Fundus examination. How is the fundus checked in adults and children? Indications for use

The fundus is examined by specialists during a routine examination or with various ophthalmic disorders. This department is an important component of the visual apparatus, its condition helps to establish the diagnosis as accurately as possible. The study of the fundus is carried out in adults and children and provides information about many diseases.

What is the fundus

Under the fundus is meant the back of the eye, visible when using special devices. Important structures are visualized in this area:

retina;
choroid;
optic disc.

The central part of the optic disc combines the central artery and retinal vein, which are divided into large and small "branches". There is a yellow spot (macula) in the region of the posterior pole of the eye.

The fundus of the eye is characterized by increased vulnerability, susceptibility to various pathologies. The coloring of this area of the eye is provided by two pigments - choroidal and retinal, the amount of which is not the same in different people.

One of the factors affecting the color of the fundus is race. In Caucasians, this structure is light, while in representatives of the Negroid race it has a darker color.

Indications for examination

The fundus of the eye is checked to identify a wide variety of pathologies that develop in the region of the visual apparatus. The procedure is carried out during preventive examinations, in pregnant women, premature babies. Other indications for research are:

The examination is prescribed for hypertension, myopia, hyperopia, astigmatism, strabismus, and other eye pathologies. The procedure does not take much time, it is safe and painless.

Research methods

To determine the condition of the fundus, most often refer to the methods of angiography and ophthalmoscopy. Both procedures are considered quite informative, not harmful to the human visual system.

Before the diagnosis, the pupils are dilated using mydriatics (Atropine, Tropicamide). Only after this, the examination shows the norm or anomalies in the visual system in adults and children.

Angiography

In the process of performing angiography, the specialist manages to clarify how the vessels are filled with blood, to study the state of blood flow in the fundus area. After inducing mydriasis, a fluorescent dye is injected into the patient's vein. Next, the subject places his head in the fixator of the diagnostic device, and the specialist takes pictures of the eye structures using a special camera.

Reasons for angiography are:

High myopia.
Pathology of the retina of the organs of vision.
Hereditary eye diseases.
Anomalies of the vessels of the retina.
Tumors (melanoma, angioma).

Some patients may develop allergic reactions to the substance used (sodium fluorescein), manifested by skin rashes, pulse disturbances, breathing problems, and a sharp decrease in blood pressure. To avoid the occurrence of negative reactions, patients are examined for contraindications before diagnosis.

Ophthalmoscopy

Ophthalmoscopy is a procedure performed during a routine eye examination or when any pathology is suspected. The method is based on the principle of reflection of light rays.

To conduct an examination, the doctor uses a special device (ophthalmoscope). The beam of light emanating from this device passes through the pupil and enters the retina, helping the doctor to examine in detail the various structures of the eye.

There are two types of ophthalmoscopy - direct and reverse. Direct is carried out using an electrical apparatus. To perform the reverse, a mirror ophthalmoscope with two magnifiers is required.

The study is conducted in a darkened room and takes an average of 5-10 minutes. During the test, the patient must keep his eyes open, perform movements at the doctor's command (look straight, up, to the right, to the left, at the ear of the specialist conducting the diagnosis).

Ophthalmoscopy takes place without pain, however, after the procedure, discomfort may appear associated with exposure to bright light on the eyeballs. After completion of the examination, dark spots may be present in the field of view, disappearing after a while.

Features of testing in children and pregnant women

Angiography should be performed no earlier than 14 years. If there are serious indications, the procedure can be prescribed at an earlier age. If the child reacts painfully to the stages of the examination, anesthesia is used.

Fluorescein can be used to examine the organs of vision during pregnancy and lactation. After the procedure, you will need to stop breastfeeding for 48 hours. This is the time it takes for the body to excrete the dye in the urine.

Ophthalmoscopy is prescribed for patients of all ages and categories. Young children are diagnosed in the presence of their parents. If during the examination the child cannot keep his eyes open, an eyelid retractor is used.

Contraindications to the study and precautions

Angiography is prohibited in the following situations:

with hypersensitivity to sodium fluorescein;
if the patient has an implanted lens;
with clouding of the cornea of the eye, vitreous body, moisture of the anterior eye section (such violations make it impossible to fix the light radiation of the dye);
in case of insufficient ability of the kidneys to filter the blood, clean it from the dye;
after a recent heart attack (for six months).

The procedure is also contraindicated in glaucoma, thrombophlebitis, which is manifested by the formation of blood clots in the venous lumen. Angiography is not prescribed for people with bronchial asthma, epileptic seizures, mental disorders, minors, people over 65 years of age.

