim. Retinal vessels usually pass over them.

Hemorrhages of the choroid are relatively rare and, being covered by the pigment epithelium, are poorly distinguishable. Fresh retinal hemorrhages have a cherry-red color and vary in size: from small, punctate extravasates to large, occupying a vast area of the fundus. When localized in the layer of nerve fibers, hemorrhages appear as radial strokes or triangles with their apex facing the optic nerve papilla. Preretinal hemorrhages are round or transversely oval. In rare cases, hemorrhages resolve without a trace, but more often they leave behind whitish, gray or pigmented atrophic foci.

Disc (nipple) of the optic nerve during ophthalmoscopy

The most prominent part of the fundus is the nipple (disc) of the optic nerve, and the study usually begins with it. The nipple is located medially from the posterior pole of the eye and enters the ophthalmoscopic field of view if the examined person turns the eye to the nose by 12–15°.

The optic nerve papilla most often has the shape of a circle or a vertical oval and very rarely a transverse oval shape. Astigmatism of the examined eye can distort the true shape of the nipple and give the doctor a false impression of its shape. A similar distortion of the shape of the nipple can also be observed as a result of errors in the examination technique, when, for example, during reverse ophthalmoscopy, the magnifying glass is placed too obliquely to the line of observation.

The horizontal size of the nipple is on average 1.5–1.7 mm. Its visible dimensions, like other elements of the fundus, are much larger during ophthalmoscopy and depend on the refraction of the eye under study and the method of examination. The optic nerve papilla can be located with its entire plane at the level of the fundus of the eye (flat nipple) or have a funnel-shaped depression in the center (excavated nipple). The recess is formed due to the fact that the nerve fibers leaving the eye begin to bend at the very edge of the scleral-choroidal canal. A thin layer of nerve fibers in the central region of the optic papilla makes the underlying whitish lamina cribrosa more visible, and therefore the excavation site appears particularly light. Often here you can find traces of holes in the lattice plate in the form of dark gray dots.

Sometimes physiological excavation is located paracentrally, somewhat closer to the temporal edge of the nipple. From pathological types of excavations, it is distinguished by a small depth (less than 1 mm) and the main obligatory presence of a rim of normally colored nipple tissue between its edge and the excavation edge. A pronounced depression at the site of the optic nerve papilla can be observed in congenital colobomas. In such cases, the nipple is often surrounded by a white rim with pigment inclusions and seems somewhat enlarged. A significant difference in the level of the nipple and the retina leads to a sharp bending of the vessels and creates the impression that they do not appear in the middle of the nipple, but from under its edge.

Rarely encountered defects (pits) in the tissue of the nipple and pulpy, myelinated fibers, which look like bright white shiny elongated spots, are also associated with an anomaly of development. They can sometimes be located on the surface of the nipple, cover it; with inattentive examination, they can be mistaken for a bizarre nipple.

Against the red background of the fundus, the optic nerve papilla stands out with its clear boundaries and pink or yellowish-red color. The color of the nipple is determined by the structure and ratio of the anatomical elements that form it: arterial capillaries, grayish nerve fibers and the whitish cribriform plate underlying them. The nasal half of the nipple contains a more massive papillomacular bundle of nerve fibers and is better supplied with blood, while in the temporal half of the nipple the layer of nerve fibers is thinner and the whitish tissue of the cribriform plate is more visible through it. Therefore, the outer half of the optic papilla almost always looks lighter than the inner half. For the same reason, due to the greater contrast with the background of the fundus, the temporal edge of the nipple is outlined more sharply than the nasal one.

However, the color of the nipple and the clarity of its borders vary markedly. In some cases, only extensive clinical experience and dynamic monitoring of the state of the fundus make it possible to distinguish the normal variant from the pathology of the optic nerve papilla. Such difficulties arise, for example, with the so-called false neuritis, when the normal nipple has fuzzy contours and appears to be hyperemic. Pseudoneuritis mostly occurs in moderate and high hypermetropia, but can also be observed in myopic refraction.

Often, the optic nerve papilla is surrounded by a white (scleral) or dark (choroidal, pigmented) ring.

The first ring, also called the cone, is usually the rim of the sclera, visible as a result of the hole in the choroid through which the optic nerve passes is wider than the hole in the sclera. Sometimes this ring is formed by glial tissue surrounding the optic nerve. The scleral ring is not always complete and may be sickle or crescent shaped.

As for the choroidal ring, it is based on the accumulation of pigment along the edge of the hole in the choroid. In the presence of both rings, the choroidal ring is located more peripherally than the scleral one; often it occupies only part of the circumference.

Changes in the optic disc in various diseases

For diseases of the optic nerve , mainly proceeding in the form of inflammation or stagnation, the nipple may become red, grayish-red or cloudy red in color and the shape of an elongated oval, irregular circle, kidney-shaped or hourglass. Its dimensions, especially with stagnation, often exceed the usual 2 times or more. The borders of the nipple become fuzzy, blurry. Sometimes the outlines of the nipple cannot be caught at all, and only the vessels emerging from it make it possible to judge its location in the fundus.

Atrophic changes optic nerve accompanied by whitening of the nipple. A gray, grayish-white or grayish-blue nipple with sharp borders is observed with primary atrophy of the optic nerve; a dull white nipple with fuzzy contours is characteristic of secondary optic nerve atrophy.

