Complete eye examination. Diagnosis of eye diseases in ophthalmology: all methods of examination When dispensary registration with an ophthalmologist is indicated

In ophthalmology, thanks to modern equipment, the latest medical techniques, eye examination takes a short time, is painless and gives very accurate results in identifying diseases of the eye organ.

vision study

At an appointment with an ophthalmologist, the patient is examined by the main standard diagnostic methods, which include checking visual acuity, measuring intraocular pressure, examining the cornea and retina.

If necessary, a more accurate and in-depth study is prescribed on modern devices using laser technology and computer programs.

Symptoms for a mandatory visit to the ophthalmologist

For timely detection of eye diseases and treatment, it is necessary to pay attention to the following symptoms:

• swelling and redness of the eyelids;
• the presence of itching and burning in the eyes;
• pain when blinking;
• redness of the inner surface;
• severe tearing;
• the presence of a film in front of the eyes, making it difficult to see;
• flies and dots before the eyes;
• flickering light flashes;
• blurry or foggy vision of objects;
• duality of objects;
• increased sensitivity to light;
• long orientation in a dark room;
• sudden disappearance of the image;
• curvature or kink of lines when looking at straight lines;
• observation of dark spots in the field of view;
• iridescent circles that blur around the light source;
• difficulty focusing on near and far objects;
• observation of spots in the center of the field of view;
• beginning to squint eyes;
• poor vision of the peripheral zone.

Who needs an eye exam

People with good one hundred percent vision should have it checked once a year for preventive purposes. For those who have visual impairment due to certain reasons, it is necessary to undergo an examination by an ophthalmologist to correct vision.

For contact lens wearers, an examination is needed to detect adaptation of the lens material to the surface of the eye. To determine allergic reactions to this material. Clarify the correct care and storage of contact lenses.

Pregnant women need to see an ophthalmologist at 10-14 weeks and 34-36 weeks. Pregnancy can cause changes in visual acuity or complications of existing eye diseases.

For people aged 40–60 years, it is advisable to plan a preventive visit to the ophthalmologist once every 2–4 years. Over 65 years old - once every 1-2 years. Children need to be treated up to three times during the first year of life and as needed.

It is desirable to come to an appointment with an ophthalmologist for people with cardiovascular diseases, suffering from hypertension and diabetes, after eye injuries or taking hormonal drugs.

Examination methods

There are many serious diseases of the human eye organ that significantly affect the visual process. These are cataracts, glaucoma, retinal detachment and many infectious diseases.

Diagnosis at an early stage, as well as treatment started on time, can prevent the further development of diseases, partial loss of vision and blindness. The earlier the diagnosis is established and treatment is started, the greater the percentage of vision that can be saved.

Basic examination methods

The applied methods of examination are basic and additional:

• Visometry - the definition of vision, its sharpness according to the tables of letters, where letters of different sizes are written in each line. While reading the lines, the current vision is set as a percentage.
• Tonometry - determination of the existing pressure inside the body. The method is aimed at determining glaucoma.
• Refractometry - determination of the refraction of the eye (optical power). It can detect nearsightedness, farsightedness and astigmatism.
• The study of color vision is aimed at recognizing color blindness and other deviations in color perception.
  The perimetry method diagnoses glaucoma and determines the degree of death of the optic nerve.
• Biomicroscopy is a method of examining the constituent parts of the eye organ, such as the cornea of ​​the eye, the external conjunctiva, the lens, the iris, and the vitreous body.
• Ophthalmoscopy is a way to examine the fundus, retina, nearby vascular tissues. Determines the degree of strabismus.
• Gonioscopy is a contact technique that allows you to examine the front of the eye to detect a foreign body or neoplasm.
• Pachymetry is a method of studying the cornea of ​​\u200b\u200bthe eye with the help of instruments, measuring its thickness.
• Skiascopy - a shadow test is carried out by observing the shadows on the surface of the pupil when a beam of light falls on it.
• Campimetry is a method of studying central vision to determine the size of the blind spot.
• For a complete examination of the eyeball, Goldman lenses are used. This device consists of three mirrors. With the help of a lens, neoplasms on the retina can be removed and it can be fully examined.

Today, methods of examining the organ of vision are enough to accurately and correctly make a diagnosis by looking into the most inaccessible and deep layers of the visual organ.

vision diagnostics- this is an important step in the prevention of eye diseases and maintaining good vision for many years! Timely detection of ophthalmic pathology is the key to successful treatment of many eye diseases. As our practice shows, the occurrence of eye diseases is possible at any age, so everyone needs to undergo a high-quality ophthalmological examination at least once a year.