Unlike the previous method, ophthalmoscopy does not have an extensive list of contraindications. The examination is not carried out only if the patient is prohibited from introducing mydriatic solutions into the organs of vision. Such restrictions apply to persons with angle-closure glaucoma, suspected injuries, neurological disorders, and those with an outdated artificial lens.

Both procedures involve mandatory pupil dilation. After the diagnosis is completed, patients are advised to refrain from driving for several hours. While the state of mydriasis persists, it is necessary to protect the organs of vision from the bright sun with the help of dark glasses.

What the study shows

If the characteristics of the fundus are normal, the specialist detects:

clear vitreous body of the eye;
slight excavation of the optic disc in comparison with its diameter;
yellow spot with good light reflexes.

The normal fundus contains a transparent retina, the optic nerve, resembling a rounded pink spot.

In myopic patients, ophthalmoscopy reveals an enlarged optic disc. In farsighted people, this part of the eye is reduced. With astigmatism, this structure has an irregular round or oval shape.

If during angiography there is no glow in certain areas of the eyeball, there is a suspicion of vasoconstriction or the formation of a blood clot. Penetration of the dye into the structure of the retina indicates damage to the blood-retinal barrier associated with detachment or inflammation of the pigment membrane.

According to the changes in patients, it is possible to judge not only ophthalmological problems. Some disorders indicate pathologies in the cardiovascular or nervous system.

In the modern world, it is increasingly difficult to find a person who would not have problems associated with impaired visual function. Medical scientists are actively looking for new ways to diagnose, restore and maintain vision.

One of the most popular methods for examining the visual organ is ophthalmoscopy. What is it, how effective is this method and what are its types? The answers to these questions are of interest to everyone who has problems with the eyes.

The essence of the method

Ophthalmoscopy is a common method that allows you to study the fundus, determine the state of the retina, identify eye diseases and other pathologies.

The procedure takes approximately 10 minutes in time. To conduct a study, the doctor needs a special device - an ophthalmoscope. There are different types of it. But none of them can do without a diagnostic lens, which enlarges the image of the fundus and allows you to see it better.

The essence of the method is as follows: a beam of light that comes from a lamp is directed into the eye and passes through the pupil, falling directly on the retina.

At this moment, the diagnostic lens magnifies the image and gives the doctor the opportunity to conduct a full examination of the eye. During the examination, the doctor tells the patient to look in different directions, which allows the ophthalmologist to better examine the fundus from certain angles and understand the state of the optic nerve, blood vessels, macula, etc. The method helps to see well what is happening with the vitreous body, as well as with the lens.

Study preparation

Preparation for the procedure does not require any extraordinary measures. The patient should calm down and understand that he will not experience any pain or discomfort during the examination. Before conducting the study, a person should take off his glasses to allow the doctor to make a qualitative and easy diagnosis. If the patient wears, then he should find out in advance whether they need to be removed during the procedure.

First of all, special drops are instilled into the eyes - mydriatics. They are needed in order to expand the pupils. With a wide pupil, it is much easier for a doctor to make a diagnosis. After a few minutes, the action of the drops begins, after which the patient is escorted to a dark, specially equipped room or office, where the examination is carried out.

Thanks to the development of technological progress, today the procedure can be carried out using an electronic ophthalmoscope. It already has a built-in halogen light source.

REFERENCE! Ophthalmoscopy can detect any changes in the optic nerve or macula, as well as diagnose a tumor.

Varieties of the procedure

Today, there are many types of this research. All of them are highly accurate. Today, aspherical lenses are used for inspection. The most common are direct and reverse ophthalmoscopy. They enable the doctor to get a fairly clear and uniform image of the object being examined. Let's see how each study is conducted.

Straight

The procedure takes place in a dark room. The method can be correlated with the study of objects through a magnifying glass. With this type of study, the image through the device can be increased by 13-16 times.

It should be noted that the ophthalmoscope should not be located closer to the visual organ than at a distance of 4 cm. During the procedure, the doctor directs where the patient should look. This is necessary for the most high-quality examination of the fundus, as well as its periphery. This method has a big drawback. With its help, it is impossible to obtain a three-dimensional image, which makes it difficult to identify tissue edema and its severity.

Direct ophthalmoscopy is usually performed using a hand-held electro-ophthalmoscope. But fundus lenses with a large Gulstrand ophthalmoscope can also be used.

Reverse

Such a study is intended for the speedy study of all components of the fundus. Ophthalmoscopes are used mirror or electric. When a mirror device is used, a beam of light falls on the eye from an independent source. The electric ophthalmoscope is more convenient to use, because the lamp is already installed in it. In addition, a special set of lenses is already built into it. During reverse ophthalmoscopy, the image can be magnified 5 times and the doctor sees it upside down.

