Ophthalmic diagnostics. Complete eye examination. What does vision diagnostics in the Excimer clinic include?

Vision is considered one of the greatest values in a person's life, and few people think about it when they are in good health. But once you encounter any eye disease at least once, you already want to give all the treasures for the very opportunity to see clearly. Timely diagnosis is important here - vision treatment will be effective only if the correct diagnosis is made.

In the modern world, there are a large number of various methods that allow you to identify any problem with the eyes even at the first signs of the manifestation of the disease. All of them make it possible to determine the nature of the threat, and the tactics of further treatment. Such studies are carried out using special equipment in ophthalmological clinics.

Despite the fact that the process of a complete examination by an ophthalmologist takes only an hour, it is better to allocate more free time for additional diagnostics. The whole problem lies in the fact that during the period of the study, the eyes are instilled with a special solution that expands the pupil. This helps to see more of the lens for better inspection. The effect of these drops can last for several hours, so it is worth refraining from any activity during this period.

Why visit an ophthalmologist?

In the life of any person, there may come a moment when you have to seek help from an eye doctor. Such a decision is determined by a number of factors that become possible during a visit to an ophthalmologist.

Comprehensive vision diagnostics.
Professional equipment and high quality consumables.
Acceptable price of the services provided.
and choice of treatment.
The presence of a special database where all information about any of the patients is stored.
Individual approach and appointment of the required examinations.
Operation followed by rehabilitation.
Consultation of related specialists.

It should be remembered that a person's vision can deteriorate for various reasons. Only a modern examination will help to find them and eliminate them.

General information

Vision diagnostics is necessary to make an accurate diagnosis or simply identify the causes that impair vision, as well as to choose the best course of treatment for each individual patient. An integrated approach to this issue will help to identify the true cause of poor vision, because many eye diseases have similar symptoms.

For this, a comprehensive diagnostics of vision is carried out, which studies a whole list of various indicators:

checking visual acuity;
finding the refraction of the eye;
establishment;
condition of the optic nerve;
measurement of the depth of the cornea of the eye and so on.

Also, the list of a comprehensive examination necessarily includes an ultrasound of the internal structures of the eye for the possibility of pathologies.

Preparation for the examination

A complete vision diagnosis or a partial examination can only be carried out after proper preparation. To do this, you should initially consult a doctor who can see if the vision problem is a concomitant symptom of some other disease. This applies to diabetes or the presence of a chronic infection in the body. When compiling an anamnesis, it is necessary to take into account the issue of the patient's heredity, which can affect his well-being at a certain period of life. Before going to the ophthalmologist itself, no special preparation is needed, except that it is better to get a good night's sleep so that you can adequately interpret the results obtained during the examination.

Vision diagnostic methods

At the moment, ophthalmology has moved far ahead in understanding the eye as a separate element of the whole organism. Thanks to this, it is possible to more accurately and quickly treat a wide variety of eye problems, for which innovative techniques are used. It is simply impossible to list all of them, but it is worth taking a closer look at the most popular and popular ones.

Visometry

Diagnosis of vision begins with the traditional method - determining acuity and refraction. For this, special tables with letters, pictures or other signs are used. In this case, it is considered the most familiar, although in recent years halogen sign projectors have taken the first place. In the latter case, doctors manage to check the acuity of binocular and color vision. Initially, a check is carried out without correction, and then together with a lens and a special spectacle frame. This solution allows the doctor to accurately diagnose the problem and choose the best treatment to eliminate it. Usually, after this, patients can regain 100% vision.

Tonometry

The most common procedure for ophthalmologists, which involves measuring intraocular pressure. Such a diagnosis of vision is of great importance in the appearance of glaucoma. In practice, such a study is carried out by contact or non-contact methods. In the first case, or Goldman is used, which needs to measure the degree of deflection of the cornea of the eye under pressure. With the non-contact method, the pneumotonometer determines the intraocular pressure using a directed air jet. Both methods have the right to exist and can make it possible to judge the possibility of a number of specific eye diseases. Such a procedure is considered mandatory for people over 40 years old, since it is at that age that the risk of developing glaucoma increases.