Why is a complete eye examination necessary?

Vision diagnostics is necessary not only to identify the primary ophthalmic pathology, but also to resolve the issue of the possibility and expediency of performing a particular operation, the choice of patient treatment tactics, as well as the accurate diagnosis of the state of the organ of vision in a dynamic aspect. In our clinic, a complete ophthalmological examination is carried out using the most modern diagnostic equipment.

The cost of vision diagnostics

The cost of a diagnostic examination (diagnostics of vision) depends on its volume. For the convenience of patients, we have formed complexes, in accordance with common eye diseases, such as cataracts, glaucoma, myopia, hyperopia, pathology of the fundus.

What studies are included in a complete diagnostic examination of the visual system and what are they?

Any ophthalmological examination begins, first of all, with a conversation, identifying complaints from the patient and taking an anamnesis. And only after that they proceed to the hardware methods of studying the organ of vision. The hardware diagnostic examination includes determining visual acuity, studying the patient's refraction, measuring intraocular pressure, examining the eye under a microscope (biomicroscopy), pachymetry (measuring the thickness of the cornea), echobiometry (determining the length of the eye), ultrasound examination of the eye (B-scan), computed keratotopography and careful (fundus) with a wide pupil, determination of the level of tear production, assessment of the patient's field of view. When an ophthalmic pathology is detected, the scope of the examination is expanded for a specific study of clinical manifestations in a particular patient. Our clinic is equipped with modern, highly professional ophthalmological equipment from such companies as ALCON, Bausch & Lomb, NIDEK, Zeiss, Rodenstock, Oculus, which allows for examinations of any level of complexity.

In our clinic, special tables with pictures, letters or other signs are used to determine the visual acuity and refraction of the patient. Using the automatic phoropter NIDEK RT-2100 (Japan), the doctor, alternately changing the diopter glasses, selects the most optimal lenses that provide the best vision for the patient. In our clinic, we use NIDEK SCP - 670 halogen sign projectors with 26 test charts and analyze the result obtained under narrow and wide pupil conditions. A computer study of refraction is carried out on a NIDEK ARK-710A autorefkeratometer (Japan), which allows you to determine the refraction of the eye and the biometric parameters of the cornea as accurately as possible.

Intraocular pressure is measured using a NIDEK NT-2000 non-contact tonometer. If necessary, the measurement of intraocular pressure is carried out by contact method - Maklakov's or Goldman's tonometers.

To study the state of the anterior segment of the eye (eyelids, eyelashes, conjunctiva, cornea, iris, lens, etc.), a NIDEK SL-1800 slit lamp (biomicroscope) is used. On it, the doctor evaluates the condition of the cornea, as well as deeper structures such as the lens and vitreous body.

All patients undergoing a complete ophthalmological examination are required to undergo an examination of the fundus, including areas of its extreme periphery, in conditions of maximum pupil dilation. This makes it possible to detect degenerative changes in the retina, to diagnose its ruptures and subclinical detachments - a pathology that is not clinically determined by the patient, but requires mandatory treatment. To dilate the pupils (mydriasis), fast and short-acting drugs (Midrum, Midriacil, Cyclomed) are used. When changes in the retina are detected, we prescribe prophylactic laser coagulation using a special laser. Our clinic uses the best and most modern models: YAG laser, NIDEK DC-3000 diode laser.

One of the important methods for diagnosing a patient's vision before any refractive surgery for vision correction is computer topography of the cornea, aimed at examining the surface of the cornea and its pachymetry - measuring the thickness.

One of the anatomical manifestations of refractive errors (myopia,) is a change in the length of the eye. This is one of the most important indicators, which is determined in our clinic by a non-contact method using the IOL MASTER device from ZEISS (Germany). This is a combined biometric device, the results of which are also important for calculating the IOL in cataracts. Using this device, during one session, directly one after another, the length of the axis of the eye, the radius of curvature of the cornea and the depth of the anterior chamber of the eye are measured. All measurements are carried out using a non-contact method, which is extremely comfortable for the patient. Based on the measured values, the built-in computer can suggest optimal intraocular lenses. The basis for this is the current international calculation formulas.