There are 2 types of pathological excavation of the optic nerve papilla

atrophic, characterized by a whitish color, regular shape, slight depth, gentle edges and a slight bend in the vessels at the edge of the nipple.
glaucomatous, characterized by a grayish or grayish-green color, it is much deeper, with undermined edges. Bending over them, the vessels seem to break off and at the bottom of the excavation, due to the deep occurrence, they are less distinguishable. They are usually displaced to the nasal edge of the nipple. Around the latter, a yellowish rim (halo glaucomatosus) is often formed.

In addition to excavations of the nipple, there is also a bulging, protrusion of it into the vitreous body. Particularly pronounced bulging of the nipple is with congestion in the optic nerve (the so-called mushroom nipple).

Vessels visible in the fundus

From the middle of the nipple of the optic nerve or a little medially from the middle comes out central retinal artery(a. centralis retinae). Next to her, laterally, enters the nipple central retinal vein(v. centralis retinae).

On the surface of the nipple, the artery and vein divide into two vertical branches - top And lower(a. et v. centralis superior et inferior). Each of these branches, leaving the nipple, again divides into two branches - temporal And nasal(a. et v. temporalis et nasalis). In the future, the vessels tree-like break up into smaller and smaller branches and spread along the fundus of the eye, leaving the yellow spot free. The latter is also surrounded by arterial and venous branches (a. et v. macularis), directly extending from the main vessels of the retina. Sometimes the main vessels divide already in the optic nerve itself, and then several arterial and venous trunks immediately appear on the surface of the nipple. Occasionally, the central retinal artery, before leaving the nipple and making its usual path, twists in a loop and protrudes somewhat into the vitreous body (prepapillary arterial loop).

Distinguishing arteries from veins with ophthalmoscopy

arteries thinner, lighter than them and less crimped. Light stripes stretch along the lumen of larger arteries - reflexes formed due to the reflection of light from a column of blood in a vessel. The trunk of such an artery, as if divided by the indicated stripes, seems to be double-circuit.

Vienna wider than arteries (their calibers are respectively 4:3 or 3:2), painted in cherry red, more convoluted. The light strip along the course of the veins is much narrower than along the course of the arteries. On large venous trunks, the vascular reflex is often absent. Often there is a pulsation of the veins in the region of the nipple of the optic nerve.

In the eyes with high hypermetropia, the tortuosity of the vessels is more pronounced than in the eyes with myopic refraction. Astigmatism of the examined eye, not corrected with glasses, can create a false impression of the uneven caliber of the vessels. In many parts of the fundus of the eye, a decussation of arteries with veins is visible, and both an artery and a vein can lie in front.

Vascular changes in various diseases

A change in the caliber of blood vessels occurs as a result of violations of vascular innervation, pathological processes in the walls of blood vessels and varying degrees of their blood supply.

For inflammation of the retina: vasodilatation, especially veins.
With arterial thrombosis: the veins are also dilated, while the arteries are constricted.
With spasm of the arteries: the transparency of their walls is not violated
With sclerotic changes: along with the narrowing of the lumen of the vessels, there is a decrease in their transparency. In severe cases of such conditions, the vascular reflex acquires a yellowish tint (a symptom of copper wire). Along the edge of vessels that reflect light more strongly, white stripes appear. With a significant narrowing of the arteries and compaction of their walls, the vessel takes the form of a white thread (a symptom of a silver wire). Often, small vessels become more tortuous and uneven in thickness. Corkscrew-shaped tortuosity of small veins occurs in the region of the macula (Relman-Guist symptom). In places where the vessels cross, compression of the underlying vein by the artery can be observed (a symptom of Gunn-Salus).

Pathological phenomena also include the occurrence of arterial pulsation, especially noticeable at the site of the bending of the vessels on the papilla of the optic nerve.

Yellow spot on ophthalmoscopy

In the posterior pole of the eye lies the most functionally important region of the retina - the yellow spot (macula lutea). It can be seen if the subject directs his gaze to the light "glare" of the ophthalmoscope.

But at the same time, the pupil narrows sharply, which makes it difficult to study. It is also interfered with by light reflexes that occur on the surface of the central part of the cornea.

Therefore, when examining this area of the retina, it is advisable to use non-reflex ophthalmoscopes, resort to pupil dilation (where possible) or direct a less bright beam of light into the eye.

With conventional ophthalmoscopy (in achromatic light), the yellow spot looks like a dark red oval, bordered by a shiny stripe - the macular reflex. The latter is formed due to the reflection of light from a roller-like thickening of the retina along the edge of the macula.

The macular reflex is better expressed in young people, especially in children, and in eyes with hyperopic refraction.

The macula lutea is surrounded by separate arterial branches, somewhat reaching its periphery.

The size of the yellow spot varies markedly. So, its larger horizontal diameter can have a value from 0.6 to 2.9 mm. In the center of the yellow spot is a darker round spot - the central fossa (fovea centralis) with a shiny bright dot in the middle (foveola). The diameter of the central fossa averages 0.4 mm.

In fact, the fundus is what the back of the eyeball looks like when viewed on examination. Here you can see the retina, choroid and optic nerve papilla.

The color is formed by retinal and choroidal pigments and can vary in people of different color types (darker in brunettes and blacks, lighter in blondes). Also, the intensity of the color of the fundus is affected by the density of the pigment layer, which can vary. With a decrease in the density of the pigment, even the vessels of the choroid become visible - the choroid of the eye with dark areas between them (picture "Parkert").

