How vision diagnostics are carried out. Complete eye examination

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

IN modern world There are a large number of different techniques that allow you to identify any problem with the eyes at the first signs of the disease. All of them make it possible to determine the nature of the threat and tactics further treatment. Such studies are carried out using special equipment in ophthalmology clinics.

Although the process full examination It only takes an hour to see an ophthalmologist; it is better to allocate more free time for additional diagnostics. The whole problem lies in the fact that during the period of the study, the eyes are instilled with a special solution that dilates the pupil. This helps to see more of the lens for a better inspection. The effects of these drops can last for several hours, so you should avoid any activity during this period.

Why see an ophthalmologist?

There may come a time in any person’s life when he has to turn to someone for help. eye doctor. Such a decision is determined by a number of factors that become possible during a visit to the ophthalmologist.

1. Comprehensive vision diagnostics.
2. Professional equipment and high-quality consumables.
3. Reasonable price for the services provided.
4. and choice of treatment method.
5. The presence of a special database where all information about any patient is stored.
6. Individual approach and appointment of required examinations.
7. Surgery followed by rehabilitation.
8. Consultation of related specialists.

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

General information

Vision diagnostics are necessary for staging accurate diagnosis or simply identifying the causes that impair vision, as well as to select the optimal course of treatment for each individual patient. An integrated approach to this issue will help identify the true cause. poor eyesight, because many eye diseases have similar symptoms.

To do this, a comprehensive vision diagnostics is carried out, studying a whole list of various indicators:

• visual acuity test;
• finding the refraction of the eye;
• establishment;
• state optic nerve;
• measuring the depth of the cornea of ​​the eye, etc.

Ultrasound is also included in the list of comprehensive examinations. internal structures eyes to the possibility of pathologies.

Preparing for the examination

A complete vision diagnosis or partial examination can only be carried out after proper preparation. To do this, you should initially consult a doctor who can see if there is a vision problem accompanying symptom some other disease. This applies to diabetes mellitus or the presence in the body chronic infection. When compiling an anamnesis, it is necessary to take into account the issue of the patient’s heredity, which can affect his well-being at a certain period of life. Before going to the ophthalmologist, no special training is not necessary, except that it is better to get a good night’s sleep so that you can adequately interpret the results obtained during the examination.

Vision diagnostic methods

On this moment Ophthalmology has made great progress in understanding the eye as a separate element of the whole organism. Thanks to this, it is possible to more accurately and quickly treat many different eye problems, for which they are used. innovative techniques. It’s simply impossible to list them all, but it’s worth taking a closer look at the most popular and popular ones.

Visometry

Vision diagnostics begins with traditional method- determination of acuity and refraction. For this, special tables with letters, pictures or other signs are used. The most common in this case is considered to be, although last years In first place were halogen sign projectors. In the latter case, doctors are able to check the acuity of binocular and color vision. Initially, a check is carried out without correction, and then together with a lens and a special spectacle frame. This solution allows the doctor to diagnose the problem as accurately as possible and select the optimal treatment to eliminate it. Patients can usually regain 100% vision after this.

Tonometry

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

Ultrasound examination of the eye and orbit

Ultrasound of the eyes is considered a non-invasive and highly informative research method, providing the opportunity to examine the posterior segment of the eye, vitreous and orbit. This technique is carried out solely on the recommendation of the attending physician and is considered mandatory before performing certain operations or cataract removal.

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

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

In terms of time, this method of studying the condition of the eye takes no more than a quarter of an hour. Ultrasound of the eye has no contraindications regarding its purpose, so it can be performed on children, pregnant women and even people with serious illnesses.

Computer vision diagnostics

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

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

Computer vision diagnostics can be prescribed by an ophthalmologist to assess the patient’s eye condition for the presence of diseases or pathogenic processes, determine the most optimal treatment plan, or confirm the need for further follow-up surgical intervention.

Ophthalmoscopy

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

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

Diagnosis of eye problems in children

Unfortunately, eye diseases can occur not only in adults - children also often suffer from similar problems. But in order to conduct a high-quality examination of a baby frightened by the mere presence of a doctor, you need to have an assistant. Vision diagnostics in children is carried out in almost the same way as in adults, but the child’s head, arms and legs must be fixed in one position to obtain the most accurate results.

It is worth noting that the diagnostic methods in this case will be identical to those stated above, however, an eyelid lifter may be needed. Children from 3 years of age undergo pyrometry in the form of fun game with colorful pictures. If it concerns instrumental research, you should use pain-relieving eye drops.

