Examination by an ophthalmologist. Computer diagnostics of vision. The study of vision for color perception

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 inspection. Needless to say, good vision costs much more than 60 minutes spent on an examination!

22.01.2016 | Viewed: 5 238 people

Regular examination is the best prevention of eye diseases. Diagnosis of such diseases can only be carried out by an experienced ophthalmologist in a specialized equipped room. It is important that the ophthalmologist detects the first signs of deviations in time. Successful treatment largely depends on the promptness of their detection at the stage of reversible changes.

One examination of the doctor and subsequent conversation with him is not enough. It is necessary to conduct additional specific examination methods using modern equipment to clarify the diagnosis and prescribe treatment. The doctor should tell you in detail about the exact diagnosis and determination of visual acuity, as well as possible deviations and pathologies.

Cutting-edge diagnostic methods contribute to the establishment of a high-precision diagnosis and allow you to control the treatment with high efficiency. Here are the most common ways to diagnose the most common eye diseases.

A doctor's examination reveals abnormalities with the following painless procedures:

A procedure that allows an ophthalmologist to see sections of the fundus on the surface of the eye. This method remains one of the most significant and popular in diagnosing eye diseases. The non-contact method is performed using a lens or a special ophthalmoscope device.

Allows you to evaluate during preventive examinations the main function - visual acuity for distance. Decreased vision is an important signal in diagnosing diseases. The examination is first performed without correction - the patient, alternately closing one eye, calls the letters on the table indicated by the ophthalmologist. If there are violations, then the procedure is performed with correction, using a specialized frame and lenses.

This method determines the optical power of the eye and diagnoses refractive errors and visual defects: myopia, farsightedness, astigmatism. Now the procedure has begun to be carried out on refractometers, which allows the patient not to spend a lot of time and facilitates the eye doctor's manipulations.

The study is recommended for people over 40 years of age, as they have an increased risk of developing glaucoma. The procedure measures intraocular pressure, which is carried out in such ways: by palpation, according to Maklakov (using weights), pneumotonometer and others.

An important method that determines the presence of peripheral vision and the diagnosis of pathological diseases - glaucoma and the process of destruction of the optic nerve. The study is carried out on specialized hemispherical electrical appliances, which display light spots.

The study of vision for color perception

Widespread and intended to determine violations of color sensitivity thresholds - color blindness. Inspection is carried out using Rabkin's polychromatic tables.

The procedure for microscopic examination of the eye segment with a special device - a slit lamp. With a significant increase, the oculist can clearly see the tissues of the eye - the cornea and conjunctiva, as well as the lens, iris, vitreous body.

Determines the degree of astigmatism of the anterior surface and refractive power of the cornea. The refraction radius is measured with an ophthalmometer.

The simple Grishberg method allows you to determine the angle of strabismus using an ophthalmoscope through which the patient is looking. The ophthalmologist determines the problem by observing the reflection of light on the corneal surface.

It is carried out with obstruction of the lacrimal canaliculi. Thin tubes (cannulas) with a syringe and solution are inserted into the lacrimal ducts. If the patency is normal, then the liquid from the syringe will penetrate into the nasopharynx. With obstruction, the solution will not pass and will spill out.

It is usually performed in infants and the elderly for medicinal purposes, as they may experience stenosis of the lacrimal openings. Bougienage is carried out with expanding probes using local anesthesia.

To determine the diagnosis of common ailments, such as conjunctivitis, myopia, cataracts, such diagnostic methods are usually sufficient. However, if the eye doctor doubts the diagnosis, then additional methods of examining diseases on specialized equipment carried out in optometric centers are possible.

Additional methods in eye diagnostics

Ultrasound is a popular research tool due to obtaining accurate information in full and high efficiency of the procedure. Ultrasound examination is necessary to detect eye abnormalities, tumors, retinal detachment.

The method determines the central field of view for colors, is used to detect diseases of the optic nerve, glaucoma and retina. The diagnostic campimeter is a special large screen, where the patient looks with each eye alternately through a slit on the black screen.

The electrophysiological research method has found extensive application in the study of the cerebral cortex, retina and the levels of damage to the optic nerve, the function of the nervous section of the optical apparatus.

A method that studies the surface of the cornea before laser correction. Carried out on an automated computer system by scanning to determine the sphericity of the surface.

Study of intraocular pressure in dynamics. IOP takes about 5 minutes, in such a short time you can get important information about the state of the outflow of fluid inside the eye.

The method allows you to accurately determine the thickness of the cornea, it is required for laser operations

Shows the condition of the fundus and retinal vessels. A series of high-precision images are taken after the administration of a fluorescent solution intravenously.

Non-contact modern OCT method is used to determine the condition of the optic nerve and retina.

Operative research under the optical device regarding detection of ticks.

The procedure for determining tearing. The test is carried out with symptoms of dry eye. An ophthalmological test is placed on the patient for the edge of the lower eyelid, with the help of which it is possible to establish its wetting with a tear.

A method for accurately determining glaucoma using a lens. The angle of the anterior chamber is examined.

It is used for dystrophy and detachment of the retina, as well as to obtain data on its peripheral parts that were not detected during the classical examination.

High-precision modern instruments and a variety of techniques allow you to accurately and efficiently conduct studies of the visual organs at the cellular level. Most diagnostics are non-contact and painless, without requiring preliminary preparation of the patient. In the relevant sections, you can familiarize yourself in detail with the methods of diagnosing eye diseases.