The optic nerve disc looks like a pinkish circle or an oval up to 1.5 mm in cross section. Almost in its center you can see a small funnel - the exit point of the central blood vessels (the central artery and retinal vein).

Closer to the lateral part of the disk, one can rarely see another depression like a bowl, it represents a physiological excavation. It looks slightly paler than the medial part of the optic disc.

Normal fundus, on which the optic nerve papilla (1), retinal vessels (2), fovea (3) are visualized

The norm in children is a more intense color of the optic disc, which becomes paler with age. The same is observed in people with myopia.
Some people have a black circle around the optic disc, which is formed by an accumulation of melanin pigment.

The arterial vessels of the fundus look thinner and lighter, they are more straight. Venous are larger in size, in a ratio of approximately 3: 2, more convoluted. After leaving the optic nerve papilla, the vessels begin to divide according to the dichotomous principle almost to the capillaries. In the thinnest part, which can be determined by the study of the fundus, they reach a diameter of only 20 microns.

The smallest vessels gather around the macula and form a plexus here. Its greatest density in the retina is achieved around the macula - the area of best vision and light perception.

The very same area of the macula (fovea) is completely devoid of blood vessels, its nutrition is carried out from the choriocapillary layer.

Age features

The fundus of the eye in normal newborns has a light yellow color, and the optic disc is pale pink with a grayish tint. This slight pigmentation usually disappears by the age of two. If a similar picture of depigmentation is observed in adults, then this indicates atrophy of the optic nerve.

The afferent blood vessels in a newborn have a normal caliber, and the outlet ones are slightly wider. If childbirth was accompanied by asphyxia, then the fundus of the eye in children will be dotted with small dotted hemorrhages along the arterioles. Over time (within a week) they resolve.

With hydrocephalus or another cause of increased intracranial pressure, the veins in the fundus are dilated, the arteries are narrowed, and the boundaries of the optic disc are blurred due to its edema. If the pressure continues to increase, then the optic nerve papilla swells more and more and begins to push through the vitreous body.

Narrowing of the fundus arteries accompanies congenital atrophy of the optic nerve. His nipple looks very pale (more in the temporal regions), but the boundaries remain clear.

Changes in the fundus in children and adolescents can be:

with the possibility of reverse development (no organic changes);
transient (they can only be assessed at the time of their appearance);
non-specific (there is no direct dependence on the general pathological process);
predominantly arterial (no changes in the retina characteristic of hypertension).

With age, the walls of blood vessels thicken, which makes small arteries less visible and, in general, the arterial network seems more pale.

The norm in adults should be assessed with an eye to concomitant clinical conditions.

Research methods

There are several methods for checking the fundus. An ophthalmological examination aimed at examining the fundus of the eye is called ophthalmoscopy.

Examination by an ophthalmologist is performed by magnifying the illuminated areas of the fundus with a goldmann lens. Ophthalmoscopy can be carried out in direct and reverse form (the image will be inverted), which is due to the optical design of the ophthalmoscope device. Reverse ophthalmoscopy is suitable for general examination, the devices for its implementation are quite simple - a concave mirror with a hole in the center and a magnifying glass. Direct use if necessary, a more accurate examination, which is performed by an electric ophthalmoscope. To identify structures invisible in ordinary lighting, the fundus is illuminated with red, yellow, blue, yellow-green rays.

Fluorescent angiography is used to obtain an accurate picture of the vascular pattern of the retina.

Why does the eyeball hurt?

The reasons for the change in the picture of the fundus may relate to the position and shape of the ONH, vascular pathology, inflammatory diseases of the retina.

Vascular diseases

The fundus of the eye most often suffers from hypertension or eclampsia during pregnancy. Retinopathy in this case is a consequence of arterial hypertension and systemic changes in arterioles. The pathological process proceeds in the form of myeloelastofibrosis, less often hyalinosis. The degree of their severity depends on the severity and duration of the course of the disease.

The result of an intraocular examination can establish the stage of hypertensive retinopathy.

First: small stenoses of arterioles, the beginning of sclerotic changes. There is no hypertension yet.

Second: the severity of stenosis increases, arterio-venous decussations appear (the thickened artery presses on the underlying vein). Hypertension is noted, but the state of the body as a whole is normal, the heart and kidneys do not suffer yet.

Third: permanent angiospasm. In the retina, there is an effusion in the form of "lumps of cotton wool", small hemorrhages, edema; pale arterioles look like a "silver wire". The indicators of hypertension are high, the functionality of the heart and kidneys is impaired.

The fourth stage is characterized by the fact that the optic nerve swells, and the vessels undergo a critical spasm.

If the pressure is not reduced in time, then over time, arteriole occlusion causes retinal infarction. Its outcome is atrophy of the optic nerve and cell death of the photoreceptor layer of the retina.

Arterial hypertension can be an indirect cause of thrombosis or spasm of the retinal veins and the central retinal artery, tissue ischemia and hypoxia.

Examination of the fundus for vascular changes is also required in case of a systemic disorder of glucose metabolism, which leads to the development of diabetic retinopathy. An excess of sugar in the blood is detected, osmotic pressure rises, intracellular edema develops, the walls of the capillaries thicken and their lumen decreases, which causes retinal ischemia. In addition, there is the formation of microthrombi in the capillaries around the foveola, and this leads to the development of exudative maculopathy.