Ultrasound examination is an important addition to the generally recognized clinical methods of ophthalmic diagnostics; it is a widely known and informative instrumental method. This study makes it possible to obtain information about the topography and structure of normal and pathological changes in the tissues of the eye and orbit. The A-method (one-dimensional imaging system) measures the thickness of the cornea, the depth of the anterior chamber, the thickness of the lens and the inner membranes of the eye, as well as the length of the eye. The B-method (two-dimensional imaging system) allows assessing the state of the vitreous body, diagnosing and assessing the height and extent of choroid and retinal detachment, identifying and determining the size and localization of ocular and retrobulbar neoplasms, as well as detecting and determining the location of a foreign body in the eye.

Study of visual fields

Another of the necessary methods for diagnosing vision is the study of visual fields. The purpose of determining the field of view (perimetry) is:

• diagnosis of eye diseases, in particular glaucoma
• dynamic monitoring to prevent the development of eye diseases.

Also, using a hardware technique, it is possible to measure the contrast and threshold sensitivity of the retina. These studies provide an opportunity for early diagnosis and treatment of a number of eye diseases.

In addition, other parametric and functional data of the patient are examined, for example, determining the level of tear production. The most diagnostically sensitive functional studies are used - the Schirmer test, the Norn test.

Optical tomography of the retina

Another modern method for studying the inner shell of the eye is. This unique technique allows you to get an idea of ​​the structure of the retina throughout its depth, and even measure the thickness of its individual layers. With its help, it became possible to detect the earliest and smallest changes in the structure of the retina and optic nerve, which are not available to the resolving abilities of the human eye.

The principle of operation of an optical tomograph is based on the phenomenon of light interference, which means that the patient is not exposed to any harmful radiation during the examination. The study takes several minutes, does not cause visual fatigue and does not require direct contact of the sensor of the device with the eye. Similar devices for diagnosing vision are available only in large clinics in Russia, Western Europe and the USA. The study provides valuable diagnostic information about the structure of the retina in diabetic macular edema and allows you to accurately formulate a diagnosis in complex cases, as well as get a unique opportunity to monitor the dynamics of treatment based not on the doctor's subjective impression, but on clearly defined digital retinal thickness values.

The study provides comprehensive information about the state of the optic nerve and the thickness of the layer of nerve fibers around it. Highly accurate measurement of the latter parameter guarantees the detection of the earliest signs of this formidable disease, even before the patient has noticed the first symptoms. Considering the ease of implementation and the absence of discomfort during the examination, we recommend repeating control examinations on the scanner for glaucoma every 2-3 months, for diseases of the central retina - every 5-6 months.

A re-examination allows you to determine the activity of the pathology, clarify the correctness of the chosen treatment, as well as correctly inform the patient about the prognosis of the disease, which is especially important for patients suffering from macular holes, since the likelihood of such a process developing on a healthy eye can be predicted after a tomography examination. Early, "preclinical" diagnosis of fundus changes in diabetes mellitus is also within the power of this amazing device.

What happens after hardware research is completed?

After the completion of hardware studies (diagnosis of vision), the doctor carefully analyzes and interprets all the information received about the state of the patient's organ of vision and, based on the data obtained, makes a diagnosis, on the basis of which a treatment plan for the patient is drawn up. All research results and treatment plan are explained in detail to the patient.

Amblyopia

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

The symptoms of amblyopia are as follows:

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

Astigmatism

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

The symptoms of astigmatism are as follows:

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

Blepharitis

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

Symptoms of blepharitis:

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

Myopia or nearsightedness

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

Symptoms of myopia:

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

Glaucoma

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

• open-angle;
• closed-angle.

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

Symptoms of glaucoma:

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

farsightedness

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

Farsightedness symptoms:

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

Cataract

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

Symptoms of a cataract:

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

Keratoconus

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

Symptoms of keratoconus:

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

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

There are three forms of keratitis:

• light;
• moderate;
• heavy.

Given the cause of keratitis, it is classified into:

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

Symptoms of keratitis:

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

computer vision syndrome

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

Symptoms of computer vision syndrome:

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

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

Conjunctivitis

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

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

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

Macular degeneration (AMD)

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

Macular degeneration symptoms:

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

Flies in the eyes

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

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

Retinal disinsertion

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

The main symptoms of this ophthalmic disease

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

Ophthalmic rosacea

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

Symptoms of ophthalmic rosacea:

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

Pterygum

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

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

Dry eye syndrome

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

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

Symptoms of dry eye syndrome:

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

halazion

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

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

Chemical burns to the eyes

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

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

Symptoms of chemical burns:

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

Electrophthalmia

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

Symptoms of electrophthalmia:

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

Endocrine ophthalmopathy

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

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

episcleritis

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

Symptoms of episcleritis:

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

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

Barley symptoms:

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

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

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

In the modern world, there are a large number of various methods that allow you to identify any problem with the eyes even at the first signs of the manifestation of the disease. All of them make it possible to determine the nature of the threat, and the tactics of further treatment. Such studies are carried out using special equipment in ophthalmological clinics.