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

Where to go for diagnostics?

If the question of carrying out one of the methods for diagnosing eye diseases has become a priority, it’s time to contact an ophthalmologist. But where can a vision diagnosis be made so that it is accurate, correct and really makes it possible to understand the root causes of vision problems?

Of course, the most experienced specialists in this regard are located in the capital, where many ophthalmological clinics are located medical institutions with special innovative equipment. This is why even regional ophthalmologists prescribe vision diagnostics in Moscow. Best clinics Russians located in this city will help you make the correct diagnosis as quickly and accurately as possible and decide on subsequent treatment tactics. Considering the reputation of modern medical institutions in the capital and the number of clients turning to them, it is worth highlighting the following options.

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

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

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

Diagnosis of any eye pathology begins with knowledge normal anatomy eye tissues. First you need to learn how to examine the organ of vision in 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 status and anatomical structure 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 if visual acuity is less than 0.6;
2. autorefractometry and/or skiascopy - determination of clinical refraction;
3. intraocular pressure (IOP) study; when it increases, electrotonometry is performed;
4. study of the visual field using the kinetic method, and according to indications - static;
5. determination of color perception;
6. determination of the function of extraocular muscles (range of action in all fields of vision and screening for strabismus and diplopia);
7. examination of the eyelids, conjunctiva and anterior segment of the eye under magnification (using loupes or a slit lamp). The examination is carried out using dyes (sodium fluorescein or rose bengal) or without them;
8. examination in transmitted light - the transparency of the cornea, chambers of the eye, lens and vitreous body is determined;
9. fundus ophthalmoscopy.

Additional tests are used based on the results of anamnesis or initial 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 of fundus parts with a fundus lens;
7. fluorescent or indocyanine green fundus angiography (FAG) (ICZA);
8. electroretinography (ERG) and electrooculography (EOG);
9. radiological studies (x-ray, CT scan, magnetic resonance imaging) structures of the eyeball and orbits;
10. diaphanoscopy (transillumination) of the eyeball;
11. exophthalmometry - determination of the protrusion of the eyeball from the orbit;
12. pachymetry of the cornea - determination of its thickness in various areas;
13. determining the condition of the tear film;
14. mirror microscopy of the cornea - examination of the endothelial layer of the cornea.

T. Birich, L. Marchenko, A. Chekina

Preservation good vision requires regular examinations by an ophthalmologist. Even if nothing bothers you, once a year it is recommended to undergo comprehensive examination eyes so that a possible disease can be detected on early stage, and his treatment did not cost a significant amount.

Modern high-tech equipment of our ophthalmological center and highly qualified ophthalmologists allow us to identify possible pathological changes eyes already at the earliest stages of the disease.

The Moscow Eye Clinic provides diagnostics for adults and children (after 3 years):

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

The Moscow eye clinic is under the direction of a doctor of the highest qualification category, member of the Russian Association of Ophthalmologists

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

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

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

Comprehensive vision diagnostics - in 1 hour!

Sign up for an initial consultation with an ophthalmologist
for only 2000 rub.

We save your time and money

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

Safety and guarantee

The modern high-tech equipment of our ophthalmological center and the highly qualified ophthalmologists allow us to identify possible pathological changes in the eyes at the very early stages of the onset of the disease.

Painless and fast

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

In what cases is vision diagnostics needed?

An ophthalmological examination is necessary to evaluate general condition visual functions, prevention of eye diseases, as well as to monitor the progression of the disease. In the latter case, diagnosis helps to select optimal treatment regimens for existing diseases, as well as to avoid serious complications and loss of vision. The examination is also necessary in cases of making decisions about the advisability and type of surgical interventions, if patients need them, in order to provide an opinion to other specialists (in antenatal clinic, neurologist, cardiologist, etc.).

How is an ophthalmological examination performed?

"Moscow Eye Clinic" has all the necessary equipment to diagnose any eye diseases.

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

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

■ Patient complaints

■ Clinical examination

External examination and palpation

Ophthalmoscopy

■ Instrumental methods examinations

Biomicroscopy Gonioscopy

Echoophthalmography

Entoptometry

Fluorescein angiography of the retina

■ Examination of the organ of vision in children

PATIENT'S COMPLAINTS

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

Decreased or changed vision;

Pain or discomfort in the eyeball and surrounding areas;

lacrimation;

External changes in the condition 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 illness; whether the patient discovered decreased vision by chance or can he accurately indicate under what circumstances this occurred; sn-

whether vision decreased gradually or whether its deterioration occurred quite quickly in one or both eyes.