With ophthalmoscopy, the picture of the fundus has characteristic features:

microaneurysms of retinal vessels in the area of stenosis;
an increase in the diameter of the veins and the development of phlebopathy;
expansion of the avascular zone around the macula, due to the overlap of capillaries;
the appearance of a hard lipid effusion and soft cotton-like exudate;
microangiopathy develops with the appearance of clutches on the vessels, telangiectasias;
multiple small hemorrhages at the hemorrhagic stage;
the appearance of an area of neovascularization with further gliosis - the growth of fibrous tissue. The spread of this process gradually can lead to tractional retinal detachment.

ONH

Pathology of the optic nerve head can be expressed as follows:

megalopapilla - the measurement shows an increase and blanching of the optic disc (with myopia);
hypoplasia - a decrease in the relative size of the optic disc in comparison with the vessels of the retina (with hypermetropia);
oblique ascent - the optic disc has an unusual shape (myopic astigmatism), the accumulation of retinal vessels is displaced towards the nasal region;
coloboma - an optic disc defect in the form of a notch, causing visual impairment;
symptom of "morning glow" - mushroom-shaped protrusion of the optic disc into the vitreous body. Ophthalmoscopy descriptions also indicate chorioretinal pigmented rings around an elevated optic disc;
congestive nipple and edema - an increase in the nipple of the optic nerve, its blanching and atrophy with an increase in intraocular pressure.

The pathologies of the fundus include a complex of disorders that occur in multiple sclerosis. This disease has a multiple etiology, often hereditary. When this occurs, the destruction of the myelin sheath of the nerve against the background of immunopathological reactions develops a disease called optic neuritis. There is an acute decrease in vision, central scotomas appear, color perception changes.

On the fundus, one can detect a sharp hyperemia and edema of the optic disc, its borders are erased. There is a sign of atrophy of the optic nerve - blanching of its temporal region, the edge of the ONH is dotted with slit-like defects, indicating the onset of atrophy of the nerve fibers of the retina. Also noticeable is the narrowing of the arteries, the formation of muffs around the vessels, macular degeneration.

Treatment for multiple sclerosis is carried out with glucocorticoid preparations, since they inhibit the immune cause of the disease, and also have an anti-inflammatory and stabilizing effect on the vascular walls. For this purpose, injections of methylprednisolone, prednisolone, dexamethasone are used. In mild cases, corticosteroid eye drops such as Lotoprednol can be used.

Inflammation of the retina

Chorioretinitis is caused by infectious-allergic diseases, allergic non-infectious, post-traumatic conditions. In the fundus, they are manifested by many rounded formations of light yellow color, which are located below the level of the retinal vessels. The retina at the same time has a cloudy appearance and a grayish color due to the accumulation of exudate. With the progression of the disease, the color of the inflammatory foci in the fundus may approach whitish, as fibrous deposits form there, and the retina itself becomes thinner. Retinal vessels practically do not change. The outcome of inflammation of the retina is cataract, endophthalmitis, exudative, in extreme cases - atrophy of the eyeball.

Diseases affecting the vessels of the retina are called angiitis. Their causes can be very diverse (tuberculosis, brucellosis, viral infections, fungal infections, protozoa). In the picture of ophthalmoscopy, vessels surrounded by white exudative muffs and stripes are visible, areas of occlusion, cystic edema of the macula zone are noted.

Despite the severity of diseases that cause pathologies of the fundus, many patients initially begin treatment with folk remedies. You can find recipes for decoctions, drops, lotions, compresses from beets, carrots, nettles, hawthorn, black currants, mountain ash, onion husks, cornflowers, celandine, immortelle, yarrow and pine needles.

I would like to draw attention to the fact that by taking home treatment and delaying a visit to the doctor, you can miss the period of development of the disease, at which it is easiest to stop it. Therefore, you should regularly undergo an ophthalmoscopy with an ophthalmologist, and if a pathology is detected, carefully follow his appointments, which you can supplement with folk recipes.

Closer to the lateral part of the disk, one can rarely see another depression like a bowl, it represents a physiological excavation. It looks slightly paler than the medial part of the optic disc.

Normal fundus, on which the optic nerve papilla (1), retinal vessels (2), fovea (3) are visualized

The norm in children is a more intense color of the optic disc, which becomes paler with age. The same is observed in people with myopia.

Some people have a black circle around the optic disc, which is formed by an accumulation of melanin pigment.

The smallest vessels gather around the macula and form a plexus here. Its greatest density in the retina is achieved around the macula - the area of best vision and light perception.

The very same area of the macula (fovea) is completely devoid of blood vessels, its nutrition is carried out from the choriocapillary layer.

Age features

Narrowing of the fundus arteries accompanies congenital atrophy of the optic nerve. His nipple looks very pale (more in the temporal regions), but the boundaries remain clear.

Changes in the fundus in children and adolescents can be:

with the possibility of reverse development (no organic changes);
transient (they can only be assessed at the time of their appearance);
non-specific (there is no direct dependence on the general pathological process);
predominantly arterial (no changes in the retina characteristic of hypertension).

With age, the walls of blood vessels thicken, which makes small arteries less visible and, in general, the arterial network seems more pale.

The norm in adults should be assessed with an eye to concomitant clinical conditions.

Research methods

There are several methods for checking the fundus. An ophthalmological examination aimed at examining the fundus of the eye is called ophthalmoscopy.

Fluorescent angiography is used to obtain an accurate picture of the vascular pattern of the retina.

Why does the eyeball hurt?

