Types of ophthalmological examination. Comprehensive diagnostics of vision and treatment of diseases of the visual apparatus Ophthalmological tests

An ophthalmological examination begins with an anamnesis (general and special). To examine the patient should be planted facing the light. First examine the healthy eye. During external examination, the condition of the eyelids, the area of ​​the lacrimal sac, the position of the eyeball, the width of the palpebral fissure, the state of the conjunctiva, sclera, cornea, anterior chamber of the eye and the iris with the pupil visible within this fissure are established. The conjunctiva of the lower eyelid and the lower transitional fold is examined by pulling back the lower eyelid while looking at the patient upwards. The conjunctiva of the upper eyelid and the upper transitional fold is examined by turning the upper eyelid inside out. To do this, when the patient is looking down, they capture the ciliary edge of the upper eyelid with the thumb and forefinger of the right hand, pull it slightly downward, moving it away from the eye at the same time; on the upper edge of the cartilage of the eyelid, the thumb of the left hand (or eye glass rod) is placed with an edge and, pressing the cartilage downwards, the eyelid is turned upwards by the ciliary edge.

To examine the eyeball in case of eyelid edema or strong eyelids, after preliminary instillation of a 0.5% solution of dicain, it is necessary to push them apart with the help of eyelid lifters inserted behind the upper and lower eyelids. When examining the lacrimal ducts, pressing a finger on the area of ​​the lacrimal sac, note the presence or absence of discharge from the lacrimal puncta. To examine the cornea, iris and the anterior surface of the lens, the side illumination method is used, focusing the light from a table lamp on the eye with a strong convex lens (+20 D). Even more clearly visible changes when viewed through a binocular loupe (see). An external examination of the eyes is completed with a study of pupillary reflexes (see). Next, they examine (see), the fundus of the eye (see), visual functions (see,) and intraocular pressure (see).

Ophthalmological examination
The study of the organ of vision must be carried out strictly according to plan. This plan should be based on an anatomical principle, that is, an anatomically consistent examination of individual parts of the organ of vision.

They start with a preliminary history, in which the patient states his complaints (pain, redness of the eye, dysfunction, etc.; a more detailed and targeted history - personal, family, hereditary - should, according to S. S. Golovin, be attributed to the end of the study). After that, they begin to study the anatomical state of the organ of vision: the adnexa, the anterior part of the eyeball, the internal parts of the eye, then they examine the functions of the eye and the general condition of the body.

In detail, an ophthalmic examination includes the following.

General information about the patient: gender, age, profession, place of residence. The main complaints of the patient, his gait.

Inspection. General habitus, skull shape, face (asymmetry, facial skin condition, one-sided graying of eyelashes, eyebrows, hair on the head, etc.).

Eye socket and adjacent areas. Eyelids - shape, position, surface, mobility; palpebral fissure, eyelashes, eyebrows. Lacrimal organs - lacrimal glands, lacrimal puncta, tubules, lacrimal sac, lacrimal canal. The connective sheath (conjunctiva) - color, transparency, thickness, surface, presence of scars, nature of the discharge. The position of the eyeball [exophthalmos, enophthalmos (see Exophthalmometry), displacement], size, mobility, intraocular pressure (see Ocular Tonometry).

Sclera - surface, color. Cornea - shape, surface, transparency, sensitivity. Anterior chamber of the eye - depth, uniformity, chamber moisture. Iris - color, pattern, position, mobility. Pupils - position, size, shape, reactions. Lens-transparency, clouding (stationary, progressive, its degree), position of the lens (displacement, dislocation). Vitreous body - transparency, consistency, hemorrhage, liquefaction, foreign body, cysticercus. The fundus of the eye (see Ophthalmoscopy), the optic disc - the size, shape, color, boundaries, course of blood vessels, level; the periphery of the fundus - the color, condition of the vessels, the presence of foci of hemorrhage, exudation, edema, pigmentation, primary and secondary retinal detachment, neoplasms, subretinal cysticercus; yellow spot - hemorrhage, degeneration, perforated defect, etc.

Special methods for examining the organ of vision - see Biomicroscopy, Gonioscopy, Diaphanoscopy of the eye, Ophthalmodynamometry, Ocular Tonometry. An electromagnetic test (see Eye magnets) makes it possible, using hand-held or stationary magnets, to determine the presence of magnetic foreign bodies in the eye or in the tissues surrounding it.

X-ray diagnostics, which is widely used in ophthalmological examination, can detect changes in the bones of the skull, orbit, its contents (tumors, etc.), foreign bodies in the eye and surrounding tissues, changes in the lacrimal ducts, etc.