Despite the fact that the process of a complete examination by an ophthalmologist takes only an hour, it is better to allocate more free time for additional diagnostics. The whole problem lies in the fact that during the period of the study, the eyes are instilled with a special solution that expands the pupil. This helps to see more of the lens for a better inspection. The effect of these drops can last for several hours, so it is worth refraining from any activity during the marked period.

Why visit an ophthalmologist?

In the life of any person, there may come a time when you have to seek help from an eye doctor. Such a decision is determined by a number of factors that become possible during a visit to an ophthalmologist.

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

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

General information

Vision diagnostics is necessary to make an accurate diagnosis or simply identify the causes that impair vision, as well as to choose the best course of treatment for each individual patient. An integrated approach to this issue will help to identify the true cause of poor vision, because many eye diseases have similar symptoms.

For this, a comprehensive diagnostics of vision is carried out, which studies a whole list of various indicators:

• checking visual acuity;
• finding the refraction of the eye;
• establishment;
• condition of the optic nerve;
• measurement of the depth of the cornea of ​​​​the eye and so on.

Also, the list of a comprehensive examination necessarily includes an ultrasound of the internal structures of the eye for the possibility of pathologies.

Preparation for the examination

A complete vision diagnosis or a partial examination can only be carried out after proper preparation. To do this, you should initially consult a doctor who can see if the vision problem is a concomitant symptom of some other disease. This applies to diabetes or the presence of a chronic infection in the body. When compiling an anamnesis, it is necessary to take into account the issue of the patient's heredity, which can affect his well-being at a certain period of life. Before going to the ophthalmologist itself, no special preparation is needed, except that it is better to get a good night's sleep so that you can adequately interpret the results obtained during the examination.

Vision diagnostic methods

At the moment, ophthalmology has moved far ahead in understanding the eye as a separate element of the whole organism. Thanks to this, it is possible to more accurately and quickly treat a wide variety of eye problems, for which innovative techniques are used. It is simply impossible to list all of them, but it is worth taking a closer look at the most popular and popular ones.

Visometry

Diagnosis of vision begins with the traditional method - determining acuity and refraction. For this, special tables with letters, pictures or other signs are used. In this case, it is considered the most familiar, although in recent years halogen sign projectors have taken the first place. In the latter case, doctors manage to check the acuity of binocular and color vision. Initially, a check is carried out without correction, and then together with a lens and a special spectacle frame. This solution allows the doctor to accurately diagnose the problem and choose the best treatment to eliminate it. Usually, after this, patients can regain 100% vision.

Tonometry

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

Ultrasound examination of the eye and orbit

Ultrasound of the eye is considered a non-invasive and highly informative research method that provides an opportunity to examine the posterior segment of the eye, the vitreous body and the orbit. Such a technique is carried out exclusively on the recommendation of the attending physician and is considered mandatory before performing certain operations or removing cataracts.

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

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

In terms of time, such a technique for examining the condition of the eye takes no more than a quarter of an hour. Ultrasound of the eye has no contraindications regarding the appointment, so it can be performed on children, pregnant women and even people with serious illnesses.

Computer vision diagnostics

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

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

Computer diagnostics of vision can be prescribed by an ophthalmologist to assess the condition of the patient's eyes for the presence of diseases or pathogenic processes, determine the most optimal treatment plan, or confirm the need for subsequent surgical intervention.

Ophthalmoscopy

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

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

Diagnosis of eye problems in children

Unfortunately, eye diseases can manifest themselves not only in adults - children also often suffer from similar problems. But in order to conduct a qualitative examination of a baby frightened by the mere presence of a doctor, an assistant is necessary. Diagnosis of vision in children is carried out in almost the same way as in adults, only the head, arms and legs of the child must be fixed in one position to obtain the most accurate results.