The reasons for the change in the picture of the fundus may relate to the position and shape of the ONH, vascular pathology, inflammatory diseases of the retina.

Vascular diseases

The result of an intraocular examination can establish the stage of hypertensive retinopathy.

First: small stenoses of arterioles, the beginning of sclerotic changes. There is no hypertension yet.

The fourth stage is characterized by the fact that the optic nerve swells, and the vessels undergo a critical spasm.

Arterial hypertension can be an indirect cause of thrombosis or spasm of the retinal veins and the central retinal artery, tissue ischemia and hypoxia.

With ophthalmoscopy, the picture of the fundus has characteristic features:

microaneurysms of retinal vessels in the area of stenosis;
an increase in the diameter of the veins and the development of phlebopathy;
expansion of the avascular zone around the macula, due to the overlap of capillaries;
the appearance of a hard lipid effusion and soft cotton-like exudate;
microangiopathy develops with the appearance of clutches on the vessels, telangiectasias;
multiple small hemorrhages at the hemorrhagic stage;
the appearance of an area of neovascularization with further gliosis - the growth of fibrous tissue. The spread of this process gradually can lead to tractional retinal detachment.

Pathology of the optic nerve head can be expressed as follows:

megalopapilla - the measurement shows an increase and blanching of the optic disc (with myopia);
hypoplasia - a decrease in the relative size of the optic disc in comparison with the vessels of the retina (with hypermetropia);
oblique ascent - the optic disc has an unusual shape (myopic astigmatism), the accumulation of retinal vessels is displaced towards the nasal region;
coloboma - an optic disc defect in the form of a notch, causing visual impairment;
symptom of "morning glow" - mushroom-shaped protrusion of the optic disc into the vitreous body. Ophthalmoscopy descriptions also indicate chorioretinal pigmented rings around an elevated optic disc;
congestive nipple and edema - an increase in the nipple of the optic nerve, its blanching and atrophy with an increase in intraocular pressure.

Inflammation of the retina

/ description of the fundus

Depends on the presence of capillaries. The thickness of their layer is equivalent to the thickness of the layer of nerve fibers, therefore, the color gradation is also normal: from almost red in the nasal part to pale pink in the temporal part. In young people, the color is often yellow-pink; in children under 1 year old, the color of the disc is pale gray.

Clear in normal or obscured in pathology. The ophthalmoscopic border of the disc is the edge of the choroid. When there is an underdevelopment of the choroid, an oblique position of the disc or stretching of the posterior pole of the eye with myopia (myopic cone) - the choroid moves away from the edge of the disc.

The senile halo is a peripapillary zone of atrophy without noticeable disorders of visual functions.

Note normal size (true micron size), enlarged or reduced. In hypermetropic eyes, the discs are usually visually smaller, in emmetropic eyes they are larger. With age, the size of the disc does not change, but part of the supporting tissue atrophies, this atrophy is manifested by flattening of the optic disc.

Form. Normally round or slightly oval.

Level in relation to the plane of the fundus.

Normally, the nasal, upper, and lower portions of the optic disc are somewhat elevated compared to the surrounding retinal tissue (vitreous prominence), and the temporal portion is at the same level as the retina.

Circulatory (anterior ischemic neuropathy, disc vasculitis - incomplete CVD thrombosis),

Hydrodynamic (stagnant disk).

Underdevelopment of the papillomacular sector of the disc: The optic disc is bean-shaped. The temporal sector is absent, pigment deposition is noted in this area.

Disc inversion- the reverse arrangement, while the vessels of the retina are located in the temporal half of the disk, and not the nasal one.

Symptom of Kestenbaum- a decrease in the number of vessels on the disk less than 7 (symptom of optic nerve atrophy).

Evulsion- tearing out of the optic nerve from the scleral ring. Ophthalmoscopically, a hole is seen instead of a disc.

avulsion- rupture, detachment of the disc from the scleral ring. The disk remains in place. Visual acuity = 0.

Omnubelation- periodic fogging, transient loss of vision, manifested by an increase in intracranial pressure.

Normally transparent (even a layer of pigment epithelium). The thickness at the optic disc is 0.4 mm, in the area of the macula 0.1-0.03 mm, at the dentate line 0.1 mm. The background of the fundus is pink. It is necessary to examine the near, middle and extreme periphery.

Aspid fundus- the background is slate gray. The norm for people of the dark race.

Albinotic fundus: pale pink color (little pigment in the retinal pigment epithelium and choroid, and the sclera is visible). The vascular pattern of the choroid is clearly visible.

Note the state of the caliber of the vessels (arteries and veins): normal caliber, narrowed, dilated, obliterated. With narrowing of the arteries, note the arteriovenous ratio.

The normal difference in the ratio of A to B is most pronounced in newborns 1:2, decreases with age - in adults 2:3 and increases again in the elderly.

Note: normal, pathological tortuosity, arteriovenous chiasm.

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How is the fundus checked and what does the study show?

A diagnostic examination of the fundus, carried out in order to obtain data on the condition of the eyeball (including blood vessels) and identify possible pathologies, is called "Ophthalmoscopy".

This method is quite informative for the specialist and safe for the patient.

What does the doctor see?

With the help of ophthalmoscopy, it is possible to assess the condition of the retina, the optic disc, and the choroid. It makes it possible to determine the functional state of the veins and arteries responsible for the blood supply to the retina.

What diseases can be found?