Ultrasound examination of the eye and orbit

Ultrasound of the eye is considered a non-invasive and highly informative research method that provides an opportunity to examine the posterior segment of the eye, the vitreous body and the orbit. Such a technique is carried out exclusively on the recommendation of the attending physician and is considered mandatory before performing certain operations or removing cataracts.

At the present time, conventional ultrasound has been replaced by ultrasound biomicroscopy, which studies the anterior segment of the eye at the micro level. With the help of such an immersion diagnostic procedure, one can obtain comprehensive information about the structure of the anterior part of the eye.

There are several techniques for performing this procedure, depending on which the eyelid can be closed or open. In the first case, the sensor is moved along the eyeball, and superficial anesthesia is performed to avoid discomfort. When the eyelid is closed, you just need to apply a little special liquid on it, which is removed at the end of the procedure with a regular napkin.

In terms of time, such a technique for examining the state of the eye takes no more than a quarter of an hour. Ultrasound of the eye has no contraindications regarding the appointment, so it can be performed on children, pregnant women and even people with serious illnesses.

Computer vision diagnostics

The noted method of diseases is considered one of the most accurate. Thanks to his help, you can find any disease of the eye. The use of specific medical devices makes it possible to assess the state of all structures of the visual organ. It is worth noting that such a procedure is performed without direct contact with the patient, therefore it is completely painless.

Computer diagnostics, depending on the age of the patient, can last from 30 minutes to an hour. To do this, a person who applied for an announced study will have to take a position near a special device that will fix their eyes on the image that appears. Immediately after this, the autorefractometer will be able to measure a number of indicators, the results of which can be used to judge the condition of the eyes.

Computer diagnostics of vision can be prescribed by an ophthalmologist to assess the condition of the patient's eyes for the presence of diseases or pathogenic processes, determine the most optimal treatment plan, or confirm the need for subsequent surgical intervention.

Ophthalmoscopy

Another method for examining the human eye, in which case particular importance is attached to the choroid of the marked organ, as well as the optic nerve and retina. During the procedure, a special device ophthalmoscope is used, which directs a beam of direct light to the eye. The main condition for this method is the presence of a maximum that makes it possible to examine hard-to-reach peripheral parts of the retina. Thanks to an ophthalmoscope, doctors can detect retinal detachment and its peripheral dystrophy, as well as pathology of the fundus, which does not manifest itself clinically. To dilate the pupil, you only need to use some kind of short-acting mydriatic.

Of course, this list of existing methods for diagnosing problems of the organs of vision is far from complete. There are a number of specific procedures that can detect only certain diseases of the eye. But only the attending physician can prescribe any of them, so at the very beginning you just need to make an appointment with an ophthalmologist.

Diagnosis of eye problems in children

Unfortunately, eye diseases can manifest themselves not only in adults - children also often suffer from similar problems. But in order to conduct a qualitative examination of a baby frightened by the mere presence of a doctor, an assistant is necessary. Diagnosis of vision in children is carried out in almost the same way as in adults, only the head, arms and legs of the child must be fixed in one position to obtain the most accurate results.

It is worth noting that the diagnostic methods in this case will be identical to the above, however, an eyelid lifter may be needed. Children from the age of 3 undergo pyrometry in the form of a fun game with colorful pictures. If it comes to instrumental research, it is worth using painkillers for the eyes.

For a better examination of the child, it is worth contacting a pediatric ophthalmologist who has special training.

Where to go for diagnostics?

If the issue of conducting one of the methods for diagnosing eye diseases has become a priority, it's time to contact an ophthalmologist. But where to make a vision diagnosis so that it is accurate, correct and really makes it possible to understand the root causes of vision problems?

Of course, the most experienced specialists in this regard are located in the capital, which houses many ophthalmic medical institutions with special innovative equipment. That is why even district ophthalmologists are assigned vision diagnostics in Moscow. The best Russian clinics located in this city will help you make the correct diagnosis as quickly and accurately as possible and decide on the tactics of subsequent treatment. Considering the reputation of modern medical institutions in the capital and the number of clients who turn to them, it is worth highlighting the following options.

Moscow Eye Clinic.
Ophthalmological center Konovalov.
MNTK "Eye Microsurgery".
Medical center "Excimer".
Medical center "Okomed".