It is worth noting that the diagnostic methods in this case will be identical to the above, however, an eyelid lifter may be needed. Children from the age of 3 undergo pyrometry in the form of a fun game with colorful pictures. If it comes to instrumental research, it is worth using painkillers for the eyes.

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

Where to go for diagnostics?

If the issue of conducting one of the methods for diagnosing eye diseases has become a priority, it's time to contact an ophthalmologist. But where to make a vision diagnosis so that it is accurate, correct and really makes it possible to understand the root causes of vision problems?

Of course, the most experienced specialists in this regard are located in the capital, which houses many ophthalmic medical institutions with special innovative equipment. That is why even district ophthalmologists are assigned vision diagnostics in Moscow. The best Russian clinics located in this city will help you make the correct diagnosis as quickly and accurately as possible and decide on the tactics of subsequent treatment. Considering the reputation of modern medical institutions in the capital and the number of clients who turn to them, it is worth highlighting the following options.

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

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

Compiled by: A.F. Belyanin

The proposed tasks will allow students to independently master the basic methods of researching eye diseases, which are necessary for work in practical classes and at outpatient appointments; correct documentation.

Introduction

Mastering the practical skills of examining patients is the most important moment in the development of any medical discipline. This is especially true for ophthalmology, since students are introduced to many research methods for the first time.

The main practical skills that students should possess are the following:

method of external examination;

examination of the conjunctiva of the upper and lower eyelids;

side lighting method;

determination of the sensitivity of the cornea;

detection of superficial defects of the cornea;

definition of peripheral vision (perimetry);

instillation of eye drops and laying ointments;

the imposition of monocular and binocular bandages, the imposition of cotton-gauze stickers;

examination of the eye in transmitted light;

skiascopy;

ophthalmoscopy;

determination of visual acuity;

determination of color perception;

determination of intraocular pressure;

determination of the refraction of the eye by the method of selecting spectacle lenses and the ability to record the data obtained;

determination of the nearest point of clear vision;

determination of the strength of an unknown spectacle glass by the method of neutralization;

determination of interpupillary distance;

ability to write a prescription for glasses.

Additionally, such methods as exophthalmometry, determination of the angle of strabismus according to Hirshberg, color lacrimal-nasal test, determination of the volume of accommodation, refractometry, etc. can be mastered.

In the process of mastering diagnostic methods, each student enters the results of the examination into his notebook. Recordings are presented to the teacher at the end of the lesson.

Task number 1 external examination, eversion of the eyelids, color tear-nasal test.

External examination is an important part of a preliminary acquaintance with the pathology of the eye and its auxiliary apparatus. It does not require special devices and is carried out, as a rule, in natural light conditions. External examination is carried out in a certain sequence.

Pay attention to the skin of the eyelids: the presence or absence of edema, hyperemia, local or diffuse infiltrates, subcutaneous hematoma and emphysema (feeling of crepitus), superficial neoplasms. Normal: the skin of the eyelids is not changed.

The position of the eyeballs is determined (the position of the visual axes, the mobility of the eyes, the uniformity of the protrusion of both eyes, their displacement to the sides). In this case, there may be a deviation of the eyes more often in horizontal meridians (convergent and divergent strabismus), limitation of eye mobility in a certain direction, unilateral or bilateral protrusion of the eye forward (exophthalmos). Instrumental methods for their more accurate study will be covered in the next task. In the presence of exophthalmos or displacement of the eyeball to the sides, palpation of the accessible zones of the orbit is performed along the entire circumference (in this case, seals, defects in the bone edge of the orbit can be detected). The degree of compression of the tissues of the orbit by the eyeball (reposition of the eye) is also determined. All this can be easily checked against each other: by pressing on the eyeball with closed eyelids, you can feel how freely it shifts deep into the orbit. In the presence of a tumor in the orbit, the reposition of the eye is difficult; with endocrine exophthalmos, it may not be disturbed. Normal: the position of the eyeballs in the orbit is correct, the movements are not limited in full.

