Ophthalmological examination. Treatment of inflammatory eye diseases Ophthalmology examination

Compiled by: A.F. Belyanin

The proposed tasks will allow students to independently master the basic methods of researching eye diseases, which are necessary for work in practical classes and at outpatient appointments; correct documentation.

Introduction

Mastering the practical skills of examining patients is the most important moment in the development of any medical discipline. This is especially true for ophthalmology, since students are introduced to many research methods for the first time.

The main practical skills that students should possess are the following:

method of external examination;

examination of the conjunctiva of the upper and lower eyelids;

side lighting method;

determination of the sensitivity of the cornea;

detection of superficial defects of the cornea;

definition of peripheral vision (perimetry);

instillation of eye drops and laying ointments;

the imposition of monocular and binocular bandages, the imposition of cotton-gauze stickers;

examination of the eye in transmitted light;

skiascopy;

ophthalmoscopy;

determination of visual acuity;

determination of color perception;

determination of intraocular pressure;

determination of the refraction of the eye by the method of selecting spectacle lenses and the ability to record the data obtained;

determination of the nearest point of clear vision;

determination of the strength of an unknown spectacle glass by the method of neutralization;

determination of interpupillary distance;

ability to write a prescription for glasses.

Additionally, such methods as exophthalmometry, determination of the angle of strabismus according to Hirshberg, color lacrimal-nasal test, determination of the volume of accommodation, refractometry, etc. can be mastered.

In the process of mastering diagnostic methods, each student enters the results of the examination into his notebook. Recordings are presented to the teacher at the end of the lesson.

Task number 1 external examination, eversion of the eyelids, color tear-nasal test.

External examination is an important part of a preliminary acquaintance with the pathology of the eye and its auxiliary apparatus. It does not require special devices and is carried out, as a rule, in natural light conditions. External examination is carried out in a certain sequence.

Pay attention to the skin of the eyelids: the presence or absence of edema, hyperemia, local or diffuse infiltrates, subcutaneous hematoma and emphysema (feeling of crepitus), superficial neoplasms. Normal: the skin of the eyelids is not changed.

The position of the eyeballs is determined (the position of the visual axes, the mobility of the eyes, the uniformity of the protrusion of both eyes, their displacement to the sides). In this case, there may be a deviation of the eyes more often in horizontal meridians (convergent and divergent strabismus), limitation of eye mobility in a certain direction, unilateral or bilateral protrusion of the eye forward (exophthalmos). Instrumental methods for their more accurate study will be covered in the next task. In the presence of exophthalmos or displacement of the eyeball to the sides, palpation of the accessible zones of the orbit is performed along the entire circumference (in this case, seals, defects in the bone edge of the orbit can be detected). The degree of compression of the tissues of the orbit by the eyeball (reposition of the eye) is also determined. All this can be easily checked against each other: by pressing on the eyeball with closed eyelids, you can feel how freely it shifts deep into the orbit. In the presence of a tumor in the orbit, the reposition of the eye is difficult; with endocrine exophthalmos, it may not be disturbed. Normal: the position of the eyeballs in the orbit is correct, the movements are not limited in full.

Next, examine the condition of the eyelids and the width of the palpebral fissures. Normally, the width of the palpebral fissure is the same on both sides and averages 6–10 mm in the center and 3–4 mm in the region of the inner and outer edges of the eyelids, the length of the palpebral fissure is about 30 mm (these parameters must be measured on each other). With a calm look straight ahead, the upper eyelid slightly covers the upper segment of the cornea, the lower eyelid does not reach the limbus by 1–2 mm. One - or bilateral narrowing of the palpebral fissure, accompanied by redness of the eye (photophobia, lacrimation), is evidence of inflammation of the eyeball or damage to its surface membranes (conjunctiva, cornea). The narrowing of the palpebral fissure, without any reaction from the eye, may be the result of congenital or acquired ptosis. In this case, the upper eyelid can partially or completely close the pupil and opens slightly only when the frontal muscle is tensed. Normally, when the eyelids close, the ciliary edges are tightly adjacent to each other. In some cases, due to paresis or paralysis of the facial nerve, with cicatricial deformities and shortening of the eyelids, tight closure does not occur (lagophthalmos). Normal: the width of the palpebral fissures without pathology.

Mark the position of the edges of the eyelids. Normally, the edges of the eyelids fit snugly against the eyeball. In pathology, the edge of the eyelid can be separated from the eyeball (eversion of the edge of the eyelid) and wrapped inward (torsion).