Three groups of reasons can be distinguished that lead to a decrease in visual acuity: refractive errors, clouding of the optical media of the eyeball (cornea, anterior chamber moisture, lens and vitreous body), as well as diseases of the neurosensory apparatus (retina, pathways and cortical section visual analyzer).

Vision changes

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

Diplopia(double vision) can only occur when fixating an object with both eyes, and is caused by a violation of the synchronization of eye movements and the inability to project an image onto the central fovea of ​​both eyes, as occurs normally. When one eye is closed, diplopia disappears. Causes: disruption of the innervation of the external muscles of the eye or uneven displacement of the eyeball due to the presence of a space-occupying formation in the orbit.

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

Photophobia(photophobia) indicates inflammatory diseases or injury to the anterior segment of the eye. In this case, the patient tries to turn away from the light source or close the affected eye.

Glare(glare) - severe visual discomfort when bright light enters the eyes. It is observed with 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, during a microattack of angle-closure glaucoma).

Photopsias- seeing 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" caused by the projection of the shadow of vitreous opacities onto the retina. They are perceived by the patient as points or lines that move along with the movement of the eyeball and continue to move after it stops. These “floaters” 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 localized in the eyelid area, in the eyeball itself, around the eye in the orbit, and also manifest itself as a headache.

Pain in the eye indicates inflammatory processes in the anterior segment of the eyeball.

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

Pain around the eye in the orbit occurs with lesions of the conjunctiva, injuries and inflammatory processes in the orbit.

Headache on the side of the affected eye is observed when acute attack glaucoma.

Asthenopia- unpleasant sensations in the eyeballs and orbits, accompanied by pain in the forehead, eyebrows, back of the head, 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.

Tearing

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

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

CLINICAL EXAMINATION

The examination always begins with the healthy eye, and in the absence of complaints (for example, during a preventive examination) - with the right eye. An examination of the organ of vision, regardless of the patient’s complaints and the doctor’s first impression, must be carried out consistently, according to the anatomical principle. Eye examination begins after a vision test, since after diagnostic studies it may get worse for a while.

External examination and palpation

The purpose of the external examination is to assess the condition of the orbital edge, 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, inspect the areas of the eyebrows, the bridge of the nose, upper jaw, zygomatic and temporal bones, the area where the pre-auricular lymph nodes are located. The condition of these lymph nodes and the edges of the orbit is assessed by palpation. Sensitivity is checked at the exit points of the branches of the trigeminal nerve, for which a point located on the border of the inner and middle third of the upper edge of the orbit is simultaneously palpated on both sides, and then a point located 4 mm below the middle of the lower edge of the orbit.

Eyelids

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

Skin of the eyelidsnormally thin, tender, with loose tissue underneath subcutaneous tissue, as a result of which swelling easily develops in the eyelid area:

At common diseases(kidney diseases and of cardio-vascular system) and allergic angioedema, the process is bilateral, the skin of the eyelids is pale;

In inflammatory processes of the eyelid or conjunctiva, the swelling is usually one-sided, the skin of the eyelids is hyperemic.

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

Palpebral fissure. Normally, the length of the palpebral fissure is 30-35 mm, width 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 disturbances in the structure or position of the eyelids, the following pathological conditions arise:

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

Ptosis - drooping upper eyelid, occurs when the oculomotor or cervical sympathetic nerve is damaged (as part of 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 due to inflammation of the conjunctiva and cornea;

Entropion is an inversion of the eyelid, usually the lower one, which 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

When the palpebral fissure is 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 the upper eyelid, it is necessary to evert the latter. To do this, ask the subject to look down. The doctor, with the thumb and forefinger of his right hand, fixes the eyelid by the edge and pulls it down and forward, and then

with the index finger of the left hand moves top edge cartilage down (Fig. 4.1).

Rice. 4.1.Stages of upper eyelid eversion

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

Redness (injection) the eyeball develops with inflammatory diseases organ of vision due to dilation 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 injections of the eyeball and types of vascularization of the cornea: 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 vascularization of the cornea

Chemosis of the conjunctiva - pinching of the conjunctiva within the palpebral fissure due to severe swelling.

