Diagnosis of eye diseases. Diagnosis, effective treatment and prevention of eye diseases

■ Complaints of the patient

■ Clinical examination

External examination and palpation

Ophthalmoscopy

■ Instrumental examination methods

Biomicroscopy Gonioscopy

Echoophthalmography

Entoptometry

Fluorescein angiography of the retina

■ Examination of the organ of vision in children

COMPLAINTS OF THE PATIENT

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

Decrease or change in vision;

Pain or discomfort in the eyeball and surrounding areas;

lacrimation;

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

visual impairment

Decreased visual acuity

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

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

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

vision changes

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

Diplopia(doubling) can occur only when fixing an object with two eyes, and is due to a violation of the 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 with a healthy eye, and in the absence of complaints (for example, during a preventive examination) - from the right eye. Examination of the organ of vision, regardless of the patient's complaints and the doctor's first impression, must be carried out sequentially, according to the anatomical principle. An eye examination is started after a vision test, as after diagnostic tests, it may worsen for a while.

External examination and palpation

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

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

Eyelids

When examining the eyelids, attention should be paid 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 evaluate the transparency of the cornea and moisture of the anterior chamber with lateral illumination of the eye, the study with transmitted light is aimed at analyzing the transparency of the lens and vitreous body.

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

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

Ophthalmoscopy

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

Reverse ophthalmoscopy

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

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

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

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

The optic disc is round or slightly oval in shape with clear boundaries, yellowish-pink in color. In the center of the disk 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, there is a gradual decrease in pressure, as part of the intraocular fluid is forced out of the eye. According to the tonography data, it is possible to judge the cause of the change in the level of intraocular pressure.

INSTRUMENTAL EXAMINATION METHODS

Biomicroscopy

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

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

Gonioscopy

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

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

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

Rice. 4.7. Gonioscope

Diaphanoscopy and transillumination

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

Echoophthalmoscopy

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

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

Entoptometry

An idea of ​​the functional state of the retina can be obtained by using entoptic tests(gr. ento- inside, ortho- see). The method is based on the patient's visual sensations, which arise as a result of the impact on 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), the 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.

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

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

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

General examination procedure:

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

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

These include:

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

T. Birich, L. Marchenko, A. Chekina

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 (mucous membrane) 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.

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!

Diagnosis of eye diseases. What symptoms of eye diseases help to correctly establish the causes of the pathology

Signs of eye disease detected during a traditional consultative examination

Diagnostics eye diseases, like any other pathologies, begins with the collection of patient complaints. There are certain combinations of symptoms that allow you to make a preliminary diagnosis. eye diseases based solely on patient complaints. So, for example, a combination of such symptoms as morning gluing of the eyelids, copious discharge from the conjunctival cavity and redness of the eye without reducing its function indicate acute conjunctivitis. Corneal lesions are characterized by a triad of symptoms - severe lacrimation, painful spasm of the eyelids and photophobia.

However, in many cases, this kind of combination is also non-specific, like individual symptoms. In particular, complaints of blurred visual fields combined with a gradual painless decrease in visual function may indicate diseases of such different nature as cataracts, open-angle glaucoma, optic nerve atrophy, etc.

Therefore, the diagnostic search for diseases of the eye can be quite difficult and require the use of special equipment. To save time, money and nerves, it is better for the patient to prepare for visiting an ophthalmologistby preparing answers to the most popular questions, such as:
1. When the symptoms of eye disease first appeared (in cases where the pathology develops gradually, it is often not so easy to remember the first minor symptoms - quickly appearing eye fatigue, flies before the eyes, gluing of the eyelids in the morning, etc.);
2. What measures were taken to eliminate unpleasant symptoms, and was there an improvement;
3. Did any of the relatives suffer from eye diseases or diseases associated with the eyes (hypertension, atherosclerosis, diabetes mellitus, increased thyroid function, etc.);
4. Is the patient's work related to occupational hazards in terms of vision;
5. What eye diseases and eye surgeries have been transferred.

After a detailed collection of information, the ophthalmologist proceeds to examine the patient. Inspection begins with a healthy eye. In cases where both eyes are affected by the pathological process, they traditionally start with the right one.

The doctor pays attention to the mobility of the eyes, the state of the palpebral fissure, the position of the eyelids, then, slightly pulling the lower eyelid, examines the mucous membrane of the conjunctival cavity.