The position of the eyelashes is noted (there may be incorrect eyelash growth - trichiasis), the condition and width of the intermarginal space (normally it is 1.5 - 2 mm), the condition and position of the lacrimal openings. They are located at the inner edge of both eyelids on a small ledge (lacrimal papilla) and, as a rule, are turned towards the eyeball in the region of the lacrimal lake in the inner corner of the eye. They are visible in the form of points with a slight pull on the inner corner of the eyelids. In pathology, there may be an anterior displacement of the lacrimal openings (eversion), their narrowing, absence (atresia), several lacrimal openings. With the pathology of lacrimation and the patient's complaints of lacrimation, one can see lacrimation, i.e. fluid level along the lower edge of the eyelid. In this case, you should always check the condition of the lacrimal sac by pressing on the place of its projection in the region of the inner corner of the eyelids. In chronic purulent inflammation of the lacrimal sac (purulent dacryocystitis), one can see how mucous or purulent discharge is released from the points.

Examine the conjunctiva of the upper and lower eyelids. The lower eyelid turns out easily, it is enough to pull it down, and ask the patient to look up. The eversion of the upper eyelid requires skill. The technique is as follows (the picture can be seen in the textbook of eye diseases, edited by T.I. Eroshevsky): the patient is asked to look down, the upper eyelid is pulled up with the thumb of the left hand, the ciliary edge of the eyelid is grabbed with the thumb and forefinger of the right hand and slightly pulled away from the eye apples down and then, pressing the thumb of the left hand on the upper edge of the cartilage, with the right hand, the edge of the eyelid is wrapped up. At the same time, it turns inside out, the thumb of the left hand is removed from under the eyelid and they also hold the eyelid by the ciliary edge in an everted state and inspect it all over. It is possible to use in the form of a lever not the thumb of the left hand, but a glass rod.

Normally, the conjunctiva of the eyelids and the eyeball is smooth, transparent, thin, moist, deep vessels, meibomian glands, located in the thickness of the cartilage in the form of yellowish-gray stripes perpendicular to the edge of the eyelid, are clearly visible through it. With inflammation, the conjunctiva becomes thickened, edematous, folded, diffuse hyperemia appears, it can contain deep and superficial follicles, mucus, pus, viscous threads of secretion.

Normally, the eyeball is white, calm, while the white sclera shines through the transparent conjunctiva. With inflammation of the eye, its hyperemia is observed, it can be superficial (conjunctival) and deep (pericorneal). Conjunctival hyperemia is characterized by a bright red color, a large number of dilated blood vessels, decreasing towards the cornea and increasing towards the vaults. With a pericorneal injection, characteristic of inflammation of the eyeball itself, there is a diffuse deep injection from bright red to bluish-violet in color, localized directly at the cornea in the limbus area along its entire circumference or in a separate sector.

In conclusion, it is necessary to check on each other the functional state of the lacrimal ducts (colored tear-nasal test). One drop of a 2% solution of collargol is instilled into the conjunctival cavity (in this case, the patient should not compress the eyelids, so the lower and upper eyelids are lightly held with fingers after instillation). With normal patency of the lacrimal apparatus, after 1-2 minutes, the paint completely disappears from the conjunctival cavity and the eyeball becomes discolored. If tear drainage is impaired, a strip of colored fluid along the edge of the lower eyelid remains for a long time. The final result of this test is evaluated after 5 - 10 minutes after the appearance of paint in the nose (when blown), but in this case you can not do this. As a rule, the rapid absorption of the paint from the conjunctival cavity indicates a good lacrimal function.

vision diagnostics- this is an important step in the prevention of eye diseases and maintaining good vision for many years! Timely detection of ophthalmic pathology is the key to successful treatment of many eye diseases. As our practice shows, the occurrence of eye diseases is possible at any age, so everyone needs to undergo a high-quality ophthalmological examination at least once a year.

Why is a complete eye examination necessary?

Vision diagnostics is necessary not only to identify the primary ophthalmic pathology, but also to resolve the issue of the possibility and expediency of performing a particular operation, the choice of patient treatment tactics, as well as the accurate diagnosis of the state of the organ of vision in a dynamic aspect. In our clinic, a complete ophthalmological examination is carried out using the most modern diagnostic equipment.