Eyeball position

When analyzing the position of the eye in the orbit, attention is paid to the 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 (anterior protrusion of the eyeball), enophthalmos (retraction of the eyeball), lateral displacement of the eye and anophthalmos (absence of the eyeball in the orbit).

Exophthalmos(proportion of the eye anteriorly) is observed in thyrotoxicosis, trauma, orbital tumors. For differential diagnosis In these conditions, reposition of the protruding eye is performed. For this purpose, the doctor presses the patient’s eyeballs through the eyelids with his thumbs and assesses the degree of their displacement inside 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 orbital bones, with damage to the cervical sympathetic nerve (as part of Bernard-Horner syndrome), as well as with atrophy of retrobulbar tissue.

Lateral displacement of the eyeball can be due to a space-occupying formation in the orbit, an imbalance in the tone of the extraocular muscles, a violation of the integrity of the orbital walls, or inflammation of the lacrimal gland.

Motility 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 how far the eyeball reaches during the study, as well as the symmetry of eye movements. 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 during pathological processes (Mikulich syndrome, tumors of the lacrimal gland). The accessory lacrimal glands located in the conjunctiva are also not visible.

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

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

Rice. 4.3. Schirmer test

Functional patency lacrimal ducts evaluate several methods.

Tubular test. Instilled into the conjunctival sac

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

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

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

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

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

Side (focal) lighting method

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

The study is carried out in a darkened room. The table lamp is installed at eye level of the seated patient, at a distance of 40-50 cm, to the left and slightly in front of him. IN right hand the doctor takes a +20 diopter magnifying glass 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 area of ​​the eye that is to be examined. Thanks to the contrast between a brightly lit small area of ​​the eye and the unlit neighboring parts of it, changes are better visible. When examining the left eye, the doctor fixes his right hand, resting his little finger on the cheekbone; 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. A yellow coloration of the sclera is observed in jaundice. Staphylomas may be observed - dark brown areas of protrusion of sharply thinned sclera.

Cornea. Ingrown blood vessels into the cornea occurs when pathological conditions. Minor defects

Rice. 4.4.Side (focal) lighting method

The corneal epithelium is detected by staining with 1% sodium fluorescein solution. The cornea may have opacities of varying location, 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 notices the touch and tries to close the eye (corneal reflex). When sensitivity decreases, the reflex is caused only by placing a thicker part of the wick. If the corneal reflex could not be evoked 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 appearing on the cornea and iris (normally 3-3.5 mm). Normally, the moisture in the anterior chamber is completely transparent. In pathological processes, an admixture of blood (hyphema) or exudate may be observed in it.

Iris. Eye color is usually the same on both sides. A change in the color of the iris of one eye 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 or complete. Severing the iris from the root is called iridodialysis. With aphakia and lens subluxation, iris trembling (iridodonesis) is observed.

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

The reaction of the pupils to light is tested 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 the pupil of the other eye constricts (cooperative pupil reaction to light). The pupillary reaction is considered “alive” if, under the influence of light, the pupil quickly narrows, and “sluggish” if the pupil reaction is slow and insufficient. The pupil may not react to light.

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

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

Transmitted light examination

This method is used to assess the transparency of the optical media of the eye - the cornea, anterior chamber moisture, lens and vitreous body. Since the transparency of the cornea and the moisture of the anterior chamber can be assessed with lateral illumination of the eye, a 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 eye being examined, examines the pupil through the opening of the ophthalmoscope.

The 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 eye media) delay some of the rays, and against the background of a pink glow appear dark spots of different shapes and sizes. If, when examining the eye in lateral illumination, opacities in the cornea and anterior chamber aqueous are not detected, then the 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 nerve head and choroid). Depending on the method of implementation, ophthalmoscopy is distinguished in reverse and direct form. This study It is easier and more effective to carry out 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, a uniform glow of the pupil is first obtained, as in a transmitted light study, and then a +13.0 diopter lens is placed in front of the eye being examined. The lens is held with the thumb and index finger 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 eye being examined by 7-8 cm, gradually achieving image magnification

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, right part- on the left (that is, the opposite, which explains the name of the method) (Fig. 4.5).

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

An examination of the fundus is carried out in a certain sequence: they start with the optic nerve head, then examine the macular region, and then the peripheral parts of the retina. When examining the optic disc of the right eye, the patient should look slightly past the doctor’s right ear; when 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), caused by bending of the optic nerve fibers.