All that remains for a person who has vision problems is simply to contact one of the indicated institutions and get the necessary assistance.

■ Complaints of the patient

■ Clinical examination

External examination and palpation

Ophthalmoscopy

■ Instrumental examination methods

Biomicroscopy Gonioscopy

Echoophthalmography

Entoptometry

Fluorescein angiography of the retina

■ Examination of the organ of vision in children

COMPLAINTS OF THE PATIENT

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

Decrease or change in vision;

Pain or discomfort in the eyeball and surrounding areas;

lacrimation;

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

visual impairment

Decreased visual acuity

It is necessary to find out what visual acuity the patient had before the disease; whether the patient discovered the decrease in vision by chance or he can accurately indicate under what circumstances this happened; reduce

whether the vision gradually decreased or its deterioration occurred fairly quickly, in one or both eyes.

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

vision changes

Metamorphopsia, macropsia and micropsia disturb patients in case of localization of pathological processes in the macular region. Metamorphopsias are characterized by the distortion of the shapes and outlines of objects, the curvature of straight lines. With micro- and macropsias, the observed object appears to be either smaller or larger in size than it actually exists.

Diplopia(doubling) can occur only when fixing an object with two eyes, and is due to a violation of the synchrony of eye movements and the impossibility of projecting an image onto the central pits of both eyes, as is normal. When one eye is closed, diplopia disappears. Causes: violation of the innervation of the external muscles of the eye or uneven displacement of the eyeball due to the presence of a volumetric formation in the orbit.

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

Photophobia(photophobia) indicates an inflammatory disease or injury to the anterior segment of the eye. The patient in this case tries to turn away from the light source or close the affected eye.

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

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

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

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

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

Pain and discomfort

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

Pain in the eye indicates inflammation of the anterior segment of the eyeball.

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

Pain around the eye in the orbit occurs with lesions of the conjunctiva, trauma and inflammation in the orbit.

Headache on the side of the affected eye is noted with an acute attack of glaucoma.

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

lacrimation

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

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

CLINICAL EXAMINATION

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

External examination and palpation

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

First, the area of the brow bone, the back of the nose, the upper jaw, the zygomatic and temporal bones, and the area where the anterior lymph nodes are located are examined. Palpation assesses the condition of these lymph nodes and the edges of the orbit. The sensitivity is checked at the exit points of the branches of the trigeminal nerve, for which, simultaneously on both sides, a point located on the border of the inner and middle third of the upper edge of the orbit is palpated, and then a point located 4 mm below the middle of the lower edge of the orbit.

Eyelids

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

Eyelid skinnormally thin, tender, loose subcutaneous tissue is located under it, as a result of which edema easily develops in the eyelid area:

In general diseases (diseases of the kidneys and the cardiovascular system) and allergic Quincke's edema, the process is bilateral, the skin of the eyelids is pale;

In inflammatory processes of the eyelid or conjunctiva, edema is usually unilateral, the skin of the eyelids is hyperemic.

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

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

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

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

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

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

Entropion - eversion of the eyelid, more often than the lower one, can be senile, paralytic, cicatricial and spastic;

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

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

Conjunctiva

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

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

Rice. 4.1.Stages of eversion of the upper eyelid

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

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

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

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

Chemosis of the conjunctiva - infringement of the conjunctiva within the palpebral fissure due to severe edema.

The position of the eyeballs

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

exophthalmos(protrusion of the eye anteriorly) is observed with thyrotoxicosis, trauma, tumors of the orbit. For differential diagnosis of these conditions, reposition of the standing eye is performed. To this end, the doctor presses with his thumbs through the eyelids on the patient's eyeballs and assesses the degree of their displacement into the orbit. With exophthalmos caused by a neoplasm, difficulty in repositioning the eyeball into the orbital cavity is determined.

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

Lateral displacement of the eyeball can be with a volumetric formation in the orbit, an imbalance in the tone of the oculomotor muscles, a violation of the integrity of the walls of the orbit, inflammation of the lacrimal gland.