Most often, the retina of the eye undergoes inflammatory or dystrophic pathological processes. Diseases of this part of the eyeball can be hereditary, but often they are associated with the influence of external factors, that is, they are acquired. Usually damage to the retina occurs as a result of a traumatic effect on the eye itself or its environment. The presence of concomitant systemic pathology (cardiovascular, endocrine) can have a significant impact on the condition of the eye itself. Sometimes the retina is damaged as a result of tumor growth or other neoplasms.

To diagnose pathologies that directly affect the retina, it is necessary to conduct a set of examinations and a thorough examination.

Basic principles of diagnosis in retinal pathology

The patient should be examined for visual acuity. In this case, the doctor establishes the safety of the function of the central regions, which can be affected in the pathology of the retina.
Be sure to measure the level of intraocular pressure.
All patients determine the boundaries of the field of view. For this, computerized perimetry is more often used. This study helps to diagnose peripheral retinal lesions.
Electrophysiological examination of the patient helps to establish the safety of the function of the optic nerve, to determine the viability of retinal cells and the neurons themselves.
During direct or indirect ophthalmoscopy, the doctor examines the features of the fundus, based on the examination, it is possible to establish areas of retinal tear, as well as their number and tendency to detach. In addition, it is possible to determine the relationship of the detachment area with the substance of the vitreous body, to identify the areas of thinning, since they require special attention during surgical treatment of the eyes.

Diagnostic methods for diseases of the retina

Patients with suspected retinal pathology undergo the following studies:

Determination of visual acuity of the patient.
The study of contrast sensitivity, which with high accuracy allows you to judge the state of the central macular zone.
Study of color perception, as well as color thresholds.
Ophthalmoscopy.
Perimetry, the purpose of which is to determine the boundaries of the field of view.
Electrophysiological methods of examination.
Fluorescent angiography, which allows you to thoroughly study the pathology of the vascular system of the eye.
Optical coherence tomography is aimed at qualitative determination of retinal pathology, as well as the severity of the process.
Photographing the fundus is carried out to register pathological changes that can be assessed over time.

Cost of retinal diagnostics

Initial consultation with a retinal specialist (laser surgeon) - 3 000 rub.
Repeated consultation with a retinal specialist (laser surgeon) - 1 000 rub.
Examination of the fundus with a narrow pupil - 1 000 rub.
Inspection of the fundus with a wide pupil - 1 200 rub.
Amsler test (for macular degeneration) - 500 rub.
Electrophysiological examination of the retina and optic nerve (KChSM) - 500 rub.
Ultrasound of the eyeball - 1 500 rub.
Optical coherence tomography of the retina - 2 000 rub.

Above are the prices for the main diagnostic services of our ophthalmological center at the time of publication of the material. You can specify the exact cost of services and make an appointment by calling the numbers listed on our website.

Maintaining good vision requires regular check-ups by an ophthalmologist. Even if nothing bothers you, it is recommended to undergo a comprehensive eye examination once a year so that a possible disease is detected at an early stage, and its treatment does not result in a significant amount.

The modern high-tech equipment of our ophthalmological center and the high qualification of ophthalmologists make it possible to detect possible pathological changes in the eyes already at the earliest stages of the onset of the disease.

The Moscow Eye Clinic performs diagnostics in adults and children (after 3 years):

refractive errors (nearsightedness, farsightedness, astigmatism),
disorders of the oculomotor apparatus (strabismus, amblyopia),
pathologies of the anterior segment of the eye of various origins (diseases of the eyelids, conjunctiva, cornea, sclera, iris, lens),
pathologies of the posterior segment of the eye (vascular and inflammatory diseases of the retina and optic nerve (including hypertension, diabetes, glaucoma)
traumatic injuries of the organ of vision

The Moscow Eye Clinic is under the direction of a doctor of the highest qualification category, a member of the Association of Ophthalmologists of Russia

A unique team of doctors, where each doctor has his own narrow specialization, which guarantees accurate diagnosis and competent treatment. MCC doctors undergo regular training abroad.

We use only the latest ophthalmic equipment and materials from leading ophthalmic brands.

We guarantee the quality of all manipulations and full control of the doctor and anesthesiologist at all stages of work.

Comprehensive vision diagnostics - in 1 hour!

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Carrying out all the necessary examinations in one place, in 1 hour, on the day of treatment!

In what cases is vision diagnostics needed?

An ophthalmological examination is necessary to assess the general condition of visual functions, prevent eye diseases, and also to control the progression of the disease. In the latter case, diagnostics helps to select optimal treatment regimens for existing diseases, as well as to avoid serious complications and loss of vision. An examination is also necessary in cases where decisions are made on the advisability and type of surgical interventions, if patients need them, to provide an opinion to other specialists (antenatal clinic, neurologist, cardiologist, etc.).

How is an ophthalmological examination carried out?

"Moscow Eye Clinic" has all the necessary equipment for the diagnosis of any eye disease.

Diagnostic procedures can last from thirty minutes to one and a half hours, depending on the nature of the patient's complaints, objective indications and his age.

Additionally, the thickness of the cornea (pachymetry) and the length of the anterior-posterior axis of the eye (AC or echobiometry) can be measured. Hardware studies also include ultrasound eye diagnostics (B-scan) and computer

■ 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

Decrease in 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(double vision) can occur only when fixing an object with both eyes, and is due to a violation of the synchronism 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 from the 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 the strip with a length of more 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 assess 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 with 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 Maklakov tonometer is the most common, 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. A 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(Greek 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.