This method has many advantages:

full view of the picture at 360˚;
high stereoscopic image quality;
examination of distant areas of the retina;
the presence of binocular vision;
image clarity;
the possibility of examination through a cloudy lens.

The video shows how a reverse ophthalmoscopy is performed:

In this form, lenses of +13 diopters are used at a distance of about 7 cm, as well as +20 diopters with an approximate distance of 5 cm. To study the optic nerve, a lens of +14 diopters is more often used, and up to +30 diopters is used to study distant parts of the retina.

Disadvantages of the method consist in insufficient magnification of the image, and also in the fact that the doctor sees the picture upside down.

With a Goldmann lens

In this study, the Goldman apparatus is used. The main component of the device is a built-in universal three-mirror lens, which allows you to thoroughly examine the fundus and the retina.

The Goldman lens helps to examine the state of the internal tissues of the visual organ, it makes it possible to observe any changes in the structure of the eye. The Goldman apparatus is able to detect even the most insignificant changes in the peripheral corners of the eyes.

It should be noted that examination with the help of this device is not prescribed for all patients. There must be good reasons for this, such as a sharp deterioration in vision, severe headaches after exertion on the visual organ, etc.

With all the advantages of this study, there are also disadvantages:

the method is contact, therefore, it is necessary to comply with increased requirements for disinfection of the device;
the technique excludes the possibility of examining the retina between the vascular arcades and the middle periphery of the eye;
this type of study is not always relevant and has its own difficulties in making a diagnosis if the patient has insufficient mobility of the eyeball.

IMPORTANT! After completion of the examination, it is not recommended to drive a vehicle, engage in work that puts strain on vision.

laser

This is a non-contact procedure. The retina of the eye is illuminated by a laser beam. In this case, the image can be broadcast on the monitor screen. There is the possibility of video recording of the study. Laser ophthalmoscopy is the most modern technique for studying the fundus and retina. No other method can compete with it in efficiency and accuracy of readings. The only one disadvantage is the high cost.

Indications for carrying out

The procedure is considered safe, so it can be carried out as a preventive measure. At the same time, ophthalmoscopy provides enough information about the condition of the eye, and the doctor is able to quickly detect violations, if they exist.

Indications for which this study is prescribed:

Using the method helps to identify not only eye diseases, but also other diseases (diabetes mellitus, heart disease, tuberculosis, kidney problems, etc.). Therefore, the procedure is recommended to be carried out both for prevention purposes and for any complaints of the patient, including those not related to visual function.

Advantages of the technique

This technique has many advantages. Among them it is worth highlighting:

detection of pathological processes in the early stages;
painlessness;
the ability to thoroughly examine the fundus and detect the slightest violations;
high accuracy and efficiency of the method;
lack of side effects and negative consequences;
quick procedure (10-15 min.).

These are the main advantages of this study, which is fundamental in making a diagnosis, because. has high accuracy.

Minuses

Along with the existing advantages, the procedure has its drawbacks. There are not many of them:

The doctor takes into account these factors and, in accordance with the condition and complaints of the patient, uses the most appropriate type of ophthalmoscopy.

What the results say

The ophthalmologist makes a diagnosis based on the results of the examination. In conclusion, he interprets the violations found, describes the degree of damage, the structure of tissues, the depth of the foci, their area. He should also pay attention to the size, shade of the eye disk, examine it for the presence of hemorrhages.

The study allows to identify such disorders of the visual organ as cataracts, retinal infarction; detect a foreign body, cyst and tumor of the iris; determine the degree of damage to the eye due to trauma.

Ophthalmoscopy is an effective way to detect not only eye diseases, but also other pathological processes in the body. The procedure is carried out using a special device - an ophthalmoscope. Today, there are many types of this technique. Ophthalmoscopy using the Goldman apparatus, as well as the laser method, has the highest accuracy.

The purpose of the examination of the fundus is to identify the pathology of the retina and the state of the internal environment of the eyeball. Preventive examinations for adult patients are shown once a year, and infants are diagnosed with the fundus every third month. This is necessary for the correct formation of the visual apparatus, because pathology is easier to prevent than to correct later. In the article, we will consider all methods of hardware diagnostics of the fundus.

Fundus examination

What is the fundus of the eye? This is the back wall of the eye. It contains the vascular network, the process of the optic nerve and the retina. The visual apparatus is distinguished by an extensive network of vessels, the state of which can be directly related to internal (not eye) diseases.

When a person gets the flu, his eyes and frontal lobes are very sore. This is a clear example of how organs and systems are interconnected.