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

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

Lacrimal organs

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

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

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

Rice. 4.3. Schirmer's test

Functional patency lacrimal ducts evaluate by several methods.

canal test. Instilled into the conjunctival sac

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

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

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

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

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

Side (focal) illumination method

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

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

The sclera is clearly visible through the transparent conjunctiva and is normally white. Yellow coloration of the sclera is observed with jaundice. Staphylomas can be observed - dark brown areas of protrusion of a sharply thinned sclera.

The cornea. The ingrowth of blood vessels into the cornea occurs in pathological conditions. Small defects

Rice. 4.4.Side (focal) illumination method

corneal epithelium is detected by staining with 1% sodium fluorescein solution. On the cornea there may be opacities of various localization, size, shape and intensity. The sensitivity of the cornea is determined by touching the center of the cornea with a cotton wick. Normally, the patient notes the touch and tries to close the eye (corneal reflex). With a decrease in sensitivity, the reflex is caused only by laying the thicker part of the wick. If the corneal reflex could not be induced in the patient, then there is no sensitivity.

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

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

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

Pupillary reaction to light is checked in a dark room. The pupil is illuminated with a flashlight. When one eye is illuminated, its pupil constricts (direct pupil reaction to light), as well as pupil constriction of the other eye (friendly pupil reaction to light). The pupillary reaction is considered "alive" if the pupil is rapidly constricted under the influence of light, and "sluggish" if the pupil reaction is slow and insufficient. Pupil reaction to light may be absent.

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

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

Transmitted light research

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

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

Rays reflected from the fundus (mainly from the choroid) are pink. With transparent refractive media of the eye, the doctor sees a uniform pink glow of the pupil (pink reflex from the fundus). Various obstacles in the path of the light beam (that is, clouding of the media of the eye) delay some of the rays, and against the background of a pink glow, dark spots of various shapes and sizes appear. If no opacities in the cornea and moisture of the anterior chamber were detected during an examination of the eye in lateral illumination, then opacities visible in transmitted light are localized either in the lens or in the vitreous body.

Ophthalmoscopy

The method allows you to assess the condition of the fundus (retina, optic disc and choroid). Depending on the method of conducting, ophthalmoscopy is distinguished in reverse and direct form. This study is easier and more efficient to conduct with a wide pupil.

Reverse ophthalmoscopy

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

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

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

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

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

Vessels of the fundus. The central retinal artery enters through the center of the optic disc and the central retinal vein exits. As soon as the main trunk of the central retinal artery reaches the surface of the disc, it divides into two branches - the upper and lower, each of which branches into the temporal and nasal. The veins repeat the course of the arteries, the ratio of the caliber of arteries and veins in the corresponding trunks is 2:3.

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

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

Ophthalmochromoscopy allows you to explore the fundus with a special electro-ophthalmoscope in purple, blue, yellow, green and orange light. This technique allows you to see early changes in the fundus.

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

Measurement of intraocular pressure

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

Palpation method

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

There are 3 degrees of increase in eye turgor:

The eyeball is squeezed under the fingers, but for this the doctor makes more effort - the intraocular pressure is increased (T + 1);

The eyeball is moderately dense (T+ 2);

Finger resistance is dramatically increased. The tactile sensations of the doctor are similar to the sensation during palpation of the frontal region. The eyeball almost does not slip under the finger - intraocular pressure is sharply increased (T + 3).

There are 3 degrees of eye turgor reduction:

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

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

On palpation, no resistance of the wall of the eyeball is felt at all (as with pressure on the cheek) - intraocular pressure is sharply reduced. The eye is not spherical or does not retain its shape on palpation (T-3).

Tonometry

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

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

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

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

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

yut for 4 minutes while the sensor is on the cornea. In this case, a gradual decrease in pressure occurs, as part of the intraocular fluid is forced out of the eye. According to the tonography data, it is possible to judge the cause of the change in the level of intraocular pressure.

INSTRUMENTAL EXAMINATION METHODS

Biomicroscopy

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

The light passing through the slit diaphragm forms a light section of the optical structures of the eye, which is viewed through a slit lamp stereomicroscope. Moving the light gap, the doctor examines all the structures of the eye with a magnification of up to 40-60 times. Additional observational, photo- and telerecording systems, laser emitters can be introduced into the stereomicroscope.

