Where to get an eye examination for inflammation. Ophthalmological examination
Regular and thorough eye examination is the best prevention eye diseases. Vision examination in patients under 40 years of age in the absence of complaints and hereditary factors risk assessment should be carried out every 3-5 years. Vision diagnostics in patients aged 40-60 years is carried out once a year. After 60 years, ophthalmologists recommend having an eye examination 2 times a year.
However, if you have such aggravating factors as a hereditary predisposition, previous inflammatory eye diseases or eye trauma, concomitant general somatic diseases (diabetes mellitus, rheumatism and others), vision diagnostics should be carried out more often.
A thorough vision diagnosis includes a number of instrumental and hardware examination methods. And if you have never had your vision tested, now is the time. Diagnostic equipment latest generation allows you to measure most of the necessary parameters of the eye completely painlessly, without touching the surface of the eye. This significantly reduces the risk of any eye inflammation and shortens the time of the vision examination procedure itself.
So, ten reasons to see an ophthalmologist:
- Wide range of ophthalmological services provided.
- Using the most modern scientific developments, professional modern equipment, high-quality consumables.
- Vision examination, full comprehensive vision examination and diagnosis on the day of treatment.
- Individual approach to patient examination.
- A unified computer system for processing and storing patient information.
- Accurate calculations of surgical parameters for myopia, cataracts and other diseases of the organ of vision.
- Vision diagnostics, initial consultation, surgery and treatment before full recovery from one specialist.
- Consultations with the involvement of related specialists (neurologist, cardiologist, endocrinologist, nephrologist) according to indications.
- Preparation for surgery and postoperative rehabilitation.
Thanks to our advanced examination and treatment methods, we are able to preserve vision and joy in life for most patients.
Deterioration of vision can be caused by many reasons. Vision diagnostics using modern equipment makes it possible to identify these causes, make the correct diagnosis, decide on the possibility and advisability of performing a particular operation, and determine the tactics of conservative treatment of the patient. Below we will try to give a brief description of the main and most informative methods of examining an ophthalmological patient, performed in our eye clinic.
Visometry
| Computer diagnostics of refraction - determination of the optical power (refraction) of the eye. The vision test is carried out using an autorefkeratometer, which allows you to objectively and accurately determine the degree of refraction of the eye (myopia, farsightedness, astigmatism), measure the radius of curvature and refractive power of the cornea, the diameter of the pupils (which is necessary to determine the zone laser exposure with excimer- laser correction). Survey data obtained on an autorefkeratometer are necessary for calculating artificial lens eyes (IOL) for cataract removal, refractive surgery for myopia, farsightedness, astigmatism, selection of contact lenses and glasses. |  |
| Measuring intraocular pressure is of great importance in the diagnosis of glaucoma, as well as a number of eye diseases accompanied by an increase or decrease in intraocular pressure. In clinical practice, tonometry is performed using applanation (non-contact) and impression (contact) methods. With non-contact tonometry, a pneumotonometer, using a directed stream of air, without touching the surface of the eye, quickly and safely measures intraocular pressure. This technology makes the measurement process more comfortable for the patient. The procedure speed is only 3 ms. If necessary, measurement of intraocular pressure is carried out with a Maklakov contact tonometer or Goldman tonometer, which consists of instilling anesthetic drops and measuring the degree of deflection of the cornea under the pressure of a weight (plunger) lowered onto the surface of the eye. |
|
| Biomicroscopy of the eye is a method of visual examination of the optical media and tissues of the eye using a slit lamp, based on creating a sharp contrast between illuminated and unlit areas, which allows you to study in detail the condition and identify diseases of the auxiliary apparatus of the organ of vision (eyelids, lacrimal organs, conjunctiva), pathology of the cornea , opacities in the lens under high magnification. The use of special lenses makes it possible to perform gonioscopy (examination of the drainage system of the eye) for glaucoma. Biomicroscopy of the eye makes it possible to study the state of the vitreous body during hemorrhages and opacities in it, to assess the nature, scale and prospects for subsequent treatment of such pathology retina, such as vascular lesions of the retina, hereditary diseases retina, retinal detachment (retinal detachment), retinal dystrophy, retinopathy. |  |
| Ophthalmoscopy - research method choroid, retina, optic nerve in rays of light that is reflected from the patient’s fundus. In the clinic, ophthalmoscopy is performed using a direct ophthalmoscope, a head-mounted binocular ophthalmoscope, or using a slit lamp and an aspheric lens or Goldmann contact lens. Ophthalmoscopy is carried out under conditions of the widest possible pupil, which allows a qualitative examination of not only central departments fundus, but also the peripheral parts of the retina that are difficult to examine, identify peripheral retinal dystrophies, retinal dissection (retinoschisis), subclinical forms of retinal detachment (retinal detachment), that is, a pathology in the fundus that is not clinically manifested, but requires mandatory treatment. Mydriatics are used to dilate the pupil short acting. |  |
This is the so-called “standard complex of primary diagnostics”. If necessary and in agreement with the patient, vision diagnostics can be expanded with additional studies.