A standard examination aimed at identifying eye diseases is carried out in daylight. Consultation with an ophthalmologist, as a rule, includes the well-known procedure for determining visual acuity using special tables (Golovin-Sivtsev table or children's visometric tables). If necessary, more complex methods of examination are prescribed.

What methods do ophthalmologists use when diagnosing eye diseases?

Most patients, after undergoing a traditional examination-consultation with an ophthalmologist, receive only preliminary diagnoses of eye diseases, to clarify which it is necessary to carry out certain additional examination methods, in particular:

• biomicroscopy (study of the optical media of eye tissues, such as the cornea, iris, anterior chamber of the eye, vitreous body, using a slit lamp);
• gonioscopy (examination of the angle of the anterior chamber of the eye, formed by the inner surface of the cornea and the outer surface of the iris and ciliary body);
• study of intraocular pressure;
• assessment of the sensitivity of the cornea (carried out in the "old-fashioned" way by gently touching a cotton swab to the surface of the membrane covering the pupil in the center and four places along the periphery);
• conifocal intravital microscopy of the cornea (examination of corneal tissues using a specially adapted microscope);
• studies of tear production and tear drainage, which determine the uniformity of the distribution of tears, the total amount of tear fluid production, the patency of the lacrimal ducts;
• diaphanoscopy and transillumination of the eye (widely used for penetrating wounds and tumor processes of the eye, assessment of the state of the internal structures and membranes of the eyeball using diaphanoscopes that direct light through the sclera (diaphanoscopy) or the cornea (transillumination of the eye));
• ophthalmoscopy (standard method of objective examination of the fundus);
• study of the central and peripheral fields of vision (study of the light sensitivity of the retina by establishing the boundaries of the fields of view and determining the usefulness of vision (absence / presence of blind spots in the field of view));
• the study of color vision, which is carried out using a special anomaloscope device, or / and special color tables and tests;
• assessment of binocular vision (friendly work of the eyes), which is used in professional selection (pilots, drivers, etc.), scheduled examinations, as well as in the pathology of the oculomotor apparatus (strabismus, professional ophthalmopathy, etc.);
• ultrasound examination of the eye;
• fluorescein angiography of the eye fundus, which allows you to examine in detail the state of the choroid of the eye by introducing a special substance fluorescein into the blood;
• optical coherence tomography (OCT) is a modern method for studying the optical structures of the eye, which allows obtaining information at the microscopic level;
• Heidelberg retinal tomography, which uses laser scanning to obtain ultra-precise information about the condition of the optic nerve head and the retina as a whole;
• laser polarimetry is the latest method of objective examination of the state of the optic nerve head;
• electrophysiological methods, which are the study of the activity of the visual analyzer based on changes in bioelectric potentials that occur in the cells of the cerebral cortex in response to light stimulation of the retina.

Treatment of eye diseases

How can eye diseases be treated in humans?
Treatment of eye diseases with folk remedies and methods
official medicine (surgical,
physiotherapy, medicine)

The main methods of official medicine are surgical and conservative. As a rule, surgical intervention is resorted to in cases where it is impossible to obtain a reliable and stable result with the help of conservative therapy.

Predominantly, the surgical method heals congenital malformations of the eye, corrects age-related changes (surgery to replace the lens in cataracts, surgical treatment of senile ptosis, inversion and eversion of the eyelids), restores the normal circulation of intraocular fluid in glaucoma, eliminates many malignant tumors, etc.

However, most eye diseases can and should be treated without resorting to a scalpel. So the need for surgery in many cases indicates untimely intervention or inadequate treatment of pathology (infectious eye diseases, "eye" complications of diabetes, etc.).

The main methods of conservative treatment of eye diseases are medication and physiotherapy. The medical method is understood as the treatment of eye diseases with the help of local medicines (special eye drops and ointments) and, much less often, general action (drugs for oral administration and injections). Physiotherapy treatment is a fight against the disease with the help of physical factors (heat, electric current, magnetic field, etc.).

Modern medicine allows and welcomes the use of so-called folk remedies (beaver stream, honey, etc.) in the complex treatment of eye diseases. However, they should be used on the recommendation and under the supervision of the attending ophthalmologist.