A big mistake is the reluctance to go to the ophthalmologist due to the lack of pain or discomfort in the eyes. Many diseases begin their development gradually, without showing themselves in any way. And only timely diagnosis can reveal a hidden pathology.

Blood vessels are very sensitive to diseases in the body and are the first to react to the presence of an emerging pathology. The fundus of the eye is densely surrounded by a network of blood vessels, according to the state of which diseases not associated with the pathology of the visual organs are diagnosed. The ophthalmologist observes precisely those vessels that supply blood to the brain through an ophthalmoscope.

Retinal detachment is a serious disease that can occur in children and adults. This is an uneven distribution of the retina over the eyeball. Such a pathology manifests itself as blurred vision, a veil before the eyes and a narrowing of the optical field.

Night blindness is a serious sign of retinal pathology.

Night blindness is manifested by the lack of clarity of vision at dusk or in the evening. This disease should be detected in time, and the treatment of night blindness will save you from loss of vision in the future.

The retina of the eye provides visual acuity. If it is located unevenly or has changed the relief, this is fraught with visual pathologies - blurred visualization, reduced quality of vision. It is possible to detect the pathological state of the retina only by diagnosing the internal structures of the eye.

Diagnostic methods

To get a detailed picture of the state of the fundus, various diagnostic methods are used:

biomicroscopy;
Goldman lenses;
Vodovozov's method;
angiography;

biomicroscopy

- This is a study of the internal structures of the optical apparatus using a slit lamp and a binocular microscope. Non-contact technique is widely used to detect many somatic pathologies not associated with diseases of the organs of vision.

Through a slit lamp, a light source is directed to the region of the eyeball, and through a powerful microscope, the ophthalmologist examines a many times enlarged image of the internal structures. If necessary, pupil dilating drops are used.

This method gives a detailed view of diseases such as:

cataract;
destructive changes in the retina;
glaucoma;
pathology of the optic nerve;
pathology of the vascular network.

How long does a biomicroscopy take? No more than fifteen minutes. The procedure does not cause discomfort, it is painless. However, there is a condition for a quality inspection - blinking should be as rare as possible. A contraindication to the diagnosis is alcohol or drug intoxication.

Goldman lenses

This is a three-mirror optical device with which you can examine the internal structures in detail even with a narrowed pupil. The Goldman lens allows diagnosing changes in the fundus, structural features of the tissues of the visual organs and their pathology.

The device is equipped with three mirrors located at different angles. Thanks to three mirrors, an ophthalmologist can examine in detail all the structural parts of the eye, even in places that are hard to reach for other diagnostic devices.

With the help of a small mirror, the angle of the anterior chamber of the eyeball and the periphery of the retina are diagnosed.
The middle mirror allows you to study the retina in front of the equator.
A large mirror sees the middle part of the periphery of the retina.

The disadvantage of the device is contact with the mucous membrane of the eyes. This is fraught with infection if the diagnostic tool was poorly sanitized after examining a previous patient. Pure alcohol is used to treat lenses.

Vodovozov method

This method is otherwise called ophthalmochromoscopy. During the examination, rays of a different color spectrum are used, which are obtained due to the filters installed on the ophthalmoscope. The green filter allows you to see the presence of hemorrhages that are invisible under normal lighting, and other pathologies of the internal environment of the eye.

Obstruction of the retinal arteries leads to cardiovascular disease and stroke. Ophthalmochromoscopy allows you to explore optical structures and media that are difficult to access for other types of diagnostics.

Applying color filters:

Red color is used to examine the vascular network;
purple color is used to examine pathological changes in the retina;
yellow color helps to identify hemorrhages under the retina;
blue color allows you to see moss-like elements.

Contraindications for diagnosis:

Pupil muscle atrophy;
glaucoma;
increased intraocular pressure;
contact lacrimation;
photophobia;
inflammation of the mucous tissue.

The examination is carried out by a non-contact method, does not cause pain and discomfort. One eye is examined for five to fifteen minutes.

Angiography

This method uses a fluorescent dye, which can be used to examine the vascular network of the fundus in detail. The doctor clearly sees the fullness of the vessels and their relief. The dye is administered intravenously. Pictures are taken before and after the introduction of fluorescent dye, then the results are compared.

Relative contraindications to diagnostics:

Breast-feeding;
cardiac pathologies;
kidney failure;
glaucoma;
taking antidepressants.

With the help of angiography, the capillaries, veins, arteries and lymphatic vessels of the retina are examined. Diagnosis is prescribed after 14 years. The method has a significant drawback - the reaction of the body to the introduction of a dye. It can be dizziness, nausea and even vomiting. Fainting is less commonly observed as a negative reaction to a contrast agent.