The cost of vision diagnostics

The cost of a diagnostic examination (diagnostics of vision) depends on its volume. For the convenience of patients, we have formed complexes, in accordance with common eye diseases, such as cataracts, glaucoma, myopia, hyperopia, pathology of the fundus.

What studies are included in a complete diagnostic examination of the visual system and what are they?

Any ophthalmological examination begins, first of all, with a conversation, identifying complaints from the patient and taking an anamnesis. And only after that they proceed to the hardware methods of studying the organ of vision. The hardware diagnostic examination includes determining visual acuity, studying the patient's refraction, measuring intraocular pressure, examining the eye under a microscope (biomicroscopy), pachymetry (measuring the thickness of the cornea), echobiometry (determining the length of the eye), ultrasound examination of the eye (B-scan), computed keratotopography and careful (fundus) with a wide pupil, determination of the level of tear production, assessment of the patient's field of view. When an ophthalmic pathology is detected, the scope of the examination is expanded for a specific study of clinical manifestations in a particular patient. Our clinic is equipped with modern, highly professional ophthalmological equipment from such companies as ALCON, Bausch & Lomb, NIDEK, Zeiss, Rodenstock, Oculus, which allows for examinations of any level of complexity.

In our clinic, special tables with pictures, letters or other signs are used to determine the visual acuity and refraction of the patient. Using the automatic phoropter NIDEK RT-2100 (Japan), the doctor, alternately changing the diopter glasses, selects the most optimal lenses that provide the best vision for the patient. In our clinic, we use NIDEK SCP - 670 halogen sign projectors with 26 test charts and analyze the result obtained under narrow and wide pupil conditions. A computer study of refraction is carried out on a NIDEK ARK-710A autorefkeratometer (Japan), which allows you to determine the refraction of the eye and the biometric parameters of the cornea as accurately as possible.

Intraocular pressure is measured using a NIDEK NT-2000 non-contact tonometer. If necessary, the measurement of intraocular pressure is carried out by contact method - Maklakov's or Goldman's tonometers.

To study the state of the anterior segment of the eye (eyelids, eyelashes, conjunctiva, cornea, iris, lens, etc.), a NIDEK SL-1800 slit lamp (biomicroscope) is used. On it, the doctor evaluates the condition of the cornea, as well as deeper structures such as the lens and vitreous body.

All patients undergoing a complete ophthalmological examination are required to undergo an examination of the fundus, including areas of its extreme periphery, in conditions of maximum pupil dilation. This makes it possible to detect degenerative changes in the retina, to diagnose its ruptures and subclinical detachments - a pathology that is not clinically determined by the patient, but requires mandatory treatment. To dilate the pupils (mydriasis), fast and short-acting drugs (Midrum, Midriacil, Cyclomed) are used. When changes in the retina are detected, we prescribe prophylactic laser coagulation using a special laser. Our clinic uses the best and most modern models: YAG laser, NIDEK DC-3000 diode laser.

One of the important methods for diagnosing a patient's vision before any refractive surgery for vision correction is computer topography of the cornea, aimed at examining the surface of the cornea and its pachymetry - measuring the thickness.

One of the anatomical manifestations of refractive errors (myopia,) is a change in the length of the eye. This is one of the most important indicators, which is determined in our clinic by a non-contact method using the IOL MASTER device from ZEISS (Germany). This is a combined biometric device, the results of which are also important for calculating the IOL in cataracts. Using this device, during one session, directly one after another, the length of the axis of the eye, the radius of curvature of the cornea and the depth of the anterior chamber of the eye are measured. All measurements are carried out using a non-contact method, which is extremely comfortable for the patient. Based on the measured values, the built-in computer can suggest optimal intraocular lenses. The basis for this is the current international calculation formulas.

Ultrasound examination is an important addition to the generally recognized clinical methods of ophthalmic diagnostics; it is a widely known and informative instrumental method. This study makes it possible to obtain information about the topography and structure of normal and pathological changes in the tissues of the eye and orbit. The A-method (one-dimensional imaging system) measures the thickness of the cornea, the depth of the anterior chamber, the thickness of the lens and the inner membranes of the eye, as well as the length of the eye. The B-method (two-dimensional imaging system) allows assessing the state of the vitreous body, diagnosing and assessing the height and extent of choroid and retinal detachment, identifying and determining the size and localization of ocular and retrobulbar neoplasms, as well as detecting and determining the location of a foreign body in the eye.