Next, examine the condition of the eyelids and the width of the palpebral fissures. Normally, the width of the palpebral fissure is the same on both sides and averages 6–10 mm in the center and 3–4 mm in the region of the inner and outer edges of the eyelids, the length of the palpebral fissure is about 30 mm (these parameters must be measured on each other). With a calm look straight ahead, the upper eyelid slightly covers the upper segment of the cornea, the lower eyelid does not reach the limbus by 1–2 mm. One - or bilateral narrowing of the palpebral fissure, accompanied by redness of the eye (photophobia, lacrimation), is evidence of inflammation of the eyeball or damage to its surface membranes (conjunctiva, cornea). The narrowing of the palpebral fissure, without any reaction from the eye, may be the result of congenital or acquired ptosis. In this case, the upper eyelid can partially or completely close the pupil and opens slightly only when the frontal muscle is tensed. Normally, when the eyelids close, the ciliary edges are tightly adjacent to each other. In some cases, due to paresis or paralysis of the facial nerve, with cicatricial deformities and shortening of the eyelids, tight closure does not occur (lagophthalmos). Normal: the width of the palpebral fissures without pathology.

Mark the position of the edges of the eyelids. Normally, the edges of the eyelids fit snugly against the eyeball. In pathology, the edge of the eyelid can be separated from the eyeball (eversion of the edge of the eyelid) and wrapped inward (torsion).

The position of the eyelashes is noted (there may be incorrect eyelash growth - trichiasis), the condition and width of the intermarginal space (normally it is 1.5 - 2 mm), the condition and position of the lacrimal openings. They are located at the inner edge of both eyelids on a small ledge (lacrimal papilla) and, as a rule, are turned towards the eyeball in the region of the lacrimal lake in the inner corner of the eye. They are visible in the form of points with a slight pull on the inner corner of the eyelids. In pathology, there may be an anterior displacement of the lacrimal openings (eversion), their narrowing, absence (atresia), several lacrimal openings. With the pathology of lacrimation and the patient's complaints of lacrimation, one can see lacrimation, i.e. fluid level along the lower edge of the eyelid. In this case, you should always check the condition of the lacrimal sac by pressing on the place of its projection in the region of the inner corner of the eyelids. In chronic purulent inflammation of the lacrimal sac (purulent dacryocystitis), one can see how mucous or purulent discharge is released from the points.

Examine the conjunctiva of the upper and lower eyelids. The lower eyelid turns out easily, it is enough to pull it down, and ask the patient to look up. The eversion of the upper eyelid requires skill. The technique is as follows (the picture can be seen in the textbook of eye diseases, edited by T.I. Eroshevsky): the patient is asked to look down, the upper eyelid is pulled up with the thumb of the left hand, the ciliary edge of the eyelid is grabbed with the thumb and forefinger of the right hand and slightly pulled away from the eye apples down and then, pressing the thumb of the left hand on the upper edge of the cartilage, with the right hand, the edge of the eyelid is wrapped up. At the same time, it turns inside out, the thumb of the left hand is removed from under the eyelid and they also hold the eyelid by the ciliary edge in an everted state and inspect it all over. It is possible to use in the form of a lever not the thumb of the left hand, but a glass rod.

Normally, the conjunctiva of the eyelids and the eyeball is smooth, transparent, thin, moist, deep vessels, meibomian glands, located in the thickness of the cartilage in the form of yellowish-gray stripes perpendicular to the edge of the eyelid, are clearly visible through it. With inflammation, the conjunctiva becomes thickened, edematous, folded, diffuse hyperemia appears, it can contain deep and superficial follicles, mucus, pus, viscous threads of secretion.

Normally, the eyeball is white, calm, while the white sclera shines through the transparent conjunctiva. With inflammation of the eye, its hyperemia is observed, it can be superficial (conjunctival) and deep (pericorneal). Conjunctival hyperemia is characterized by a bright red color, a large number of dilated blood vessels, decreasing towards the cornea and increasing towards the vaults. With a pericorneal injection, characteristic of inflammation of the eyeball itself, there is a diffuse deep injection from bright red to bluish-violet in color, localized directly at the cornea in the limbus area along its entire circumference or in a separate sector.

In conclusion, it is necessary to check on each other the functional state of the lacrimal ducts (colored tear-nasal test). One drop of a 2% solution of collargol is instilled into the conjunctival cavity (in this case, the patient should not compress the eyelids, so the lower and upper eyelids are lightly held with fingers after instillation). With normal patency of the lacrimal apparatus, after 1-2 minutes, the paint completely disappears from the conjunctival cavity and the eyeball becomes discolored. If tear drainage is impaired, a strip of colored fluid along the edge of the lower eyelid remains for a long time. The final result of this test is evaluated after 5 - 10 minutes after the appearance of paint in the nose (when blown), but in this case you can not do this. As a rule, the rapid absorption of the paint from the conjunctival cavity indicates a good lacrimal function.