The study of visual functions - see Campimetry, Visual acuity, Field of view.

Eye refraction (see) is determined by subjective (selection of corrective glasses) and objective methods (see Skiascopy, Refractometry of the eye).

Accommodation - the position of the nearest point of view, the strength and width of the accommodation are determined.

Color perception (see) - color recognition by central vision - is more often studied using the tables of E. B. Rabkin. Light perception - adaptation to light and darkness - is studied with the help of adaptometers (see) and adaptometers of S. V. Kravkov and N. A. Vishnevsky, A. I. Dashevsky, A. I. Bogoslovsky and A. V. Roslav-tsev and other Eye movements - determination of the symmetrical position of the eyes, their mobility, fusion ability, binocular vision, latent and obvious strabismus, muscle paralysis and other movement disorders. Electroretinography (see) is of known importance in the diagnosis of certain eye diseases.

Association with general diseases. Examination of the patient's body with the participation of relevant specialists. Laboratory studies - microbiological, blood, urine, cerebrospinal fluid tests, Wasserman reaction, tuberculin tests; x-ray studies, etc.

Amblyopia

Amblyopia is a visual impairment that has a functional origin. It is not amenable to therapy with various lenses and glasses. Visual impairment progresses irrevocably. There is a violation of contrast perception and accommodation possibilities. Such changes can occur in one, and sometimes in two eyes. At the same time, pronounced pathological changes in the visual organs are not observed.

The symptoms of amblyopia are as follows:

• blurred vision in one or both eyes;
• the occurrence of problems with the visualization of volumetric objects;
• difficulties in measuring the distance to them;
• problems in learning and obtaining visual information.

Astigmatism

Astigmatism is an ophthalmological disease, which consists in a violation of the perception of light rays by the retina. With corneal astigmatism, the problem lies in the wrong structure of the cornea. If pathological changes occur in the lens, then the disease can be of the lenticular or lens type.

The symptoms of astigmatism are as follows:

• blurry visualization of objects with jagged and fuzzy edges;
• double vision;
• the need to strain your eyes to better visualize the object;
• headaches (due to the fact that the eyes are constantly in tension);
• constant squinting.

Blepharitis

Blepharitis is a common inflammatory eye condition that affects the eyelids. There are many types of blepharitis. Most often, the course is chronic, it is difficult to treat with medication. Blepharitis may be accompanied by other ophthalmic diseases such as conjunctivitis and ocular tuberculosis. There may be purulent lesions of the eyelids, loss of eyelashes. Treatment requires serious antibiotic therapy and identification of the root causes of the pathology.

Symptoms of blepharitis:

• swelling around the eyelids;
• burning sensation, sand in the eyes;
• severe itching;
• loss of eyelashes;
• feeling of dryness of the skin in the eye area;
• peeling on the eyelids;
• the appearance of crusts and abscesses;
• loss of vision;
• photophobia.

Myopia or nearsightedness

Myopia is an ophthalmic disease associated with refractive error. With a disease, it becomes impossible to clearly see objects located at a great distance. The pathology consists in a violation of the fixation of the rays on the retina - they lie not in the retinal zone itself, but in front of it. This results in image blur. Most often, the problem lies in the pathological refraction of rays in the visual system.

Symptoms of myopia:

• blurring of objects, especially located at long distances;
• pain in the frontal and temporal zones;
• burning in the eyes;
• the inability to clearly focus on distant objects.

Glaucoma

Glaucoma is an ophthalmic disease that has a chronic form. It is based on a pathological increase in intraocular pressure, which leads to damage to the optic nerves. The nature of the damage is irreversible. Ultimately, there is a significant deterioration in vision, and its complete loss is also possible. There are such types of glaucoma:

• open-angle;
• closed-angle.

The consequences of the disease depend on the stage of its course. Acute glaucoma can cause sudden and permanent loss of vision. Treatment of the disease should be carried out by an ophthalmologist together with a neuropathologist.

Symptoms of glaucoma:

• the presence of dark objects in front of the eyes;
• deterioration of lateral vision;
• loss of vision in the dark;
• sharpness fluctuations;
• the appearance of "rainbow" overflows when looking at a light source.

farsightedness

Farsightedness is an ophthalmic disease in which there is a violation of refraction, due to which the rays of light are fixed not on the retina, but behind it. At the same time, the ability to distinguish objects that are nearby is significantly worsened.

Farsightedness symptoms:

• fog before the eyes;
• asthenopia;
• strabismus;
• deterioration of fixation with binocular sight.
• Rapid eye fatigue.
• Frequent headaches.