Ophthalmoscopy

Ophthalmoscopy is a painless diagnosis of the fundus, which allows to detect many serious diseases at an early stage. Even if there is no reason to visit an ophthalmologist, a preventive examination is recommended to take place annually.

The result of ophthalmoscopy may be of interest to gynecologists, endocrinologists, neurologists and cardiologists. Also, the result of the diagnosis of the fundus may be required by the therapist to clarify the proposed diagnosis.

The following pathologies can be detected in the diagnosis:

retinopathy;
retinal disinsertion;
night blindness (hemeralopia);
cataract;
malignant neoplasms;
vascular pathology;
pathology of the optic nerve;
macular edema.

Retinopathy is not an inflammatory disease. Diagnosed in patients with diabetes mellitus, it affects the retinal tissue. The disease is manifested by a decrease in visual acuity due to the periodic inability of blood vessels to expand.

Retinal detachment is not accompanied by discomfort and pain, but qualitatively changes visual functions. The patient complains of a narrowing of the field of vision, the appearance of a veil before the eyes and clouding. Pathology is caused by an unequal distribution of retinal tissue over the eyeball, it can be diagnosed in patients of any age.

An alarming sign of congenital retinal pathology in children is night blindness. Parents are obliged to immediately take the child for examination to an ophthalmologist until the pathology has become irreversible.

Macular edema (yellow spot) accompanies diabetes mellitus and is an alarming symptom leading to loss of visual function. Edema can develop against the background of mechanical injury to the eyes or as a result of complications of the vascular membrane of an inflammatory nature.

Indications and contraindications

Ophthalmoscopy is indicated for all children aged:

one year;
four years;
six years;
every second year of life.

For adults, this diagnosis is shown annually. Due to the timely examination of the fundus, it is possible to prevent the development of severe somatic diseases.

Contraindications:

pregnant women;
hypertension disease;
inflammatory processes in the kidneys;
diabetes;
premature newborn babies
miosis (pathologically narrowed pupil);
glaucoma.

Also, diagnosis is impossible with uncontrolled lacrimation and photophobia. These pathologies are characteristic of infectious and inflammatory diseases with severe symptoms. Diagnosis cannot be made with the opacity of the internal media of the eye and with some pathologies of cardiac activity.

Unscheduled ophthalmoscopy is performed in emergency cases:

traumatic brain injury;
systematic attacks of headaches;
constant pain in the eyes;
poor visualization at dusk, dark time of the day;
pathology of the vestibular apparatus.

However, if the patient is constantly crying due to inflammation of the cornea or other reasons, ophthalmoscopy cannot be performed. In this case, the check is postponed until favorable times.

Ophthalmoscopy technique

Before starting the diagnosis, the doctor measures the intraocular pressure in the patient, since artificial dilation of the pupil can provoke an acute attack of glaucoma. If the indicators are normal, the doctor instills drops to dilate the pupil.

Do I need to remove my glasses and contact lenses when examining the fundus? In certain cases, they are allowed not to be removed, but it is better to coordinate this issue with the doctor.

In ophthalmic practice, two diagnostic methods are used:

direct ophthalmoscopy;
reverse ophthalmoscopy.

Direct ophthalmoscopy allows you to examine in detail important areas of the fundus, and the reverse one gives a general idea of the state of the internal media of the optical apparatus. Direct examination is carried out in a dark room with an extraneous light source. The doctor directs a stream of light to the eye of the subject in order to examine the internal structures. This procedure is non-invasive, that is, the doctor does not penetrate the structures of the eye with the help of instruments, but conducts an examination from the outside.

With indirect diagnostics, the internal environments of the patient's eye can be viewed in detail using image magnification. The doctor visualizes the patient's fundus in the opposite direction. That is, the top is at the bottom and the bottom is at the top. Diagnostics is also carried out in a darkened room. The doctor is located at arm's length from the patient and directs the reflected light flux from the ophthalmoscope into the pupil. After that, the examination is carried out using a biconvex magnifying glass.

Procedure for examining a patient:

optic disc;
retinal area;
periphery of the eye.

For direct diagnosis:

the doctor receives a fifteenfold increase in the image;
a monocular device is used;
the doctor sees a direct image of the tissues;
using hand tools;
built-in condenser lenses are used;
focusing is carried out using the wheels on the tool;
the examination is carried out at a close distance from the eye;
examination area - the central part of the fundus.

Disadvantages of direct diagnosis:

there is no overview picture;
monocular examination;
the need for close contact with the patient's eye - up to 4 cm.

Despite the fact that during direct examination, the doctor sees an enlarged image of the tissues, there is no general picture. This type of diagnostics gives an idea only about a limited area of the object under study. The ophthalmologist is forced to move around the areas in order to get a complete picture of the state of the internal environment of the eyeball.