This diagnostic procedure checks for the following problems:

any deviations in the structure of the retina (hemorrhage, dystrophy, detachment, swelling, ruptures, foci of inflammation);
the presence of opacities in the vitreous body of the eyeball;
possible deviations of the optic nerve head from the norm, which does not exclude the presence of various pathologies of the brain (in particular, increased intracranial pressure);
changes in the pattern of the vessels of the circulatory system in the organ of vision, which indirectly indicates the occurrence of complications in the case of diabetes mellitus, as well as the state of blood pressure.

Thus, an ophthalmological examination is a mandatory procedure for people suffering from diseases of the circulatory and nervous systems. It is also shown to people who have problems with metabolism and endocrine disorders.

How is the research going?

Inspection is carried out using special equipment - a fundus lens and a slit lamp or an ophthalmoscope. Often, a fundus camera is used - a highly specialized device that allows you to take pictures of the fundus.

If necessary, mydriatics can be used - eye drops that help dilate the pupil. When using them, the ability to clearly see objects at various distances is temporarily lost. The time of action of these funds is 1 - 1.5 hours, after which visual acuity returns to its original state. It is important for motorists to remember this, because. driving vehicles for some time will be difficult.

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Fundus pressure, normal, symptoms.

The phrase fundus pressure is incorrect. In ophthalmology, there is no such thing as fundus pressure. This phrase combines two ophthalmological concepts: the fundus and intraocular pressure.

The fundus is the inner part of the eye that the doctor sees, with a special study - ophthalmoscopy. Usually, in the fundus, the doctor normally sees the optic disc, the retina and its vessels. Therefore, the pressure of the fundus loses all meaning, because the image (picture) that the doctor sees cannot have pressure.

In turn, intraocular pressure is the tone of the eye, or the force with which the inner liquid part of the eye presses on the walls of the eye itself.

The norm of the pressure of the fundus

Intraocular pressure is measured in millimeters of mercury and normally, with a standard study according to Maklakov, it is mm Hg.

In the CIS countries, eye pressure is usually measured using the Maklakov method. An anesthetic (lidocaine, alkine) is instilled into both eyes, a special tonometer device is taken. A tonometer is a weight of 10g. which has two platforms. These areas are lubricated with a special harmless paint and after that the guzi is placed on the front of the eye - the cornea. There is an imprint on the site. The size of the eye pressure is determined by the diameter of the imprint.

Elevated intraocular pressure can lead to changes in the normal fundus. Usually, changes in the optic nerve occur in the fundus. It turns pale, the number of its vessels decreases and a hole appears in it (pressed through by increased pressure) - excavation.

You can often hear the phrase: what are the symptoms of fundus pressure. Most likely, symptoms of increased intraocular pressure are implied. Usually, in the early stages, an increase in intraocular pressure is asymptomatic. There may be blurred vision, iridescent circles before the eyes, narrowing of the lateral fields of vision (especially from the side of the nose). With a sharp and strong increase in intraocular pressure, there may be pain in the eye and head, redness of the eye, blurred vision. Usually, an increase in eye pressure appears in people after 40 years. Therefore, all people after 40 years of age, once every 1-2 years, it is necessary to measure eye pressure and conduct an examination of the fundus.

With various diseases of the eye, the picture of the fundus may also change. Especially the fundus is affected by high blood pressure, diabetes, myopia and glaucoma.

And so, let's sum it up. Fundus pressure is a collective concept of two ophthalmological terms that have a certain relationship with each other.

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How to assess intraocular pressure

The fundus is the back part of the inner wall of the eyeball. When examining it with an ophthalmoscope, the doctor sees the condition of the vessels, the optic disk (optic disc) and the retina. Intraocular pressure (IOP) is measured by a doctor with a special tonometer. Then he analyzes the results of diagnostic procedures and evaluates the force with which the fundus pressure is produced by the vitreous body. The norm for an adult or a child is different. However, the IOP should correspond to the level mm Hg. Art. (mercury column), then the visual organ will function correctly.

How is intraocular pressure measured?

During tonometry, the ophthalmologist may use one of several contact or non-contact diagnostic methods. It depends on the model of the tonometer that the doctor has. Each meter has its own standard IOP rate.

Most often, the fundus is examined by the Maklakov method.

In this case, a person lies down on a couch, he is given local anesthesia - an ophthalmic antiseptic drug is instilled into his eyes, for example, a solution of Dikain 0.1%. After removing the tear, a colored weight is carefully placed on the cornea and prints are made on the platform of the tonometer. The value of intraocular pressure is estimated by the clarity and diameter of the remaining pattern. According to Maklakov, for adults and children, normal IOP is within the limits of mm Hg.

Relationship between IOP and fundus pressure

Intraocular pressure is determined by the amount of aqueous humor in the chambers and the volume of circulating blood in the episcleral veins. IOP directly affects all membranes and structures of the visual organ from the inside.

As for such concepts as fundus pressure or its norm, they do not exist in ophthalmology. These phrases mean IOP, its effect on the sclera with the cornea and the vitreous body, which presses on the back of the shell from the inside. That is, normal, weak (below 10 mm Hg) and high (more than 30 mm Hg) pressure force of the vitreous body mass on the retina, vessels, optic disc located in the fundus area is possible. The higher or lower the level of IOP compared to the norm, the stronger the deformation of the structural elements.

With prolonged high intraocular pressure under continuous pressure, the retina, blood vessels and nerve are flattened, and they may break.