Fundus vessels. The central retinal artery enters and exits through the center of the optic disc central vein retina. Once the main trunk of the central retinal artery reaches the surface of the disc, it divides into two branches - superior and inferior, each of which branches into the temporal and nasal. The veins follow the course of the arteries; the ratio of the caliber of arteries and veins in the corresponding trunks is 2:3.

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

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

Ophthalmochromoscopy allows you to examine the fundus of the eye using a special electroophthalmoscope 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 condition of the fundus is the use of laser radiation and computer image assessment.

Measuring intraocular pressure

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

Palpation method

During the examination, the patient's gaze should be directed downward, eyes closed. The doctor fixes the III, IV and V fingers of both hands on the patient’s forehead and temple, and places the index fingers on the upper eyelid of the eye being examined. 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 collapses even with light pressure, that is, the pressure is normal (short notation T N). Eye turgor may be increased or decreased.

There are 3 degrees of increase in eye turgor:

The eyeball is crushed under the fingers, but for this the doctor applies more force - intraocular pressure is increased (T+ 1);

The eyeball is moderately dense (T+ 2);

Finger resistance has been dramatically increased. The doctor's tactile sensations are similar to those felt when palpating the frontal area. The eyeball almost does not fall under the finger - intraocular pressure is sharply increased (T+ 3).

There are 3 degrees of reduction in eye turgor:

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

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

During palpation, no resistance to the wall of the eyeball is felt at all (as when pressing on the cheek) - intraocular pressure is sharply reduced. The eye does not have a spherical shape, or its shape is not preserved upon palpation (T -3).

Tonometry

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

In our country, the most common tonometer is Maklakov, 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 onto which a thin layer of special paint is applied. During the examination, the patient lies on his back, his gaze is fixed strictly vertically. A solution is instilled into the conjunctival cavity local anesthetic. The doctor widens the palpebral fissure with one hand, and with the other sets the tonometer vertically on the eye. Under the weight of the load, the cornea flattens, and at the point of contact of the platform with the cornea, the paint is washed away with a tear. As a result, a circle devoid of paint is formed on the tonometer platform. An imprint of the area is made on paper (Fig. 4.6) and the diameter of the unpainted disc is measured using a special ruler, the divisions of which correspond to the level of intraocular pressure.

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

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

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

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. Based on tonography data, one can judge the cause of changes in the level of intraocular pressure.

INSTRUMENTAL METHODS OF EXAMINATION

Biomicroscopy

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

Light passing through the slit diaphragm forms a light slice of the optical structures of the eye, which is viewed through a slit lamp stereomicroscope. By moving the light slit, the doctor examines all structures of the eye with a magnification of up to 40-60 times. Additional observational, photo- and tele-recording systems, and laser emitters can be introduced into the stereomicroscope.

Gonioscopy

Gopioscopy- a method of 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 Beuningen, Goldmann 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 corner.

Rice. 4.7. Gonioscope

Diaphanoscopy and transillumination

Instrumental examination 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 makes it possible to detect massive hemorrhages in the vitreous body (hemophthalmos), some intraocular tumors and foreign bodies.

Echoophthalmoscopy

Ultrasound research method structures of the eyeball are used in ophthalmology to diagnose retinal detachment and choroid, tumors and foreign bodies. It is very important that echoophthalmography can also be used in cases of opacification of the optical media of the eye, when the use of ophthalmoscopy and biomicroscopy is impossible.

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

Entoptometry

Picture of functional state retinas can be obtained by using entoptic tests(Greek ento- inside, orto- I see). The method is based on the patient’s visual sensations, which arise as a result of the influence of adequate (light) and inadequate (mechanical and electrical) stimuli on the retinal receptive field.

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

Autoophthalmoscopy- a method that allows you to assess the safety of the functional state of the retina in opaque optical environments of the eye. The retina functions if, with rhythmic movements of the diaphanoscope along the surface of the sclera, the patient notices the appearance of visual patterns.

Fluorescein angiography of the retina

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

Rice. 4.8.Retinal angiography (arterial phase)

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

VISUAL EXAMINATION IN CHILDREN

When conducting an ophthalmological examination of children, it is necessary to take into account their fatigue and the inability to hold gaze for long periods of time.

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

Visual functions in children under one year of age can be assessed indirectly by the appearance of tracking (end of the 1st and beginning of the 2nd month of life), fixation (2 months of life), 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 the age of one year, children's visual acuity is assessed by showing them toys of different sizes from different distances. Children aged three years and older are examined using children's optotype tables.