Cataract

Cataract is a disease that is associated with an increasing clouding of the lens of the eye. This disease can affect both one eye and both, developing on part of the lens or completely affecting it. Due to clouding, light rays cannot pass to the retina, inside the eye, resulting in reduced visual acuity, and in some cases, it may be lost. Older people often lose their sight. The youth category may also be susceptible to this disease. The cause may be experienced somatic diseases or eye injuries. There is also a congenital cataract.

Symptoms of a cataract:

• vision becomes blurry;
• its sharpness is actively reduced;
• there is a need for regular replacement of glasses, the optical power of new lenses is constantly growing;
• very poor visibility at night;
• increased sensitivity to bright light;
• the ability to distinguish colors decreases;
• difficulty reading;
• in some cases, double vision appears in one eye when the other is closed.

Keratoconus

Keratoconus is a degenerative disease of the cornea. When thinning of the cornea occurs, due to the effect of intraocular pressure, it protrudes forward, taking the shape of a cone, despite the fact that the norm is a spherical shape. This disease often appears in young people, during the course of the disease, the optical properties of the cornea change. Because of this, visual acuity deteriorates significantly. At an early stage of the disease, vision correction with the help of glasses is still possible.

Symptoms of keratoconus:

• a sharp deterioration in vision in one eye;
• the outlines of objects are not clearly visible;
• when looking at bright light sources, halos appear around them;
• there is a need to regularly change glasses with lens enhancement;
• development of myopia is observed;
• eyes get tired quickly.

Keratitis is a disease during which the cornea of ​​​​the eyeball becomes inflamed, which causes clouding in the eyes. The most common cause of this disease is a viral infection or injury to the eye. Inflammation of the cornea can also spread to other parts of the eye.

There are three forms of keratitis:

• light;
• moderate;
• heavy.

Given the cause of keratitis, it is classified into:

• exogenous (the inflammatory process began due to an external factor);
• endogenous (the cause of inflammation was internal negative changes in the human body).

Symptoms of keratitis:

• fear of light;
• frequent tearing;
• reddened shell of the eyelid or eyeball;
• blepharospasm (eyelid convulsively shrinks);
• there is a feeling that something has got into the eye, the natural luster of the cornea is lost.

computer vision syndrome

Computer vision syndrome is a set of pathological visual symptoms caused by computer work. In varying degrees, computer vision syndrome manifests itself in approximately 60% of users. This happens mainly due to the specifics of the image on the monitor. Incorrect ergonomics of the workplace, as well as non-compliance with the recommended mode of working at the computer, contributes to the occurrence of these symptoms.

Symptoms of computer vision syndrome:

• there may be a decrease in visual acuity;
• increased eye fatigue;
• trouble focusing on distant or close objects;
• split image;
• photophobia.

Pain, pain, burning, hyperemia (redness), tearing, dry eyes are also possible.

Conjunctivitis

Conjunctivitis is an inflammation of the conjunctiva (mucosa) that covers the outer surface of the eyeballs, as well as the surface of the eyelids in contact with them. Conjunctivitis can be viral, chlamydial, bacterial, fungal or allergic. Some types of conjunctivitis are contagious and can be quickly spread through the household. In principle, infectious conjunctivitis does not pose a threat to vision, but in some cases it can lead to serious consequences.

The symptoms of conjunctivitis vary depending on the type of the disease: Hyperemia (redness) and swelling of the eyelids.

• discharge of mucus or pus;
• tearing;
• itching and burning.

Macular degeneration (AMD)

The macula is a small area located in the center of the retina of the eye, responsible for the clarity of vision and the accuracy of color perception. Macular degeneration is a chronic degenerative disease of the macula that exists in two forms: one is wet, the other is dry. Both cause a rapidly increasing decline in central vision, but the wet form is much more dangerous and is fraught with a complete loss of central vision.

Macular degeneration symptoms:

• cloudy spot in the middle of the field of view;
• inability to read;
• distortion of lines and contours of the image.

Flies in the eyes

"Flies" in the eyes - this phenomenon has the second name of the destruction of the vitreous body. Its cause is local disturbances in the structure of the vitreous body, leading to the appearance of optically opaque particles perceived as floating "flies". Destruction of the vitreous body occurs quite often, there is no threat to vision from this pathology, but psychological discomfort may occur.

Symptoms of the destruction of the vitreous body: they appear mainly in bright light in the form of extraneous images (dots, small spots, threads) that move smoothly in the field of view.

Retinal disinsertion

Retinal detachment is a pathological process of detachment of the inner layer of the retina from the deep pigment epithelial tissue and choroid. This is one of the most dangerous diseases that can be found among other eye diseases. If an urgent surgical intervention is not performed during detachment, then a person may completely lose the ability to see.