Gonioscopy

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

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

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

Rice. 4.7. Gonioscope

Diaphanoscopy and transillumination

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

Echoophthalmoscopy

Ultrasonic research method structures of the eyeball are used in ophthalmology for the diagnosis of retinal and choroidal detachments, tumors and foreign bodies. It is very important that echo-ophthalmography can also be used for clouding of the optical media of the eye, when the use of ophthalmoscopy and biomicroscopy is impossible.

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

Entoptometry

An idea of the functional state of the retina can be obtained by using entoptic tests(gr. ento- inside, ortho- see). The method is based on the visual sensations of the patient, which arise as a result of exposure to the receptor field of the retina of adequate (light) and inadequate (mechanical and electrical) stimuli.

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

Autoophthalmoscopy- a method that allows assessing the safety of the functional state of the retina in opaque optical media of the eye. The retina functions if, with rhythmic movements of the diaphanoscope along the surface of the sclera, the patient notes the appearance of visual pictures.

Fluorescein angiography of the retina

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

Rice. 4.8.Retinal angiography (arterial phase)

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

EXAMINATION OF THE ORGAN OF VISION IN CHILDREN

When conducting an ophthalmological examination of children, it is necessary to take into account their rapid fatigue and the impossibility of long-term fixation of the gaze.

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

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

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

Intraocular pressure in young children is measured under anesthesia.

Modern people are hostages of a hectic life in huge cities, who have practically no time left to take care of their own health. Therefore, visits to the doctor, especially preventive ones, are very rare, and it is easier to prevent or cure diseases at an early stage than to courageously fight the consequences of a neglected disease.

This truth is 100% true in relation to diseases of the eyes, "rejuvenated" in recent times, as well as other diseases of the body. Taking care of the health of the vision system of our patients, and taking into account the total lack of free time, the "Clinic of Dr. Shilova" introduced an effective method of complex diagnostics of the organ of vision in one visit to the ophthalmologist.

This technique is universal, but at the same time, it is individual and allows you to fully take into account the peculiarities of the eyes of each individual person. After the initial appointment, the analysis of symptoms and the study of possibly available medical records, an experienced specialist determines a set of necessary diagnostic procedures that will create a complete picture of the health of the visual system on the same day.

Equipment for computer diagnostics is a special pride of our clinic. It is considered one of the most high-precision not only in Moscow, but also in the world. Advanced diagnostic technology, the use of innovative research methods and the experience of ophthalmologists working in the clinic guarantee the success of a complete examination of the visual system.

Video about the types of vision examinations

Our eye clinic in the television program "Diagnostic Method".

In the "Clinic of Dr. Shilova" the patient is offered:

Checking visual acuity by traditional (subjective), as well as computer methods, with and without correction (when only a consultation is needed).
Selection of contact lenses and glasses of any complexity.
Autorefkeratometry - determination of the clinical refraction of the eye (detection of myopia, hyperopia, astigmatism).
Pneumotonometry is a study of IOP by a non-contact computerized method using an air jet, indispensable in the early diagnosis of glaucoma.
Echobiometry is a non-contact measurement of the parameters of the human eye (its length, lens thickness, pupil diameter, anterior chamber depth, etc.), using a unique ultrasonic device AL-Scan (NIDEK, Japan). This study is mandatory when calculating the strength of the intraocular lens in cataract surgery, to detect the progression of the myopic process, etc.
Biomicroscopic examination - examination of the fundus using a fundus lens, which reveals pathologies of the central as well as peripheral areas of the retina and optic nerve. It is necessary for patients with any degree of myopia and retinal dystrophy.
Perimetry - the study of visual fields for each eye using a special computer perimeter. The study is mandatory in the diagnosis of the degree of glaucoma, lesions of the optic nerve, diseases of the central nervous system.
A-method echoscopy is an ultrasound examination of the intraocular membranes and media to detect retinal detachment, tumors and hemorrhages in the eye.
Echoscopy by the B-method - ultrasound of the eyeball to determine the existing pathologies in the case of opacity of the optical media, which is prescribed as an additional to a complete diagnostic examination of the eyes.
Keratopachymetry is an ultrasound examination of the thickness of the cornea, which is important in the diagnosis of keratoconus, as well as in laser vision correction.
Computed keratotopography is a study of the curvature of the corneal surface, which is mandatory for clarifying the degree of astigmatism and diagnosing keratoconus, as well as necessary for laser vision correction.