What are the drugs for the treatment of eye diseases

All drugs for the treatment of eye diseases are divided into seven large groups according to their purpose and principle of action.

Anti-infective drugs are used to treat inflammatory processes caused by exposure to microorganisms. This large group of drugs includes the following types of drugs:

• Antiseptics or disinfectants are drugs that do not penetrate into the inner layers of the skin and mucous membranes, but have a powerful local anti-infective and anti-inflammatory effect. The most popular are Vitabact eye drops, combined preparations containing boric acid, silver salts, etc.;
• Antibiotics are substances of biological origin, as well as their synthetic analogues, which have a pronounced antimicrobial effect. For the treatment of infectious eye diseases, antibiotics from the group of chloramphenicol (eye drops levomycetin 0.25%), aminoglycosides (eye drops tobramycin (Tobrex)) and the latest broad-spectrum antibiotics fluoroquinolones (eye drops Tsipromed (ciprofloxacin)) are most often used.
• Sulfonamides are one of a group of chemotherapy drugs that are effective against most types of bacterial infection. In ophthalmic practice, sulfonamides are represented by such a well-known drug as eye drops Albucid (sulfacyl sodium).
• As antifungal drugs for the treatment of eye diseases, as a rule, drugs intended for oral administration (Nystatin tablets, etc.) are used.
• Antiviral drugs used to treat eye diseases are divided into antiviral chemotherapeutic agents that directly eliminate viruses (for example, 3% Acyclovir ointment) and immune drugs that activate the body's defenses (drug for intramuscular injection Cycloferon).

Anti-inflammatory drugs are typically used to treat non-infectious inflammatory eye conditions. It is also possible to use drugs of this group for protracted infections in combination with anti-infective therapy.

This distinguishes between steroidal anti-inflammatory drugs, for example, dexamethasone drops, and non-steroidal anti-inflammatory drugs, such as eye drops containing a 0.1% solution of diclofenac sodium.

In addition, there are combined drugs with anti-infective and anti-inflammatory effects. Such drugs include Sofradex, Tobradex and Maxitrol drops, which are successfully used in infectious and inflammatory eye diseases with an allergic component.

Antiallergic drugs are intended for the treatment of eye diseases of allergic origin and include medicines from several groups. First of all, these are the so-called membrane-stabilizing drugs that prevent the release of inflammatory mediators from mast cells responsible for the development of the allergic process (Lekrolin and Ketatifen eye drops).

Dacryocystitis is an inflammation of the lacrimal sac, a special cavity for collecting lacrimal fluid located at the inner corner of the eye.

The lacrimal fluid performs the most important function, protecting the mucous membranes of the organ of vision from drying out and the development of dangerous infectious and degenerative eye diseases. Tears are produced by a specialized lacrimal gland located in the upper lateral part of the orbit.

The lacrimal fluid is evenly distributed in the cavity of the conjunctiva, while excess tears are removed through the lacrimal canaliculus, the mouths of which open on the conjunctiva of the inner corner of the eye below.

Through the lacrimal ducts, the lacrimal fluid enters the lacrimal sac, which ends blindly from above, and downwards passes into the nasolacrimal canal, which opens into the nasal cavity.

During fetal development, the opening of the nasolacrimal canal is closed, so that normally it opens with the first loud cry of the newborn. In cases where the thin film that blocks the nasolacrimal canal remains intact, there is a real threat of developing dacryocystitis in newborns.

The fact is that the lacrimal fluid is a good breeding ground for microorganisms that begin to multiply intensively in the overflowing lacrimal sac, causing an inflammatory reaction.

Symptoms of dacryocystitis in newborns in many ways resemble the signs of conjunctivitis: the affected eye begins to fester, there is increased lacrimation, and cilia may stick together in the morning.

Such a characteristic symptom as damage to only one eye and an increased amount of tears in the conjunctival sac will help to suspect dacryocystitis in newborns.

Finally, you can verify the presence of inflammation in the lacrimal sac by slightly pressing on the area of ​​\u200b\u200bits projection (the lateral surface of the nose at the inner corner of the eye) - at the same time, droplets of pus and / or blood will appear from the lacrimal openings, which are the mouths of the lacrimal ducts.