The main symptoms of this ophthalmic disease

• frequent occurrence of glare and sparks in the eyes;
• a veil before the eyes;
• deterioration in sharpness;
• visual deformation of the appearance of surrounding objects.

Ophthalmic rosacea

Ophthalmic rosacea is a type of dermatological disease that is better known as rosacea. The main manifestations of this disease are slight irritation and dryness of the eyes, blurred vision. The disease reaches its climax in the form of severe inflammation of the surface of the eyes. Against the background of ophthalmic rosacea, the development of keratitis is possible.

Symptoms of ophthalmic rosacea:

• increased dryness of the eyes;
• redness;
• feeling of discomfort;
• fear of light;
• swelling of the upper eyelid;
• white particles on the eyelashes in the form of dandruff;
• barley;
• loss of eyelashes;
• blurred vision;
• repeated infectious diseases of the eyes, swelling of the eyelids.
• terigum

Pterygum

Pterygum is a degenerative eye disease that involves the conjunctiva of the eyeball and, as it progresses, can reach the center of the cornea. In an acute form, the disease threatens to infect the central optical zone of the cornea, which can subsequently lead to a decrease in the level of vision, and sometimes to its complete loss. An effective method of treating the disease is surgery.

Symptoms of pterygum at the initial stage of the disease are completely absent. If the disease progresses, there is a decrease in the level of visual acuity, fog in the eyes, discomfort, redness, itching and swelling.

Dry eye syndrome

Dry eye syndrome is quite common these days. The main causes of the syndrome are impaired lacrimation and evaporation of tears from the cornea of ​​​​the eyes. Very often, the disease can cause progressive Sjögren's syndrome or other diseases that have a direct effect on reducing the number of tears, and can also provoke infection of the lacrimal glands.

Dry eye syndrome can occur due to eye burns, the use of certain medications, oncological diseases, or inflammatory processes.

Symptoms of dry eye syndrome:

• large lacrimation or, on the contrary, the complete absence of tears;
• eye redness;
• discomfort;
• fear of light;
• foggy images;
• burning in the eyes;
• decrease in visual acuity.

halazion

Chalazion is a tumor-like inflammation of the meibomian gland. The disease can occur due to blockage of the sebaceous glands or their swelling. Swelling may occur due to the accumulation of a large amount of opalescent fluid. This disease occurs in people of any age. In its form, the tumor is similar to a small ball, but in the course of the disease it can increase in size, in connection with this, put pressure on the cornea and distort vision.

Symptoms of a chalazion: at the initial stage, a chalazion manifests itself in the form of swelling of the eyelids, slight pain. At the next stage, there is a slight swelling of the eyelid, which does not cause any discomfort and pain. Spots of gray and red may also appear on the inside of the eyelid.

Chemical burns to the eyes

Chemical burns of the eyes are one of the worst injuries of the eyeball. They appear due to the ingress of acid or alkali on apples. The severity is determined by the type, amount, temperature and time of exposure to chemicals, as well as how deep they have penetrated into the eye. There are several degrees of burns, ranging from mild to severe.

Eye burns can not only reduce the level of vision, but also lead to disability. If chemicals come into contact with the eyeballs, you should immediately seek medical help.

Symptoms of chemical burns:

• Pain in the eyes;
• redness or swelling of the eyelid;
• sensation of a foreign body in the eye;
• inability to open the eyes normally.

Electrophthalmia

Electrophthalmia occurs due to exposure of the eye to ultraviolet rays. The disease can develop if eye protection is not used in the process of observing bright light. You can get exposure to ultraviolet rays when relaxing at sea, walking in mountainous snowy places, and also when looking at a solar eclipse or lightning. Also, this disease occurs from artificially generated UV rays. It can be a reflection from electric welding, solarium, quartz lamps, reflection of light from a flash.

Symptoms of electrophthalmia:

• redness and soreness of the eyes;
• discomfort;
• tearing;
• blurred vision;
• nervousness;
• eye sensitivity.

Endocrine ophthalmopathy

Graves' ophthalmopathy, or endocrine ophthalmopathy, is an autoimmune disease that leads to dystrophic infection of orbital and periorbital tissues. This disease most often occurs against the background of problems with the thyroid gland, but independent appearance is not excluded.

Symptoms of endocrine ophthalmopathy: a feeling of tightness and soreness in the eyes, increased dryness, color blindness, bulge of the eyeball forward, swelling of the conjunctiva, swelling of the periorbital part of the eye.

episcleritis

Episcleritis is an inflammatory disease that affects the episcleral tissue of the eye, located between the conjunctiva and the sclera. This disease begins with reddening of some parts of the sclera, most often located near the cornea. At the site of inflammation, there is a small swelling. There are simple and nodular episcleritis. The cure of the disease most often occurs on its own, but relapses are also possible.