For indirect diagnosis:

the device provides a maximum of three times the increase;
a binocular device is used (3D image);
portable or hand tools are used;
in addition to the built-in lens, an additional one is required;
the doctor sees the image upside down;
focusing with head movements;
the examination is carried out at a distance of half a meter from the patient;
the area of examination is the periphery of the fundus.

To examine all parts of the internal environment of the eyeball, the doctor will require fixation of the gaze in different directions. Therefore, the diagnosis is carried out only with the patient's eyes open.

Ophthalmoscopy is performed only with the patient's eyes open. With clouding of the lens, only an indirect method of examination is possible.

For direct diagnosis, an electrical apparatus is used. And for the examination of the fundus in an indirect form, an electric or mirror instrument is used. In modern diagnostic practice, electronic media are increasingly used. Small appliances have internal monitors. Computers are connected to stationary devices and the image is viewed on large monitors.

Examination of children

Do children need to have their eyes checked? In practice, examination of children is carried out much more often than adults. This is due to the constant change in the structures of the visual organs as the child grows up: it is important not to miss the beginning of the development of pathology. If the examination of the internal environment of the eyes of a newborn causes concern, an ultrasound of the brain is prescribed.

How do doctors manage to examine the fundus of the eye in young children? To do this, use drops to dilate the pupils and eyelid dilators. If the child shows anxiety, doctors distract his attention with a bright toy or picture. If this does not help, the baby is put into a state of physiological sleep with anesthesia.

The approach to the examination of the internal environment of the optical apparatus in children does not differ from the adult procedure. If necessary, ophthalmoscopy is supplemented with computerized keratotopography.

Types of ophthalmoscopes

An ophthalmoscope is a round concave mirror with a small hole in the center. This hole is necessary to direct the flow of light rays to the fundus of the eye.

According to the method of inspecting the internal media of the optical apparatus, devices are classified into:

straight;
indirect.

In modern practice, two types of ophthalmoscope are used:

electric;
mirror.

With the mirror method, the ophthalmologist uses an autonomous light source for examination. Electric ophthalmoscopes are equipped with an internal light source (built-in halogen lamp).

Tools are divided into several types depending on the method of application:

manual ophthalmoscopes - electric apparatus, Helmholtz device;
Goldman lens;
Skepens head mirror;
slit lamp;
laser device;
electronic ophthalmoscope;
digital ophthalmoscope.

The mirror apparatus is equipped with two types of mirrors - straight and concave. There is a round hole in the center of the mirrors. Ophthalmic mirrors are made in two versions - monocular, binocular.

Using the Helmholtz apparatus and an electrical device, the ophthalmologist examines the patient in manual mode. The Goldman lens allows you to view the internal environment of the eye in an enlarged image. An ophthalmologist can see the smallest details and pathology of the fundus and periphery.

Unlike the Helmholtz apparatus and the Goldmann lens, the Skepens ophthalmic device allows you to examine the patient with two eyes. This greatly expands the possibilities of diagnostics. The slit lamp allows you to see the diagnostic picture in a three-dimensional image. With the help of a slit lamp, it is possible to study in detail the state of the vitreous body and the retina, as well as their mutual influence.

The laser device is a conventional ophthalmoscope with a quantum generator. Diagnosis with a laser ophthalmoscope does not involve the use of pupil dilating drops, since this function is performed by the device itself. During laser examination, the built-in video camera displays an image of the internal environment of the eye on the monitor.

The electronic ophthalmoscope is able to carry out any diagnostics.

The digital device is an overlay for an iPhone. Examination accuracy is comparable to a slit lamp. This device differs from stationary ophthalmoscopes in autonomy: it does not require an external power source. That is, an eye examination can be carried out anywhere without being tied to stationary equipment.

In addition to the above methods of inspection, spectral scanning is used. The use of color filters provides an accurate diagnostic picture for various pathological abnormalities of the visual apparatus.

Ophthalmoscopy results

Despite the simplicity of the examination, ophthalmoscopy is a fairly informative diagnosis. The results of ophthalmoscopy help other doctors to understand the cause of the patient's disease.

Cardiologists draw conclusions about the degree of degeneracy of atherosclerosis by changing the vascular network of the fundus.

Neurologists need information about the optic nerve head, vein and artery, which undergo destructive transformations in osteochondrosis of the cervical spine. The vascular network of the fundus is also subjected to destructive changes in case of nervous diseases, strokes and increased intracranial pressure.

Tuberculosis can be diagnosed with ophthalmoscopy.