With a low level of IOP, the vitreous body does not fit snugly against the wall. This can cause a shift in visual fields, retinal detachment and other functional disorders of the organ.

Some subjective symptoms of deviations or fluctuations in intraocular pressure can be confused with signs of jumps in arterial or intracranial pressure, spasms of cerebral vessels. For example, a migraine that gives pain to the eye occurs with vegetovascular dystonia, hypertension, as well as the formation of neoplasms inside the cranial cavity. To confirm or refute these diseases, ophthalmoscopy and / or tonometry is required.

Fundus changes in hypertension

The pressure will return to normal! Just don't forget once a day.

In arterial hypertension, more than 50% of patients are diagnosed with damage to small vessels and capillaries during diagnosis. Changes in the fundus of the eye in hypertension are analyzed in terms of severity, degree of tortuosity, the ratio of the sizes of veins and arteries, as well as their reaction to light. Their condition depends on the speed of blood flow and the tone of the vascular walls.

Changes in the fundus with hypertension:

in the place of branching of the retinal arteries, the acute angle disappears, which straightens almost to;
small veins around the macula (macula lutea) become corkscrew-shaped tortuosity;
arterioles narrow, the branches of the arterial tree are less noticeable, they are thinner compared to the venous network;
there are symptoms of decussation of the Gunn-Salus vessels (squeezing of the vein by the artery);
hemorrhages (hemorrhages) in the retina;
the presence of swelling of the nerve fibers, in which characteristic white cotton-like foci appear;
the back wall of the eyeball is hyperemic, swollen, darker in color retina and disc.

The ophthalmologist also evaluates visual functions. With hypertension, dark adaptation decreases, the area of the blind spot expands, and the field of view narrows. The study of the fundus helps to diagnose hypertension at an early stage.

Classification of changes in the organ of vision in hypertension

The systematization of pathological changes in the eyes against the background of hypertension was last carried out by L. M. Krasnov in 1948. It is his classification that is used by ophthalmologists working in countries that were previously part of the USSR.

Krasnov L. M. divided the development of hypertension into three stages:

Hypertensive angiopathy.
Hypertensive angiosclerosis.
Hypertensive retinopathy.

At the first stage, a change in the pressure of the fundus primarily affects the functioning of the retinal vessels, causing their spasms, narrowing, partial squeezing, increasing tortuosity. With hypertensive angiosclerosis, the symptoms of the previous stage are aggravated, the permeability of the walls of blood vessels increases, and other organic disorders appear. In the third stage, the lesion already covers the retinal tissue. If the optic nerve is damaged in the process, then the pathology develops into neuroretinopathy.

Excessively elevated IOP significantly reduces the duration of each stage, causing changes in the organ of vision in a short time. The process can affect both eyes. Often, laser coagulation of the retina is required to eliminate violations.

Fundus pressure symptoms

With each disease, there are certain subjective and objective signs inherent in a particular pathology.

In the early stages, deviations of IOP from the norm for a person may be subtle, or there are no symptoms at all.

In order not to miss the onset of pathological processes, doctors recommend undergoing ophthalmoscopy every 12 months, and tonometry every 3 years.

In between examinations, self-diagnosis of the level of IOP can be done, evaluating the shape, firmness and elasticity of the eyeball by lightly pressing a finger on it through closed eyelids. If the organ is too hard and does not bend under the hand, there is any painful discomfort, then there is a rather high pressure in it. The finger seems to have fallen inward, and the eye itself is softer than usual - the IOP is too low. In both cases, an urgent consultation with an ophthalmologist is required.

Symptoms of high pressure in the fundus:

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bursting pain or discomfort inside the organ of vision;
redness of the sclera;
heaviness of the eyelids;
distortion of the picture, loss of several fragments from it, other visual impairments.

Signs of low IOP include sunken eyes in the sockets (as in dehydration), dryness of the conjunctiva, and disappearance of shine on the protein and cornea. With weak pressure on the fundus, vision is also impaired, the viewing angle may change. With any deviation of IOP, eye fatigue increases. Other symptoms of disturbances and the degree of damage are visible when using ophthalmic instruments.

Conclusion

The pressure of the fundus, the norm of IOP, the optic nerve, the choroid, the retina, and other structural elements of the sensory organ are closely interconnected. Dysfunction of the ciliary body, impaired circulation of blood or aqueous humor can lead to failure of the entire system, disease or irreversible processes. To maintain visual acuity, it is recommended to undergo scheduled examinations by an ophthalmologist in a timely manner.

Examination of the fundus - why is such an examination necessary?

Modern medicine means ophthalmoscopy by examining the fundus. Such an examination allows ophthalmologists to identify a number of pathologies and possible serious diseases. Examination of the fundus can accurately assess the state of the retina, as well as all its individual structures: the choroid, the macula, the optic nerve head, etc. This procedure should be carried out regularly, you should not be afraid of it, since it is absolutely painless, does not require long holding time. Moreover, an examination of the fundus is mandatory for pregnant women, as well as premature babies in case of manifestation of pathological symptoms of ophthalmic diseases.

Why is an eye examination necessary?

Even if a person does not have any problems in the performance of the function of the visual system, an examination of the fundus should be carried out regularly. This procedure is indicated for pregnant women, as it helps to identify certain ophthalmic diseases that can be transmitted to the baby. It is also necessary to conduct such an examination for people suffering from diabetes mellitus, since this pathological disease can very negatively affect the condition of the retina.