Symptoms of episcleritis:

• slight or severe discomfort in the eye area;
• their redness;
• acute reaction to light;
• clear discharge from the conjunctival cavity.

Barley is an inflammatory process of the membomian gland of a purulent nature. It occurs on the ciliary edge of the eyelid or on the hair follicle of the eyelashes. Distinguish between internal and external form. Barley occurs due to a bacterial infection, often due to Staphylococcus aureus. There are cases when the disease can become chronic (chalazion).

Barley symptoms:

• redness around the edge of the eyelid;
• itching and swelling of the edge of the eyelid;
• painful sensations during touching.

In addition, lacrimal discharge may form, discomfort is felt, sometimes headaches, soreness in the body and fever, general weakness.

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 a better inspection. The effect of these drops can last for several hours, so it is worth refraining from any activity during the marked period.

Why visit an ophthalmologist?

In the life of any person, there may come a time 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.

1. Comprehensive vision diagnostics.
2. Professional equipment and high quality consumables.
3. Affordable price for the services provided.
4. and choice of treatment.
5. The presence of a special database where all information about any of the patients is stored.
6. Individual approach and appointment of the required examinations.
7. Operation followed by rehabilitation.
8. 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 the trip 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, the person who applied for the 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 ophthalmological 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.

1. Moscow Eye Clinic.
2. Ophthalmological center Konovalov.
3. MNTK "Eye Microsurgery".
4. Medical center "Excimer".
5. 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.

Thanks

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

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What happens at an appointment with an ophthalmologist?

Where does the ophthalmologist take?

Examination by an ophthalmologist

An examination by an ophthalmologist includes:

• Visual acuity test. Allows you to evaluate the ability of the eye to clearly see two different points located at a certain distance from each other. Primary impairment of visual acuity can occur with myopia, hyperopia, astigmatism and other pathologies.
• Study of the refractive structures of the eye. Allows you to determine the functional state of the refractive system of the eye, that is, the ability of the cornea and lens to focus the image directly on the retina.
• Study of visual fields. Allows you to explore peripheral vision, which can be impaired in glaucoma and other pathologies.
• Examination of the fundus. Allows you to study the vessels of the fundus and the retina, the defeat of which can cause a decrease in visual acuity, narrowing of the visual field and other defects in the visual analyzer.
• Measurement of intraocular pressure. It is the main study in the diagnosis of glaucoma.
• Color vision test. Allows you to determine whether a person can distinguish different colors from each other. This function of the visual analyzer may be impaired in some individuals suffering from color blindness.

Table of an ophthalmologist for checking visual acuity

The essence of the study is as follows. The patient sits down on a chair located at a distance of 5 meters from a table fixed on the wall and well lit. The doctor gives the patient a special flap and asks him to cover one eye with it, but not completely close it ( that is, do not close your eyelids). With the second eye, the patient should look at the table. Next, the doctor begins to point to the letters in the various rows of the table ( first into larger ones, then into smaller ones.), and the patient must name them. Satisfactory is the result in which the patient easily ( without squinting) will be able to read letters out of 10 ( above) row of the table. In this case, we are talking about one hundred percent vision, which the ophthalmologist records in the patient's card. Then he asks to cover the other eye with a shutter and repeats the procedure in the same way.

When examining young children ( who can't read yet) tables with images of animals, plants and other objects are used. At the same time, for examining deaf and dumb patients, instead of letters, circles are shown on the tables with a notch on one side ( right, left, up or down). During the examination, the patient must indicate to the doctor which side the tenderloin is on.

Oculist's device for examining the fundus of the eye

The essence of the procedure is as follows. The bright light in the room is turned off, and the patient sits on a chair opposite the doctor. The doctor holds an ophthalmoscope to the patient's eye a device consisting of a light source and a magnifying lens) and directs light through the pupil into the eye being examined. Rays of light enter the fundus of the eye and are reflected from it, as a result of which the doctor can observe various structures in this area through a magnifying glass - the retina, the vessels of the fundus, the optic nerve head ( the place in the fundus where nerve fibers of photosensitive cells leave the eyeball and travel to the brain).

Examination of the fundus helps in the diagnosis of:

• Glaucoma. Characteristic for this pathology is the so-called excavation of the optic disc, which is "squeezed" outward as a result of increased pressure inside the eyeball.
• Angiopathy of the retina. During ophthalmoscopy, the doctor reveals modified, irregularly shaped and sized blood vessels in the fundus.
• Retinal detachments. Under normal conditions, the retina is very weakly attached to the wall of the eyeball, supported mainly by intraocular pressure. Under various pathological conditions ( with eye injuries, wounds) the retina can detach from the wall of the eye, which can lead to deterioration or complete loss of vision. During ophthalmoscopy, the doctor can determine the localization and severity of detachment, which will allow planning further treatment tactics.