Gynecologists need information about the condition of the fundus to determine the risk of retinal detachment during childbirth. If there is a risk, the woman is prescribed a caesarean section, natural childbirth can lead to visual pathology.

Endocrinologists need information about the condition of the fundus in patients with diabetes mellitus. This is necessary for the timely prevention of the development of cataracts and retinopathy.

Risks of ophthalmoscopy

Modern ophthalmoscopes are equipped with halogen and xenon lamps. The device creates bright and uniform illumination, the light flux is softened by a polarizing filter, there is no corneal glare. The doctor can change the brightness of the light smoothly and imperceptibly for the patient: this does not cause blinding.

There are some risks after a fundus examination. Basically, the risks are associated with the instillation of pupil dilating drops. Unpleasant consequences include:

nausea, vomiting;
dizziness;
tearing;
dryness of the oral mucosa;
a sharp increase in intraocular pressure.

The patient may feel some discomfort due to the directional light beam. After the end of the diagnosis, colored glare may flash before the eyes, but this reaction quickly passes.

If pupil dilating drops were instilled before the examination, it is recommended to wear sunglasses when going outside. With an enlarged pupil, the eye becomes unprotected from UV radiation, and may suffer. Also, after instillation of drops, it is not recommended to drive a car for at least 2 hours, so you should get home by public transport or ask someone to take you.

Outcome

Ophthalmoscopy examines the fundus for the presence of pathologies of the optic nerve, retina, vascular network and lens. In the modern practice of ophthalmology, this is the fastest and most reliable method for detecting diseases in the initial stage, when the disease does not manifest itself as negative symptoms.

Ophthalmoscopy also reveals somatic diseases of varying severity. Therefore, the results of ophthalmic diagnostics are also used by other specialists - endocrinologists, gynecologists, neurologists, cardiologists and therapists.

Ophthalmoscopy - examination of the fundus of the eye. This is a visual assessment of the state of the optic nerve head, retinal arteries and veins, as well as retinal tissue. The fundus is the inner surface of the eyeball, which is lined with the retina. For this method, the synonym "retinoscopy" is also sometimes used. Examination of the fundus is carried out as part of both diagnostics and dynamic monitoring of the patient's condition.

Ophthalmoscopy is a method of examining the inner zone of the eyeball, which is performed using an ophthalmoscope. The tool allows you to study in detail the retina, blood vessels and optic nerve. Duration

The cost of ophthalmoscopy is 1,100 rubles.

20-30 minutes

(duration of study)

Hospitalization is not required

Indications

Most often, the diagnosis of the fundus is prescribed for the study of retinal pathologies, which can be an independent disease, or can be a symptom of a number of other diseases.

The cause of the painful condition of the retina can be inflammation, or diseases of a non-inflammatory nature. Very often, the retina suffers from systemic diseases, such as: diabetes mellitus, arterial hypertension, etc. There are also a number of genetic diseases of the retina, which are characterized by its gradual destruction and accumulation of pigment. The procedure also allows diagnosing the state of the vitreous body, choroid and optic nerve head.

Types of ophthalmoscopes

There are electric and mirror tools. SLRs are used in special lighting to get more information. Electric have a built-in light source. All models have a mount for lenses that differ in diopter power. There is also an additional division of models into manual, stationary, forehead.

How is a retinal detachment detected?

Examination of the fundus with the help of special tools reveals retinal detachment even in the early stages, but by indirect signs. In this case, it is possible to ascertain the presence of pathology even in the complete absence of symptoms. Therefore, specialists around the world use ophthalmoscopy to determine detachment at an early stage (before the loss of visual acuity).

How is research done?

Examination of the fundus is carried out by an ophthalmologist through the pupils of the patient, using special equipment. The study is painless, non-invasive. In most cases, for examination, the patient's pupils are first dilated with drops, for which the patient must sit with his eyes closed for 20-40 minutes, while distance vision is temporarily reduced. Pupils constrict (and vision is restored) usually 1-1.5 hours after the examination.

What equipment is used to study the fundus of the eye?

The equipment for examining the fundus can be different: a mirror ophthalmoscope, a direct electric ophthalmoscope, a large non-reflex ophthalmoscope, a slit lamp and a magnifying glass.

Types of ophthalmoscopy

Indirect ophthalmoscopy

Using an ophthalmoscopic speculum or a binocular head ophthalmoscope, the doctor illuminates your eye and places a lens in front of it. It collects the rays of light reflected from the fundus, forming an inverted image. Therefore, this technique is otherwise called ophthalmoscopy in reverse.

The indirect method is often referred to as the reverse method. To obtain information, a person does not need to look around and follow the doctor's commands. The specialist uses a head ophthalmoscope and illuminates the organs of vision, so that you can see the eyeballs through the instrument with a magnification of 5 times (which gives the specialist much more information).