Neonatal dacryocystitis is an eye infection that should not be treated with antimicrobial agents. After all, purulent inflammation is only a consequence of pathological obstruction of the nasolacrimal canal.

So the most adequate treatment for dacryocystitis in newborns is to massage the lacrimal sac, which helps open the nasolacrimal canal. This is a simple procedure, the video of which can be easily found on the Internet. With clean hands, the mother gently presses on the projection of the lacrimal sac from top to bottom.

In the vast majority of cases, with the help of regularly repeated simple manipulations, it is possible to get rid of the film covering the mouth of the nasolacrimal canal. As soon as the lacrimal fluid stops accumulating in the lacrimal sac, the infectious process is spontaneously eliminated.

In cases where a weekly course of lacrimal sac massage does not lead to success, the patency of the nasolacrimal canal is restored by surgical methods (probing and washing the lacrimal ducts, which is performed under general anesthesia).

Eye diseases in premature babies. Retinopathy (pathology of the retina) of premature babies: causes, symptoms, treatment

The main problem of premature babies is the immaturity of all body systems, as well as the need for many resuscitation measures that save the life of the baby, but can have an adverse effect on its further development.

A typical disease of the eyes of prematurely born children is retinopathy of prematurity, a severe pathology that often leads to irreparable loss of vision.

The immediate cause of retinopathy of prematurity is the immaturity of the vasculature of the retina - the inner shell of the eyeball, responsible for the actual light perception.

The vascular network of the retina begins to develop only at the 17th week of development. At the same time, by the 34th week of pregnancy (the gestational age is calculated from the first day of the last menstruation), the formation of vessels located at the nasal part of the retina is completed, so that the optic nerve head and macula (the area of ​​\u200b\u200bthe retina responsible for the best vision) are already normally supplied with blood, however, the temporal part the retina is still extremely poor in blood vessels. Fully formation of retinal vessels ends only by the last - 40th week of gestation.

If a child is born prematurely, many unfavorable external and internal factors begin to affect his still immature retina, which can cause the main manifestation of retinopathy of prematurity - a violation of the normal formation of retinal vessels, expressed in their germination inward into the vitreous body of the eye.

As a result, hemorrhages form in the vitreous body, and pathological tension of the retina by improperly growing vessels leads to its local or even complete detachment, ruptures, and other irreversible changes.

Retinopathy of prematurity as an eye disease of varying severity develops in 76% of children born at 24-25 weeks of gestation, and in 54% of children born at 26-27 weeks of gestation. At the same time, retinopathy of prematurity, threatening retinal detachment, occurs in 5% of children born before 32 weeks of gestation, and the risk of developing this terrible complication in children born at 24-25 weeks reaches 30%.

It should be noted that retinopathy of prematurity also occurs in children born at term. This happens when it comes to an immature fetus and / or exposure to extremely aggressive factors in the first hours and days of life.

• born at less than 32 weeks of gestation;
• born at any time with a weight of less than 1500 g;
• born at a gestational age of 32 to 36 weeks and receiving oxygen for more than 3 days;
• all premature infants with episodes of complete apnea (lack of breathing requiring emergency resuscitation).

During this eye disease, three periods are distinguished:
1. Active(about six months), when abnormal development of blood vessels occurs, hemorrhages occur in the vitreous body, as well as detachment, detachment and ruptures of the retina.
2. reverse development (second half of life), when there is a partial, and in mild cases, a complete restoration of the functions of the retina and vitreous body.
3. Cicatricial period or a period of residual manifestations, which can be judged a year after birth. The most common complications of retinopathy of prematurity are:

• cicatricial changes after ruptures and retinal detachment;
• myopia of medium or high degree;
• clouding and / or displacement of the lens;
• glaucoma (increased intraocular pressure);
• subatrophy of the eyeballs;
• corneal dystrophy with the subsequent formation of a walleye.

Specific prevention of retinopathy of prematurity has not been developed to date. All at-risk infants at the 5th week of life (but not earlier than at the 44th week of the estimated gestation) undergo an examination of the fundus.

In the event of a real threat of retinal detachment, ruptures or tears in this eye disease, either cryotherapy (cauterization of germinating vessels with cold) is performed, which can reduce the risk of irreversible blindness by half, or laser therapy (laser exposure to abnormal vessels), which is just as effective, but significantly less painful.

