The shells of the eye wash out an accurate diagnosis. Diagnosis of eye diseases in ophthalmology: all methods of examination

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.

■ 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 a strip longer than 15 mm is wetted with a tear.

Rice. 4.3. Schirmer's test

Functional patency lacrimal ducts evaluate by several methods.

canal test. Instilled into the conjunctival sac

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

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

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

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

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

Side (focal) illumination method

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

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

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

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

Rice. 4.4.Side (focal) illumination method

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

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

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

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

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

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

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

Transmitted light research

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

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

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

Ophthalmoscopy

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

Reverse ophthalmoscopy

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

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

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

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

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

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

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

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

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

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

Measurement of intraocular pressure

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

Palpation method

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

There are 3 degrees of increase in eye turgor:

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

The eyeball is moderately dense (T+ 2);

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

There are 3 degrees of eye turgor reduction:

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

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

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

Tonometry

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

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

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

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

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

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

INSTRUMENTAL EXAMINATION METHODS

biomicroscopy

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

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

Gonioscopy

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

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

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

Rice. 4.7. Gonioscope

Diaphanoscopy and transillumination

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

Echoophthalmoscopy

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

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

Entoptometry

An idea of the functional state of the retina can be obtained by using entoptic tests(gr. ento- inside, ortho- see). The method is based on the visual sensations of the patient, 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.

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. A triad of symptoms is characteristic of corneal lesions - 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 vision 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, diagnostic search for eye diseases 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 are in many ways reminiscent of 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 that covers 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;
moderate or high myopia;
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.

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

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

Why is early vision diagnostics on innovative equipment necessary?

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

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

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

Advantages of the VISION clinic

1.High-precision diagnostics

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

2. Qualification of doctors

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

3.Innovation in treatment

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

4. Top level eye surgery

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

5. Responsible approach

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

6.Transparent prices

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

7. Social orientation.

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

8.Convenient location

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

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

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

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

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

1. identification of complaints, collection of anamnesis.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

General examination procedure:

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

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

These include:

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

T. Birich, L. Marchenko, A. Chekina