Study of visual fields

Another of the necessary methods for diagnosing vision is the study of visual fields. The purpose of determining the field of view (perimetry) is:

• diagnosis of eye diseases, in particular glaucoma
• dynamic monitoring to prevent the development of eye diseases.

Also, using a hardware technique, it is possible to measure the contrast and threshold sensitivity of the retina. These studies provide an opportunity for early diagnosis and treatment of a number of eye diseases.

In addition, other parametric and functional data of the patient are examined, for example, determining the level of tear production. The most diagnostically sensitive functional studies are used - the Schirmer test, the Norn test.

Optical tomography of the retina

Another modern method for studying the inner shell of the eye is. This unique technique allows you to get an idea of ​​the structure of the retina throughout its depth, and even measure the thickness of its individual layers. With its help, it became possible to detect the earliest and smallest changes in the structure of the retina and optic nerve, which are not available to the resolving abilities of the human eye.

The principle of operation of an optical tomograph is based on the phenomenon of light interference, which means that the patient is not exposed to any harmful radiation during the examination. The study takes several minutes, does not cause visual fatigue and does not require direct contact of the sensor of the device with the eye. Similar devices for diagnosing vision are available only in large clinics in Russia, Western Europe and the United States. The study provides valuable diagnostic information about the structure of the retina in diabetic macular edema and allows you to accurately formulate a diagnosis in complex cases, as well as get a unique opportunity to monitor the dynamics of treatment based not on the doctor's subjective impression, but on clearly defined digital retinal thickness values.

The study provides comprehensive information about the state of the optic nerve and the thickness of the layer of nerve fibers around it. Highly accurate measurement of the latter parameter guarantees the detection of the earliest signs of this formidable disease, even before the patient has noticed the first symptoms. Considering the ease of implementation and the absence of discomfort during the examination, we recommend repeating control examinations on the scanner for glaucoma every 2-3 months, for diseases of the central retina - every 5-6 months.

A re-examination allows you to determine the activity of the pathology, clarify the correctness of the chosen treatment, as well as correctly inform the patient about the prognosis of the disease, which is especially important for patients suffering from macular holes, since the likelihood of such a process developing on a healthy eye can be predicted after a tomography examination. Early, "preclinical" diagnosis of fundus changes in diabetes mellitus is also within the power of this amazing device.

What happens after hardware research is completed?

After the completion of hardware studies (diagnosis of vision), the doctor carefully analyzes and interprets all the information received about the state of the patient's organ of vision and, based on the data obtained, makes a diagnosis, on the basis of which a treatment plan for the patient is drawn up. All research results and treatment plan are explained in detail to the patient.

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

If you experience redness of the eyes, lacrimation, swelling, pain discharge from the eyes, decreased vision, you should consult an ophthalmologist as soon as possible. Often these symptoms are indicative of development of the inflammatory process in one of the departments of the eyeball or closely located tissues. Without the participation of a qualified ophthalmologist, who will accurately establish the diagnosis and prescribe timely (and in some cases urgent) treatment, eye inflammation can become chronic, cause such unpleasant problems as eyelid closure (blepharospasm), purulent inflammation, uveitis and others. , which carry a serious threat up to complete loss of vision.

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

Ophthalmologists at ON CLINIC have modern diagnostic equipment, time-tested and proprietary methods of complex eye treatment, which allow achieving positive results.

What inflammatory eye diseases are treated in ON CLINIC

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

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

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

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

There are many reasons for the development of eye inflammation:

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

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

The administrator will contact you to confirm the registration. IMC "ON CLINIC" guarantees complete confidentiality of your treatment.

Diagnosis of inflammatory eye diseases

Examination allows to prescribe the most effective complex of treatment. First, ON CLINIC ophthalmologists carefully examine and study the condition of the patient's eyes, and collect an anamnesis.

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

Of particular importance in the process of conducting an examination is differential diagnosis, since many eye diseases have similar symptoms. In any case, it is necessary to comprehensive diagnosis of inflammatory eye diseases which may include the following studies:

ON CLINIC has its own clinical diagnostic laboratory, which provides an opportunity for complex laboratory and instrumental examination in inflammatory eye diseases.

Treatment of inflammatory eye diseases in ON CLINIC

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

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

• effective drugs (antibacterial, antiviral, etc.) that allow you to destroy the causative agent of the infection;
• specific immunotherapy and allergotherapy;
• special eyelid massage;
• ozone therapy (intravenous infusions and / or irrigation of the conjunctival cavity);
• physiotherapeutic methods, in particular magnetic stimulation, color therapy, etc.;
• with the development of complications - sparing microsurgical intervention, etc.