What does an ophthalmologist instill into the eye to dilate the pupil?

It is worth noting that these drugs cannot be used in the presence of glaucoma, since pupil dilation can lead to blockage of the aqueous humor outflow pathways and provoke an increase in intraocular pressure. Also, the doctor must inform the patient that for a certain time after the procedure, the patient may experience pain or burning in the eyes when in bright light, and will not be able to read books, work at the computer. The fact is that the drugs used to dilate the pupil also temporarily paralyze the ciliary muscle, which is responsible for changing the shape of the lens when viewing closely spaced objects. As a result, the lens is maximally flattened and fixed in this position, that is, a person will not be able to focus on a nearby object until the effect of the drug ends.

Ophthalmologist instruments for measuring IOP

To measure IOP, the ophthalmologist uses a special tonometer - a cylindrical weight with a mass of 10 grams. The essence of the study is as follows. After instillation of a local anesthetic solution into the patient's eye ( a drug that temporarily “turns off” the sensitivity of the eyes, as a result of which they will not respond to the touch of foreign objects on the cornea) the patient lies on the couch face up, directing his gaze strictly vertically and fixing it on some point. Next, the doctor tells the patient not to blink, after which he places the surface of the cylinder on the cornea ( tonometer), which was previously coated with a special paint. Upon contact with wet ( hydrated) part of the paint is washed off the tonometer by the surface of the cornea. After a few seconds, the doctor removes the cylinder from the patient's eye and presses its surface against a special paper, which leaves a characteristic imprint in the form of a circle. At the end of the study, the doctor measures the diameter of the formed circle-imprint with a ruler, on the basis of which he sets the exact intraocular pressure.

Color vision test ( ophthalmologist pictures for drivers)

To check color perception, the ophthalmologist uses special tables. Each of them depicts numerous circles of various sizes, colors ( mostly green and red) and shades, but similar in brightness. With the help of these circles in the picture, a certain image is “masked” ( number or letter), and a person with normal vision can easily see it. At the same time, for a person who does not distinguish between colors, recognizing and naming an “encrypted” letter will be an impossible task.

How else does an ophthalmologist check vision?

If necessary, the ophthalmologist may prescribe:

• Biomicroscopy of the eye. The essence of this study is that with the help of a special slit lamp, a narrow strip of light is directed into the patient's eye, translucent to the cornea, lens and other transparent structures of the eyeball. This method makes it possible to detect various deformations and damages of the studied structures with high accuracy.
• Study of corneal sensitivity. To assess this parameter, ophthalmologists usually use a thin hair or several threads from a bandage that touch the cornea of ​​the examined eye ( first in the center and then along the edges). This allows you to identify a decrease in the sensitivity of the organ, which can be observed in various pathological processes.
• Study of binocular vision. Binocular vision is the ability of a person to clearly see a certain image with both eyes at the same time, ignoring the fact that each eye looks at the object from a slightly different angle. To check binocular vision, ophthalmologists use several methods, the simplest of which is the so-called Sokolov experiment. To conduct this experiment, you should take a sheet of paper, roll it into a tube and bring it to one eye ( Both eyes must remain open during the entire examination.). Next, on the side of the paper tube, you need to place an open palm ( its edge must be in contact with the tube). If the patient has normal binocular vision, at the moment of bringing the hand to the paper, the effect of the so-called “hole in the palm” will appear, through which what is seen through the paper tube will be seen.

What tests can an optometrist prescribe?

The ophthalmologist may prescribe:

• General blood analysis- to determine the cellular composition of the blood and identify signs of infection in the body.
• Microscopic studies- to identify microorganisms that have caused infectious and inflammatory lesions of the eye, eyelids or other tissues.
• Microbiological research- to identify and identify the causative agent of an eye infection, as well as to determine the sensitivity of an infectious agent to various antibiotics.
• Biochemical blood test– to determine the level of glucose ( Sahara) in the blood if diabetic retinal angiopathy is suspected.