Tonography
Tonography is a method for studying the hydrodynamics of the eye, which consists of graphically recording the results of repeated measurements of intraocular pressure against the background of prolonged compression eyeball tonometer. Tonography allows you to measure fluctuations in intraocular pressure, production and outflow rates intraocular fluid for a given period of time. Conducting this study is especially important for verifying the diagnosis when glaucoma is suspected and as a control of the effectiveness of treatment for those patients in whom glaucoma was previously identified.
Perimetry
|
Perimetry is intended to diagnose the state of the visual field - the space that the human eye sees when fixed. Often a person does not notice the appearance of defects (losses) in the field of vision due to the ability given by nature to look at the world with two eyes. Modern perimeter models have wide range threshold studies and highly specialized tests, which makes it possible to identify initial stages ocular pathology such as glaucoma, retinal dystrophy, retinal vascular pathology (occlusions and thrombosis of retinal vessels), retinopathy, retinal detachment. Diagnostic capabilities for inflammatory and vascular pathology optic nerve, optic nerve atrophy, neuro-ophthalmological pathology. Perimetry with short screening testing methods is reliable enough to detect even minimal visual field defects without a large investment of time. |
 |
Ultrasound examination of the eye and orbit
Ultrasound examination of the eye and orbit is a highly informative, safe, non-invasive instrumental research method that allows one to obtain a two-dimensional image of the vitreous cavity, the posterior segment of the eye and the orbit. A/B scanning provides high-resolution images and allows measuring the size of intraocular structures with an accuracy of 0.01 mm. Ultrasound examination of the eye is performed for the following main indications:
- Measuring the thickness of the cornea, the depth of the anterior chamber of the eye, the thickness of the lens, the size of the vitreous body, the anteroposterior size of the eyeball. This information is necessary when performing a variety of operations, including cataract removal.
- Identification and determination of the size and topography of neoplasms of the ciliary body, choroid and retina, retrobulbar tumors. Quantitative assessment of their changes in dynamics. Differentiation clinical forms exophthalmos.
- Identification, assessment of the height and extent of retinal detachment, detachment of the ciliary (ciliary) body and choroid and their relationship with the vitreous body. Differentiation of primary retinal detachment from secondary retinal detachment caused by tumor growth.
- Detection of destruction, exudate, opacities, blood clots, mooring in the vitreous body. Determination of their localization, density and mobility, relationship with the retina of the organ of vision.
- Detection of foreign bodies in the eye due to trauma to the organ of vision, including clinically invisible and X-ray negative ones. Determination of their location in the eye and relationship with intraocular structures.
- Calculation of the refractive power required for implantation of an artificial eye lens (IOL).
|
IN lately V clinical practice being implemented new method acoustic visualization of intraocular structures of the anterior segment of the eye - ultrasound biomicroscopy. This method allows you to examine the anterior segment of the eye at the microstructural level. Ultrasound biomicroscopy is a B-scanning ultrasound immersion diagnostic procedure with linear scanning, which provides quantitative and qualitative information about the structure of the anterior segment of the eye (cornea, iris, anterior chamber angle, lens) for the purpose of diagnosing glaucoma, anterior tumors, and the consequences of eye injuries. |
 |
Fluorescein angiography with computer registration
Today, not a single clinic in the world can do without this informative diagnostic study. Fluorescein angiography, based on contrasting retinal vessels with a special dye, is the only method of its kind for accurate and effective diagnostics diseases of the retina, optic nerve and choroid. It reveals the structure of the retinal vascular bed, gives a clear idea of hemodynamics, the state of permeability of the vascular walls, pigment epithelium and Bruch's membrane, and allows one to differentiate inflammatory changes from vascular, dystrophic and tumor processes.
|
Fluorescein angiography is performed on a retinal camera both for diagnostic purposes and to determine the indications, tactics and timing of laser treatment, as well as to evaluate the results of the treatment. This study allows us to identify ischemic zones and newly formed vessels, which is important to identify in diseases such as diabetic retinopathy, thrombosis of the central retinal vein and its branches, occlusion of the central retinal artery and its branches, vasculitis, anterior ischemic neuropathy, pathology of the central zone of the retina (edema, cysts, ruptures), recurrent hemophthalmos and a number of other diseases. |
 |
| Electroretinography (ERG) is a method for recording changes in the bioelectric potential of the retina, graphically expressing the electrical activity of the cellular elements of the retina in response to light stimulation. Electroretinography allows one to judge the functional state of the photopic and scotopic systems of the organ of vision, regardless of the transparency of the optical media of the eye. The study of the thresholds of electrical sensitivity and electrical lability of the visual analyzer allows us to assess the functional state inner layers retina and axial fascicle of the optic nerve. |  |
Electroretinography is performed:
- if it is impossible to visually assess the condition of the retina,
- in the presence of an inflammatory process in the eye,
- if sympathetic ophthalmia is suspected,
- For early diagnosis retinitis pigmentosa,
- for the diagnosis of macular degeneration,
- for acute circulatory disorders in the retina,
- for early diagnosis of metallosis,
- in case of poisoning with neurotropic poisons.