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 visual field are somewhat wider than in adults.

Intraocular pressure in young children is measured under anesthesia.

To maintain high visual acuity, each of us needs to undergo regular ophthalmological examinations. An annual comprehensive eye examination should become the norm, even if nothing is bothering you yet. After all, a disease identified at an early stage will be easier and cheaper to cure without resorting to emergency or radical measures.

Modern high-tech equipment and highly qualified specialists of the Virtual Eye Clinic allow us to identify possible pathologies eyes in the initial stages of the disease. In our Clinic, adults and children (over 3 years old) are offered to undergo diagnostics of the visual organ to identify:

• pathologies ( , ),
• pathologies of the oculomotor system (,),
• changes in the anterior segment of the eye of various nature (diseases, conjunctiva,),
• changes in the posterior segment of the eye in vascular or inflammatory diseases, as well as in the optic nerve (including conditions in hypertension, diabetes mellitus),
• injuries to the organ of vision.

When is vision diagnostics necessary?

Data diagnostic examination necessary in assessing the general state of eye function, as a control of disease progression and in the prevention of eye diseases. Timely diagnosis will help to select optimal treatment regimens that prevent serious complications that can lead to vision loss. The examination is also mandatory in cases where a decision has to be made on the need and type of surgical intervention or to provide an opinion at the place of request (to the antenatal clinic, neurologist, cardiologist, etc.)

Ophthalmological examination procedure

The diagnostic procedure can take from 30 minutes. up to 1.5 hours, which depends on the nature of the complaints and the age of the patient, as well as on the objective indications that served as the basis for the examination. During the diagnosis, visual acuity, changes in refraction are determined, and intraocular pressure is measured. The specialist examines the eyes using a biomicroscope, examining (the zones of the optic nerve and retina) with narrow and dilated vision. Sometimes the level is determined or visual fields are examined in detail (according to indications). Additionally, the thickness of the cornea () or the length of the anteroposterior axis of the eye (echobiometry, PZO) can be measured. Hardware studies also include ultrasound diagnostics (B-scan) of the eyes and computer keratotopography. However, other types of studies can be carried out if indicated.

Capital ophthalmology clinics have all the equipment necessary for high-quality vision diagnostics.
At the end of the examination, the ophthalmologist must explain the diagnostic results to the patient. As a rule, after this an individual treatment regimen is prescribed or several are offered to choose from. possible schemes, and also gives preventive recommendations.

Video about comprehensive vision diagnostics

Cost of vision diagnostics in Moscow

The final cost of the examination is the amount consisting of the volume of prescribed diagnostic procedures, which is determined by the patient’s objective complaints, a pre-established diagnosis, or an upcoming planned operation.

The price of standard primary eye diagnostics, including studies such as determination of visual acuity, measurement of intraocular pressure, autorefractometry and examination of the fundus with a narrow pupil, starts from 2,500 rubles. and depends on the level of the clinic, the qualifications of the doctor and the equipment used.

When visiting a specialized eye clinic for vision diagnostics, the patient receives the following advantages(compared to an appointment with an ophthalmologist in a clinic or an examination at an optical office):

• each visitor can use any necessary equipment located on the premises of the clinic;
• highly accurate, detailed diagnostics of the organ of vision, including examination of the fundus, will not take more than 1-2 hours;
• an extract with the diagnostic results will be handed to the patient, along with detailed recommendations for treatment, as well as prevention of the existing disease;
• if necessary, the patient will be referred for consultation to an ophthalmologist who specializes in the identified pathology.

Remember that timely diagnosis is half the success of treatment for any disease. Don’t skimp on your vision, because losing it is much easier than regaining it!

Additionally, the following diagnostic studies can be performed:

• determination of the angle of strabismus
• ophthalmometry
• tonography
• (including computer)
• pachymetry
• echobiometry
• determination of CFC (Critical flicker fusion frequency)
• study of visual acuity in conditions of cycloplegia
• determination of the nature of vision
• determination of the dominant eye
• fundus examination with a wide pupil

The best eye clinics in Moscow specializing in vision diagnostics

Average cost of some vision diagnostic services in Moscow clinics

Name of diagnostic procedure	Price, rub
Initial consultation with an ophthalmologist (without examinations)
Repeated consultation with an ophthalmologist (without examinations)
Fundus examination with a narrow pupil
Computer perimetry