Selection of glasses and lenses at the ophthalmologist

Eyeglasses or contact lenses can correct:

• Myopia ( myopia). As mentioned earlier, with this pathology, the light rays passing through the cornea and lens are refracted too much, as a result of which they are focused in front of the retina. To correct this disease, the doctor selects a diverging lens that “shifts” the focal length somewhat backwards, that is, directly onto the retina, as a result of which the person begins to clearly see distant objects.
• Hypermetropia ( farsightedness). With this pathology, light rays are focused behind the retina. To correct the defect, the ophthalmologist selects a converging lens that shifts the focal length anteriorly, thereby eliminating the existing defect.
• Astigmatism. With this pathology, the surface of the cornea or lens has an uneven shape, as a result of which the light rays passing through them fall on different areas in front of the retina and behind it. To correct the defect, special lenses are made that correct the existing irregularities in the refractive structures of the eye and ensure that the rays are focused directly on the retina.

Does an ophthalmologist prescribe glasses for a computer?

Medical examination and certificate from an ophthalmologist

It is also worth noting that a certificate from an ophthalmologist may be needed in some other circumstances ( for example, to obtain a permit to carry a firearm, to obtain a driver's license, and so on). In this case, the examination by an ophthalmologist does not differ from that during a regular physical examination ( the doctor evaluates visual acuity, visual fields and other parameters). If during the examination the specialist does not reveal any deviations from the organ of vision in the patient, he will issue an appropriate conclusion ( certificate). If the patient has a decrease in visual acuity, narrowing of the visual fields, or some other deviation, the doctor may prescribe appropriate treatment for him, but in the conclusion he will indicate that this person is not recommended to engage in activities that require one hundred percent vision.

Are ophthalmologist services paid or free?

It is worth noting that the free services of an ophthalmologist under the MHI policy ( compulsory health insurance) are found only in state medical institutions ( clinics and hospitals). All ophthalmological consultations and examinations of the visual analyzer performed in private medical centers are subject to a fee.

When is a dispensary registration with an ophthalmologist shown?

The reason for dispensary registration with an ophthalmologist may be:

• Cataract- clouding of the lens, in which it is recommended to visit an ophthalmologist 2 times a year.
• Glaucoma- an increase in intraocular pressure, in which you need to visit a doctor at least 4 times a year.
• Detachment and other retinal lesions– consultation with an ophthalmologist is required at least 2 times a year ( if complications occur, an unscheduled consultation is indicated).
• Damage to the refractive system of the eye myopia, farsightedness, astigmatism) – examination by an ophthalmologist 2 times a year ( provided that before this a full diagnosis was carried out and corrective glasses or contact lenses were selected).
• eye injury-recommended regular weekly or monthly) examination by an ophthalmologist until complete recovery.
• Retinal angiopathy- you need to visit a doctor at least 1-2 times a year ( depending on the cause of the disease and the severity of damage to the retinal vessels).

When can an ophthalmologist admit you to the hospital?

The reason for hospitalization in this case may be a severe course of the patient's disease ( for example, retinal detachment in several places) or the development of complications of the underlying disease ( for example, retinal hemorrhage, penetrating injury to the eyeball with damage to adjacent tissues, and so on). In this case, the patient is placed in a hospital, where he will be under the constant supervision of doctors during the entire period of treatment. Before the operation, all the studies necessary for an accurate diagnosis and determination of the operation plan are performed. After surgical treatment, the patient also remains under the supervision of doctors for several days, which allows timely identification and elimination of possible complications ( e.g. bleeding).

After discharge from the hospital, the doctor gives the patient recommendations on further treatment and rehabilitation, and also sets the dates for follow-up consultations, which will allow you to control the recovery process and identify possible late complications.

How to get a sick leave from an ophthalmologist?

Can I call an ophthalmologist at home?

At home, an ophthalmologist can perform:

• external examination of the eye;
• assessment of visual acuity;
• study of visual fields ( tentatively);
• fundus examination;
• measurement of intraocular pressure.

When an ophthalmologist sends for a consultation with other specialists ( oncologist, endocrinologist, ENT specialist, allergist, neuropathologist, cardiologist)?

The ophthalmologist can refer the patient for a consultation:

• To the oncologist- if you suspect a tumor disease of the eye or adjacent tissues.
• To the endocrinologist- in case of diabetic retinal angiopathy.
• TO LOR ( otorhinolaryngologist) - in case of detection of diseases of the nose or paranasal sinuses, which could be complicated by damage to the eyes.
• To the allergist– in case of allergic conjunctivitis ( damage to the mucous membrane of the eye).
• To a neurologist- if there is a suspicion of damage to the optic nerve, the brain ( visual center) and so on.
• To the cardiologist- with retinal angiopathy caused by hypertension ( persistent increase in blood pressure).

What treatment can an ophthalmologist prescribe?