Keratotopography
Optical coherence tomography (OCT)
| Optical coherence tomography(OCT) - non-invasive imaging method biological structures, which makes it possible to obtain in vivo (“intravital”) two-dimensional images of transverse optical sections of biological tissues with a resolution approaching cellular level(10-15 microns). Technological basis This method is to measure the optical reflectivity of biological structures. The device is based on a new diagnostic technology, which allows you to obtain a two-dimensional image of a section of the membranes of the eyeball and the optic nerve with high resolution, measure the thickness of their longitudinal section by analyzing the light signal reflected from the boundaries of biological layers. The device makes it possible to conduct a vision examination even in cloudy environments with minimal strain on the patient’s eye. |  |
What after vision diagnostics?
So, the vision test is completed. What's next? After careful and full examination Our specialist will have a conversation with you and, based on all the diagnostic data received, will prescribe the appropriate conservative or
Many diseases can be prevented if detected early. The same applies to the visual system - the sooner problems are identified, the better. By the way, modern vision diagnostics greatly contributes to this. No one will be able to pass by the perfect equipment. serious illnesses, nor hidden pathologies...
Why do you need to follow the recommendations of ophthalmologists and get checked at least once a year?
It’s probably not because there’s nothing to do that ophthalmologists around the world are trumpeting: “Check your eyesight at least once a year! Especially if you are part of any risk group!” They worry about the health of every person. Indeed, today, in the age of innovative industry, vision problems are taking on large proportions. Helpers for this are televisions, computers, our carelessness, laziness and many other things.
Meanwhile, as it shows world practice, preventive examination allows:
- Reveal hidden pathologies.
- Diagnose significant vision problems.
- Select the correct means of correction.
- Prescribe adequate treatment in a timely manner: medications, devices, surgery.
- Significantly reduce side effects treatment.
But, alas, few people follow the recommendations of ophthalmologists. Most people seek help when even surgery does not guarantee a successful outcome. After all, the causes of vision loss can be different. For example, with cataracts it decreases due to clouding of the lens, with glaucoma - due to poor circulation and increased intraocular pressure, etc.
In any case, these and other diseases without timely detection and treatment can lead to significant loss of vision, and often to complete darkness, i.e. blindness...
What does a complete diagnostic examination involve?
In many clinics they limit it to a simple check using Sivtsev’s tables. But this may not always reflect the true picture of the state of the visual system. Therefore, we need to insist on a comprehensive review.
If the clinic at your place of residence does not have the opportunity to carry it out, then you can take free referral to an ophthalmology center or use paid services.
Comprehensive vision diagnostics includes:
- Measuring visual acuity.
- Determination of eye refraction.
- Measuring intraocular pressure.
- Biomicroscopy (examination of the eyeball through a microscope).
- Pachymetry (measurement of corneal depth).
- Echobiometry (measurement of eye length).
- Ultrasound internal structures eyes, including opaque ones.
- Computer keratotopography.
- Diagnosis of hidden pathologies.
- Determining the level of tear production.
- Visual field test.
- Study of changes in the retina (with a wide pupil), optic nerve.
Such diagnostics allows us to identify all the features of the visual system and the causes of vision loss. Prediction of the outcome of a particular treatment also depends on the results.
Comprehensive vision diagnostics helps to detect diseases such as hypertension, diabetes, atherosclerosis and rheumatism at the initial stages of development. And also tuberculosis, cervical osteochondrosis, problems with the thyroid gland and many other diseases.
How is a comprehensive examination carried out?
As a rule, vision diagnostics in children and adults begins with test tables. They may depict letters, pictures and other signs.
Additionally, a test can be carried out using an autorefractometer - a device that automatically determines the refraction of the eye and the parameters of the cornea and immediately produces the result.
If vision problems are identified, the ophthalmologist will begin to select lenses of the required optical power. For this, special glasses can be used, into which test glasses are inserted, or a phoropter, a device where the lenses change automatically.
Intraocular pressure is measured using a tonometer. If glaucoma is suspected, computer perimetry is additionally performed - checking the visual field.
The anterior segment of the eye (eyelashes, eyelids, conjunctiva, cornea, etc.) is examined using a biomicroscope. This is necessary to assess the condition of the cornea, check for scars on it, cloudiness in the lens, etc.