Direct ophthalmoscopy

The doctor brings a manual electric ophthalmoscope closer to your eye and directs a beam of light into the pupil from a distance of 0.5-2 cm. The fundus is examined directly through the hole in the ophthalmoscope.

It is carried out in a dark room in which the specialist illuminates the patient's eyes and conducts a study using an instrument. The brightness of the illumination is continuously adjustable so that the fundus of the eye can be seen in all details. Despite this, it is impossible to see the big picture. You can only locally study the tissues of the eye. To get more information, you need to strictly follow the commands of the ophthalmologist (move your eyes left-right or up-down).

Biomicroophthalmoscopy

Examination of the fundus is also possible behind a slit lamp using a strong converging lens or a contact lens. The doctor asks you to place your chin on the stand of the device, illuminates your eye and places a strong converging lens at a distance of 1-1.5 cm from it. In the eyepieces of the slit lamp, an inverted image of your fundus becomes visible.

Sometimes the examination of the fundus is carried out with the help of a contact lens, which is touched to your eye after preliminary instillation of "freezing" drops. The technique is absolutely painless.

It is famous for its high accuracy compared to direct and indirect methods, since minimal changes in the fundus can be tracked. This is achieved due to the fact that the ophthalmoscopic lens is inserted directly into the beam path of the slit illuminator. The method can only be used after dilating the pupil with the help of drops and with ideal transparency of the optical media. The specialist can determine the thickness of the retina, as well as assess the relief of the fundus.

Vodovozov method

This is a diagnostic method called "ophthalmochromoscopy", created in the 80s by the Soviet specialist A. M. Vodovozov. The method involves the use of lighting devices with filters that supply beams of light of different colors. Therefore, both superficial and deep tissues are studied using different colors of illumination. For example, with yellow-green light, an ophthalmologist clearly sees hemorrhages after mechanical damage to the eyeballs.

From the point of view of medicine, a person's ability to see is a function of reflection on the retina of light from objects that have fallen into the viewing area. The retina is a complex sensitive organ, therefore it is hidden inside - it lines the inner surface of the apple.

What can a specialist see during an eye exam?

Fundus examination - standard examination, which allows you to identify deviations in the retinal area:

examine the entire optic disc;
check the condition of the macula (this is important at the age of 55, when the process of its degeneration begins): in the fundus examination card, this area is called the macula, photoreceptors of the organs of vision are concentrated in it. There is an area of the yellow spot in the center of the retina;
examine the periphery of the retina and its choroid (choroid);
to detect clouding of the lens and a decrease in the transparency of the media.

In practice fundus examination the most common method using a mirror ophthalmoscope (the name of the device and the procedure itself was called ophthalmoscopy). Often, powerful converging lenses are used for ophthalmoscopy, in some cases contact lenses are used.

Procedure and methods of ophthalmoscopy

The process of examining the fundus is based on the principles of reflection and refraction of light:

a light source is installed in front and to the side of the patient;
the light beam collected in a beam, falling on the pupil, illuminates the inner surface of the apple and allows the ophthalmologist to see the organ “from the inside” in the process of examining the fundus;
for a detailed examination, magnifiers, mirrors (Goldman ophthalmoscope), binocular head-mounted devices with a magnifier are used.

Depending on the equipment and technology used, the fundus examination can be carried out:

with a dilated pupil or in a normal state (in the first case, before starting, the patient is instilled with eyes, this will help the ophthalmologist to better examine the inner surface of the organ);
with a head-mounted ophthalmoscope or a table-top device on which the position of the patient's head is fixed.

The picture that the specialist sees can be straight or inverted. On this basis, the examination of the fundus is divided into two types - reverse (image upside down) and direct. When a slit lamp is used in the process, the method is called biomicroophthalmoscopy.

What disorders/conditions require examination of the inner surface of the eyes?

Fundus examination is a standard procedure and is recommended for regular medical examinations. It is prescribed for the prevention, treatment of eye, neurological, cardiac, genetic diseases, it is very important for monitoring the course of therapy.

Absolute indications for the examination of the fundus will be:

pregnancy (the goal is to determine the degree of risk of retinal detachment during the natural course of childbirth);
suspicion of myopia, indications for surgical correction of vision;
diabetes;
stroke;
hypertension;
kidney pathology;
it is obligatory to conduct an examination of the fundus for tuberculosis;
syphilis and other diseases of the same group;
independent pathologies of the retina (as a result of trauma, illness, due to age-related processes);
atherosclerosis, cervical osteosclerosis;
increased pressure (intracranial);
genetic anomalies in the retina (including the so-called night blindness).