Specialists of the "Clinic of Dr. Shilova" strongly recommend that each patient undergo a set of diagnostic procedures if:

The last visit to the ophthalmologist was a year or more than a year ago.
Work is associated with overstrain or eye strain.
Parents or close relatives have been diagnosed with eye disease.

Do not postpone an ophthalmological examination "for later." Be sure to make an appointment with the doctor at a convenient time for you. Come visit us after work or on a day off with the whole family, making a fun adventure out of a scheduled visit. Needless to say, good vision costs much more than 60 minutes spent on an examination!

In ophthalmology, instrumental research methods based on the achievements of modern science are used, which allow early diagnosis of many acute and chronic diseases of the organ of vision. Leading research institutes and clinics of eye diseases are equipped with such equipment. However, an ophthalmologist of various qualifications, as well as a general practitioner, can, using a non-instrumental research method (external (external examination) of the organ of vision and its accessory apparatus), conduct express diagnostics and make a preliminary diagnosis in many urgent ophthalmological conditions.

Diagnosis of any eye pathology begins with knowledge of the normal anatomy of eye tissues. First you need to learn how to examine the organ of vision in a healthy person. Based on this knowledge, the most common eye diseases can be recognized.

The purpose of an ophthalmological examination is to assess the functional state and anatomical structure of both eyes. Ophthalmological problems are divided into three areas according to the place of occurrence: the adnexa of the eye (eyelids and periocular tissues), the eyeball itself and the orbit. A complete baseline survey includes all of these areas except the orbit. For its detailed examination, special equipment is required.

General examination procedure:

visual acuity test - determination of visual acuity for distance, for near with glasses, if the patient uses them, or without them, as well as through a small hole with visual acuity less than 0.6;
autorefractometry and / or skiascopy - determination of clinical refraction;
study of intraocular pressure (IOP); with its increase, electrotonometry is performed;
study of the visual field by the kinetic method, and according to indications - by the static method;
determination of color perception;
determination of extraocular muscle function (range of action in all fields of view and screening for strabismus and diplopia);
examination of the eyelids, conjunctiva and anterior segment of the eye under magnification (using magnifiers or a slit lamp). The examination is carried out with or without dyes (sodium fluorescein or rose Bengal);
a study in transmitted light - the transparency of the cornea, eye chambers, lens and vitreous body is determined;
ophthalmoscopy of the fundus.

Additional tests are applied based on the results of an anamnesis or primary examination.

These include:

gonioscopy - examination of the angle of the anterior chamber of the eye;
ultrasound examination of the posterior pole of the eye;
ultrasound biomicroscopy of the anterior segment of the eyeball (UBM);
corneal keratometry - determination of the refractive power of the cornea and the radius of its curvature;
study of corneal sensitivity;
examination with a fundus lens of the details of the fundus;
fluorescent or indocyanine-green fundus angiography (FAG) (ICZA);
electroretinography (ERG) and electrooculography (EOG);
radiological studies (X-ray, computed tomography, magnetic resonance imaging) of the structures of the eyeball and orbits;
diaphanoscopy (transillumination) of the eyeball;
exoophthalmometry - determination of the protrusion of the eyeball from the orbit;
corneal pachymetry - determination of its thickness in various areas;
determination of the state of the tear film;
mirror microscopy of the cornea - examination of the endothelial layer of the cornea.

T. Birich, L. Marchenko, A. Chekina

Why is it so important to undergo a comprehensive high-tech diagnostics of vision?

Comprehensive diagnostics of vision is a necessary condition for maintaining its sharpness for many years. The VISION ophthalmological clinic uses innovative diagnostic equipment to detect eye diseases at the earliest stage, and the qualifications of doctors ensure an accurate diagnosis. The experience of our specialists and advanced examination methods guarantee the selection of effective treatment methods. We have been working for more than 11 years so that you can enjoy the bright colors of the world.

Why is early vision diagnostics on innovative equipment necessary?