What to do with dacryocystitis in a child - video

Prevention of eye diseases in adults and children

Primary and secondary prevention of eye diseases in humans

There are primary and secondary prevention of eye diseases in children and adults. At the same time, primary prevention is aimed at preventing the development of eye diseases, and includes a set of hygienic and health-improving measures (observance of the correct mode of work and rest, the use of special exercises for the eyes, reducing the time spent doing eye-tiring activities, the use of protection factors in the presence of occupational hazards, etc. .).

Secondary prevention is a measure taken for the timely detection and treatment of eye pathology (scheduled examinations by an ophthalmologist, refusal of self-treatment, strict adherence to all doctor's prescriptions). Thus, if primary prevention is powerless, adequate treatment of a timely detected pathology allows avoiding serious consequences for the organ of vision and the body as a whole.

Prevention of eye diseases in children

The primary prevention of eye diseases in children primarily includes occupational and rest hygiene during all activities that require eye strain (reading, writing, drawing, working at a computer, playing with small details of designers, etc.).

It is necessary to observe the daily routine so that children's eyes rest well during sleep. Rational lighting and teaching the child the rules of reading and writing hygiene will help protect against eye diseases.

Many children like to read while lying down, as well as while riding in transport, often using material on electronic media for this, which puts a significant strain on the organs of vision. Parents should warn offspring that such behavior, as well as the use of material with small print and poor contrast, can lead to the development of serious eye diseases.

The hygiene of school classes provides for sufficiently long breaks between lessons, during which it is strongly recommended to provide complete rest to the eyes. After attending school, children should walk outdoors or indoors, and do homework only after a sufficient break (at least 2 hours).

Many parents ask when watching TV and using a computer can pose a risk of eye disease. It all depends on the overall load on the organ of vision. Of course, if a student is forced to spend a lot of time with textbooks, it is better for him to choose another type of entertainment (active games, sports sections, walks, etc.).

Secondary prevention of eye diseases in children consists in the timely passage of scheduled examinations by an ophthalmologist and the timely application for specialized medical care when any alarming signs appear on the part of the organ of vision.

Prevention of eye diseases in adults. How to prevent the development of eye disease from the computer

Everyone knows that scientific and technological progress has not only led to tremendous advances in medicine, but also caused the emergence of many diseases, including eye diseases.

The most common eye disease associated with the new conditions of human life is a computer syndrome, manifested by the following symptoms:

• eye fatigue;
• feeling of "sand" in the eyes;
• soreness of the eyeballs;
• pain when moving the eyes;
• eye redness;
• color vision disorders;
• slow refocusing of the eyes from distant objects to near ones and vice versa;
• the appearance of blurred vision, doubling of objects, headache during prolonged work with a computer.

The main reason for the development of computer syndrome is a violation of hygiene rules that protect the organ of vision. Therefore, in order to protect yourself from such an eye disease, it is enough just to follow all the simple requirements.
1. If the work is connected with a long stay at the computer, it is necessary to spare the eyes during off-hours. For example, instead of reading, you can listen to audio books, and learn the news from radio programs. It is necessary to drastically reduce the time for visiting social networks, reading forums, etc. It should be noted that "sedentary" work generally adversely affects health, therefore, in the list of entertainment, it is better to replace a computer and TV with outdoor walks, going to the pool or a trip to the country.
2. While working at the computer, you should observe the alternation of work and rest: 10 minutes break every 50 minutes of work.
3. It is advisable to complete every 20 minutes of work with a 20-second break for elementary gymnastics for the eyes (fixing the gaze on objects located at a distance of 6 meters and further from the monitor).
4. In the presence of eye diseases such as myopia, hyperopia or astigmatism, you should work at the computer with glasses or corrective lenses.
5. The optimal distance to the display (80 cm) should be observed, while it is desirable that the center of the screen be 10-20 cm below eye level.
6. Use high-resolution screens when using your computer regularly.
7. In order to choose the ideal working font size, it is necessary to empirically determine the minimum readable font size. The working size should be three times larger. The best type of text is black and white. Avoid dark backgrounds whenever possible.
8. Watch out for lighting, do not work near bright light sources, flickering lamps. In bright natural light, it is better to curtain the window, and cover the table surface with a matte material.

Prevention of eye diseases

Before use, you should consult with a specialist.

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.