Checking the condition of the fundus is also mandatory for people suffering from retinopathy - a non-inflammatory disease, as well as any inflammatory ophthalmic processes. These diseases lead to a sharp deterioration in visual function, since the fundus of the eye suffers from an aneurysm during the development of pathologies, which causes the ability to expand the lumen of the retinal vessels to be impaired.

Inspection of the retina is also necessary in order to timely recognize signs of retinal detachment. With this pathology, a person does not feel any painful symptoms, but his vision is gradually deteriorating. The main symptom of retinal detachment is the appearance of a "veil" or "fog" before the eyes. Ophthalmoscopy also helps to recognize this pathology in a timely manner, since with this examination it is possible to see all the irregularities on the retina, leading to its detachment.

Preparation for the examination of the fundus

An ophthalmological examination is carried out only by a medical specialist. Before conducting an examination of the fundus, the patient needs to dilate the pupil. For this, the ophthalmologist uses special medications (usually a 1% solution of tropicamide or drugs such as Irifrin, Midriacil, Atropine).

If the patient wears glasses, then before the procedure for examining the fundus, they must be removed. In the event that vision correction is carried out with the help of contact lenses, then the question of the need to remove them is decided by the ophthalmologist individually.

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No other special preparation is required before the examination of the fundus.

Fundus check

A medical examination for examining the fundus is not difficult. For all adults, as well as for children, the methods for conducting such an examination are the same. How is an eye examination performed?

As a rule, a mirror ophthalmoscope is used for examination - this is a mirror with a concave lens and a small hole in the center. The ophthalmologist looks into the patient's eye through the device. A thin beam of light passes through a small hole in the ophthalmoscope, which allows the doctor to see the fundus through the pupil.

How is an eye examination performed? The procedure for examining the fundus is direct and reverse. With a direct check, you can see the main areas of the fundus, as well as their pathology. A reverse fundus examination is a quick and general examination of all parts of the eye.

The examination procedure must be carried out in a darkened room. The doctor directs a beam of light into the patient's eye, first at a short distance, and then brings the appropriate device closer and closer to the eye. This manipulation allows the ophthalmologist to carefully see the fundus, the lens, and the vitreous body. The procedure for examining the fundus takes about 10 minutes, the ophthalmologist must examine both eyes, even if the patient assures that his vision is absolutely normal.

During the examination, the doctor examines:

the optic nerve area is the norm when it has a round or oval shape, clear contours, and also a pale pink color;
the central region of the retina, as well as all its vessels;
the yellow spot in the center of the fundus is a red oval, along the edge of which a light stripe runs;
pupil - normally, the pupil may become red during examination, but any focal opacities indicate the presence of a certain pathology.

Ophthalmoscopy is also performed by other methods:

Vodovozov technology - multi-colored rays are used during the procedure for examining the fundus.
Biomicroscopy or examination of the fundus with a Goldman lens - the examination uses a slit light source. This method of examination can be carried out even with a narrowed pupil.
Laser ophthalmoscopy - the fundus is examined using a laser.
Examination of the fundus with a fundus lens - the device is used in conjunction with a binocular microscope, which are available in a slit lamp. With this method, all areas of the fundus are scanned, even up to the post-equatorial zone.

Who needs an eye exam?

An ophthalmological examination is a preventive procedure and should be carried out by every person regularly, but there are a number of diseases in which an examination of the fundus is mandatory:

atherosclerosis;
hypertension;
cataract;
diabetes;
increased intracranial pressure;
stroke;
osteochondrosis;
prematurity in children;
retinal dystrophy;
syndrome of "night blindness";
color vision disorders.

Contraindications for fundus examination

The patient has ophthalmic pathologies with symptoms of photophobia and lacrimation;
The inability to expand the pupil of the patient;
If the patient has a physiological deviation - insufficient transparency of the lens of the eye, as well as the vitreous body.

Fundus Examination Precautions

An ophthalmic procedure should be prescribed by a therapist for people suffering from cardiovascular diseases. In some embodiments, this procedure is contraindicated in such patients.
You can not drive after the examination of the fundus.
Sunglasses must be worn after the procedure.

The fundus of the eye - structure and functions. The fundus of the eye is normal in adults How is the condition of the fundus determined

Fundus examination

Disc (nipple) of the optic nerve during ophthalmoscopy

Changes in the optic disc in various diseases

Vessels visible in the fundus

Distinguishing arteries from veins with ophthalmoscopy

Vascular changes in various diseases

Yellow spot on ophthalmoscopy

Age features

Research methods

Why does the eyeball hurt?

Vascular diseases

ONH

Inflammation of the retina

Age features

Research methods

Why does the eyeball hurt?

Vascular diseases

Inflammation of the retina

/ description of the fundus

How is the fundus checked and what does the study show?

What does the doctor see?

What diseases can be found?

How is the research going?

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Fundus pressure, normal, symptoms.

The norm of the pressure of the fundus

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How to assess intraocular pressure

How is intraocular pressure measured?

Relationship between IOP and fundus pressure

Fundus changes in hypertension

Classification of changes in the organ of vision in hypertension

Fundus pressure symptoms

Conclusion

Examination of the fundus - why is such an examination necessary?

Why is an eye examination necessary?

Preparation for the examination of the fundus

Fundus check

Who needs an eye exam?

Contraindications for fundus examination

Fundus Examination Precautions