Vitamins for the eyes

• Vitamin A- to improve the condition of the retina.
• Vitamin B1- improves metabolism in the nervous tissue, including in the retina and in the nerve fibers of the optic nerve.
• Vitamin B2- improves metabolism at the cellular level.
• Vitamin E- prevents tissue damage during various inflammatory processes.
• lutein and zeaxanthin- prevent damage to the retina when exposed to light rays.

Eye drops

For therapeutic purposes, the ophthalmologist may prescribe:

• Antibacterial drops- for the treatment of barley, chalazion, bacterial conjunctivitis and other infectious eye diseases.
• Antiviral drops- for the treatment of viral conjunctivitis and other similar diseases.
• Anti-inflammatory drops- to eliminate the inflammatory process in infectious and inflammatory eye diseases.
• Antiallergic drops- with allergic conjunctivitis.

Operations on the eyes

Surgical treatment in ophthalmology may be required:

• with diseases of the cornea;
• for lens transplantation;
• for treatment

Surprisingly, a huge arsenal of examinations and diagnostic procedures is aimed at such a small organ of vision: from simple alphabetic tables to obtaining a layered image of the retina and optic nerve head using OCT and a detailed study of the course of blood vessels in the fundus with FAH.

Most studies are conducted on strict indications. However, when going to an ophthalmologist, be prepared to spend half an hour to an hour or more, depending on the number and complexity of the examinations you need, and on the workload of your doctor.

Determination of visual acuity and refraction

Visual acuity is determined for each eye separately. In this case, one of them is covered with a shield or palm. At a distance of 5 meters, you will be shown letters, numbers or signs of various sizes that you will be asked to name. Visual acuity is characterized by signs of the smallest size that the eye can distinguish.

Next, you will be given a frame in which the doctor will put different lenses, asking you to choose which one you see clearer. Or they will install a device called a phoropter in front of you, in which the change of lenses is carried out automatically. Refraction is characterized by the power of the lens, which provides the highest visual acuity for this eye, and is expressed in diopters. Positive lenses are required for farsightedness, negative lenses for nearsightedness, cylindrical lenses for astigmatism.

Automatic refractometry and aberrometry

The aberrometer, based on the analysis of the wave front of the eye, determines even imperceptible optical imperfections of its media. These data are important when planning LASIK.

Study of visual fields

It is carried out using a device - a perimeter, which is a hemispherical screen. You are asked to fix the mark with the examined eye and, as soon as you notice with peripheral vision the luminous dots that appear in different parts of the screen, press the signal button or say “yes”, “I see”. The visual field is characterized by the space in which the eye with a permanently fixed gaze detects visual stimuli. Characteristic visual field defects occur with eye diseases, such as glaucoma, as well as damage to the optic nerve and brain by a tumor or as a result of a stroke.

Measurement of intraocular pressure

Non-contact measurement is carried out using an automatic tonometer. You are asked to place your chin on the stand of the device and fix the luminous mark with your eyes. The autotonometer releases a jet of air in the direction of your eye. Based on the resistance of the cornea to air flow, the device determines the level of intraocular pressure. The technique is absolutely painless, the device does not contact your eyes.

The contact technique for measuring intraocular pressure is accepted in Russia as a standard. After instillation of "freezing" drops, the doctor touches your cornea with a weight with a colored area. The level of intraocular pressure is determined on paper by the diameter of the imprint of the unpainted zone. This technique is also painless.

Since glaucoma is a disease associated with an increase in intraocular pressure, regular measurement of it is a necessary condition for maintaining the health of your eyes.

Cover Test

There are many methods for diagnosing strabismus. The simplest of these is the cover test. The doctor asks you to fix an object in the distance with your eyes and, alternately covering one of your eyes with your palm, watches the other one: whether there will be an adjusting movement. If it occurs inside, a divergent strabismus is diagnosed, if outwards, it is convergent.

Biomicroscopy of the eye

A slit lamp or biomicroscope allows you to examine the structures of the eye under high magnification. You are asked to place your chin on the instrument stand. The doctor illuminates your eye with the light of a slit lamp and, under high magnification, first examines the anterior part of the eye (eyelids, conjunctiva, cornea, iris, lens), and then, using a strong lens, examines the fundus (retina, optic nerve head and blood vessels). Biomicroscopy allows diagnosing almost the entire spectrum of eye diseases.

Retinal examination

Using an ophthalmoscope, the doctor directs a beam of light into your eye and examines the retina, optic nerve head and blood vessels through the pupil.

Often, for a more complete view, you are first instilled with drops that dilate the pupil. The effect develops in 15-30 minutes. During their action, sometimes for several hours, you may experience difficulty in focusing your eyes on objects located nearby. In addition, the sensitivity of the eye to light increases, it is recommended to wear sunglasses on the way home after the examination.