According to statistics, up to 65% of eye diseases proceed without symptoms for a long time, imperceptibly for the patient. Therefore, it is important to regularly examine the entire visual apparatus: check visual acuity, the condition of the tissues of the eyeball, the work of the visual analyzer. The VISION clinic has technological capabilities for diagnosing all parts of the eye, including at the cellular level. This allows you to prescribe the right treatment in a timely manner and stop the processes that lead to loss or deterioration of vision.

We take care of patients by choosing the best methods of diagnosis and treatment

Examination at the VISION clinic is suitable for patients of any age. So, the initial manifestations of retinal dystrophy can occur as early as 18-30 years. An optical tomograph allows you to get a 3D image of the structure of the retina and see the slightest changes in it. After 30 years, prerequisites for retinal detachment, glaucoma, and the first stages of neoplasms are revealed. And after 50 years, you can detect cataracts or macular degeneration - diseases that lead to complete blindness. The diagnosis always includes a consultation with an ophthalmologist who will select the optimal therapy regimen or recommend surgery to correct vision. Surgical treatment can also be performed by experienced ophthalmic surgeons of our clinic.

Advantages of the VISION clinic

1.High-precision diagnostics

The use of modern equipment, including optical tomographs. Some of the diagnostic methods are unique.

2. Qualification of doctors

The clinic employs qualified specialists - ophthalmologists and ophthalmic surgeons who love their job and have expert knowledge. We do not have visiting doctors, only permanent employees.

3.Innovation in treatment

The latest methods of surgical and non-surgical treatment of myopia, cataracts, glaucoma and other pathologies. Compliance with the international quality standard GOST ISO 9001-2011.

4. Top level eye surgery

Ophthalmic surgeons with unique experience and the latest generation of operating equipment - a high chance of maintaining and improving vision even in difficult cases.

5. Responsible approach

Our doctors are responsible for the accuracy of the diagnosis and the effectiveness of the treatment. You will receive a detailed consultation on the state of eye health.

6.Transparent prices

There is a fixed cost in accordance with the price list. No hidden co-payments or unexpected costs once treatment has begun.

7. Social orientation.

Our clinic has loyalty programs and social discounts for veterans, pensioners, and the disabled. We want new technologies in ophthalmology to be accessible to everyone.

8.Convenient location

The clinic is located in the center of Moscow, on Smolenskaya Square. From the metro Smolenskaya Filevskaya line just 5 minutes on foot.

The cost of the examination includes a consultation with a highly professional ophthalmologist.

The level and depth of research enable the ophthalmologist, based on the analysis of the data obtained, to make a complete diagnosis, determine tactics, prescribe and carry out treatment, as well as predict the course of some pathological processes in the vascular, nervous and endocrine systems of the body.

A complete ophthalmological examination takes from one to one and a half hours.

Protocol of ophthalmological examination of patients in the ophthalmological center "VISION"

1. identification of complaints, collection of anamnesis.

2. visual study anterior segment of the eyes, for the diagnosis of diseases of the eyelids, pathology of the lacrimal organs and the oculomotor apparatus.

3.Refractometry and Keratometry- study of the total refractive power of the eye and cornea separately in order to detect myopia, hyperopia and astigmatism with a narrow pupil and in conditions of cycloplegia.

4. Measurement of intraocular pressure using a non-contact tonometer.

5. Determination of visual acuity with and without correction, using a character projector and a set of trial lenses.

6. Definition of character vision (binocular)- test for latent strabismus.

7. Keratotopography- study of the relief of the cornea using automatic computer keratotopograph in order to determine congenital, degenerative and other changes in the shape of the cornea (astigmatism, keratoconus, etc.).

8. Point selection taking into account the nature of visual work.

9. Biomicroscopy- study of eye structures (conjunctiva, cornea, anterior chamber, iris, lens, vitreous body, fundus) using a slit lamp - biomicroscope.

10. Gonioscopy- study of the structures of the anterior chamber of the eye using a special lens and a biomicroscope.

11. Schirmer's test- determination of tear production.

12. Computer perimetry- examination of the peripheral and central fields of vision using an automatic projection perimeter (diagnosis of diseases of the retina and optic nerve, glaucoma).

13. Ultrasound eye to study the internal structures, measure the size of the eye. This study allows you to identify the presence of foreign bodies, retinal detachment, eye neoplasms in opaque internal environments.