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

ON CLINIC - comprehensive diagnostics and effective treatment of inflammatory eye diseases!

Service cost

In ophthalmology, thanks to modern equipment, the latest medical techniques, eye examination takes a short time, is painless and gives very accurate results in identifying diseases of the eye organ.

vision study

At an appointment with an ophthalmologist, the patient is examined by the main standard diagnostic methods, which include checking visual acuity, measuring intraocular pressure, examining the cornea and retina.

If necessary, a more accurate and in-depth study is prescribed on modern devices using laser technology and computer programs.

Symptoms for a mandatory visit to the ophthalmologist

For timely detection of eye diseases and treatment, it is necessary to pay attention to the following symptoms:

• swelling and redness of the eyelids;
• the presence of itching and burning in the eyes;
• pain when blinking;
• redness of the inner surface;
• severe tearing;
• the presence of a film in front of the eyes, making it difficult to see;
• flies and dots before the eyes;
• flickering light flashes;
• blurry or foggy vision of objects;
• duality of objects;
• increased sensitivity to light;
• long orientation in a dark room;
• sudden disappearance of the image;
• curvature or kink of lines when looking at straight lines;
• observation of dark spots in the field of view;
• iridescent circles that blur around the light source;
• difficulty focusing on near and far objects;
• observation of spots in the center of the field of view;
• beginning to squint eyes;
• poor vision of the peripheral zone.

Who needs an eye exam

People with good one hundred percent vision should have it checked once a year for preventive purposes. For those who have visual impairment due to certain reasons, it is necessary to undergo an examination by an ophthalmologist to correct vision.

For contact lens wearers, an examination is needed to detect adaptation of the lens material to the surface of the eye. To determine allergic reactions to this material. Clarify the correct care and storage of contact lenses.

Pregnant women need to see an ophthalmologist at 10-14 weeks and 34-36 weeks. Pregnancy can cause changes in visual acuity or complications of existing eye diseases.

For people aged 40–60 years, it is advisable to plan a preventive visit to the ophthalmologist once every 2–4 years. Over 65 years old - once every 1-2 years. Children need to be treated up to three times during the first year of life and as needed.

It is desirable to come to an appointment with an ophthalmologist for people with cardiovascular diseases, suffering from hypertension and diabetes, after eye injuries or taking hormonal drugs.

Examination methods

There are many serious diseases of the human eye organ that significantly affect the visual process. These are cataracts, glaucoma, retinal detachment and many infectious diseases.

Diagnosis at an early stage, as well as treatment started on time, can prevent the further development of diseases, partial loss of vision and blindness. The earlier the diagnosis is established and treatment is started, the greater the percentage of vision that can be saved.

Basic examination methods

The applied methods of examination are basic and additional:

• Visometry - the definition of vision, its sharpness according to the tables of letters, where letters of different sizes are written in each line. While reading the lines, the current vision is set as a percentage.
• Tonometry - determination of the existing pressure inside the body. The method is aimed at determining glaucoma.
• Refractometry - determination of the refraction of the eye (optical power). It can detect nearsightedness, farsightedness and astigmatism.
• The study of color vision is aimed at recognizing color blindness and other deviations in color perception.
  The perimetry method diagnoses glaucoma and determines the degree of death of the optic nerve.
• Biomicroscopy is a method of examining the constituent parts of the eye organ, such as the cornea of ​​the eye, the external conjunctiva, the lens, the iris, and the vitreous body.
• Ophthalmoscopy is a way to examine the fundus, retina, nearby vascular tissues. Determines the degree of strabismus.
• Gonioscopy is a contact technique that allows you to examine the front of the eye to detect a foreign body or neoplasm.
• Pachymetry is a method of studying the cornea of ​​\u200b\u200bthe eye with the help of instruments, measuring its thickness.
• Skiascopy - a shadow test is carried out by observing the shadows on the surface of the pupil when a beam of light falls on it.
• Campimetry is a method of studying central vision to determine the size of the blind spot.
• For a complete examination of the eyeball, Goldman lenses are used. This device consists of three mirrors. With the help of a lens, neoplasms on the retina can be removed and it can be fully examined.

Today, methods of examining the organ of vision are enough to accurately and correctly make a diagnosis by looking into the most inaccessible and deep layers of the visual organ.