A complete picture of the condition of the eye is obtained by examining the fundus through a dilated pupil. This allows you to determine whether there are changes in the retina, what is the condition of the optic nerve, etc.
Pachymetry allows you to calculate the maximum corneal depth permissible for laser exposure. And in cases high degree myopia helps to establish how complete correction can be carried out and which method is best to choose for this.
And if you need topography and the refractive ability of the cornea, then a keratotopograph will come to the rescue. It can be used to examine individual optical defects of the cornea. Such diagnostics lasts only a few seconds, but during this time its entire surface is scanned.
Information obtained from the keratotopograph is also necessary for performing laser refractive correction. Indeed, during its implementation, the cornea is directly affected. At the same time, the machine produces results in the form of digital data, which allows you to predict visual acuity after laser correction. In general, diagnostics using a keratotopograph helps to identify initial signs keratoconus (changes in the shape of the cornea) and many other diseases.
Echobiometry allows you to measure the length of the eyeball, determine the size of the lens and the depth of the anterior chamber. Wave aberrometry – measure optical system eyes, identify all deviations from the norm on the retina and its other structures.
Why is it important to examine children in a timely manner (video):
A comprehensive examination allows you to more fully cover the human visual system, identify its features and weak points, and, of course, appoint the most effective treatment. Do you agree? The answer is in the comments!
Vision diagnostics- this is an important step in the prevention of eye diseases and maintaining good vision for many years! Timely detection of ophthalmological pathology is the key successful treatment 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 vision diagnostic necessary?
Vision diagnostics is necessary not only to identify primary ophthalmological pathology, but also to decide on the possibility and advisability of performing a particular operation, choosing treatment tactics for the patient, as well as accurately diagnosing the condition 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.
Cost of vision diagnostics
The cost of a diagnostic examination (vision diagnostics) depends on its volume. For the convenience of patients, we have created complexes in accordance with common eye diseases, such as cataracts, glaucoma, myopia, farsightedness, and fundus pathology.
| Service code | Service name | Qty services |
Price |
|---|---|---|---|
| A02.26.004 | Visometry, 2 eyes Code: A02.26.004 |
1 | 350 ₽ |
| A02.26.013 | Code: A02.26.013 |
1 | 550 ₽ |
| A02.26.015 | Ophthalmotonometry, 2 eyes Code: A02.26.015 |
1 | 300 ₽ |
| A03.26.001 | Biomicroscopy, 2 eyes Code: A03.26.001 |
1 | 900 ₽ |
| A03.26.018 | Code: A03.26.018 |
1 | 700 ₽ |
| A12.26.016 | Code: A12.26.016 |
1 | 350 ₽ |
| B01.029.001.009 | Code: B01.029.001.009 |
1 | 700 ₽ |
| Service code | Service name | Qty services |
Price |
|---|---|---|---|
| A02.26.004 | Visometry, 2 eyes Code: A02.26.004 |
1 | 350 ₽ |
| A02.26.013 | Determination of refraction using a set of trial lenses, 2 eyes Code: A02.26.013 |
1 | 550 ₽ |
| A02.26.015 | Ophthalmotonometry, 2 eyes Code: A02.26.015 |
1 | 300 ₽ |
| A03.26.001 | Biomicroscopy, 2 eyes Code: A03.26.001 |
1 | 900 ₽ |
| A03.26.003.001 | Code: A03.26.003.001 |
1 | 1,950 RUR |
| A03.26.018 | Biomicroscopy of the fundus (central zone), 2 eyes Code: A03.26.018 |
1 | 700 ₽ |
| A12.26.016 | Autorefractometry with a narrow pupil, 2 eyes Code: A12.26.016 |
1 | 350 ₽ |
| B01.029.001.009 | Consultation with an ophthalmologist Code: B01.029.001.009 |
1 | 700 ₽ |
| Service code | Service name | Qty services |
Price |
|---|---|---|---|
| B01.029.001.009 | Consultation with an ophthalmologist Code: B01.029.001.009 |
1 | 700 ₽ |
| В01.029.001.010 | Consultation with an ophthalmologist (surgeon) Code: B01.029.001.010 |
1 | 1,700 ₽ |
| B01.029.001.011 | Consultation with an anesthesiologist Code: B01.029.001.011 |
1 | 1,000 ₽ |
| B01.029.001.012 | Consultation with an ophthalmologist (vitreoretinologist) Code: B01.029.001.012 |
1 | 1 100 ₽ |
| B01.029.001.013 | Consultation with a candidate of medical sciences Code: B01.029.001.013 |
1 | 2,200 ₽ |
| B01.029.001.014 | Consultation with a doctor of medical sciences Code: B01.029.001.014 |
1 | RUB 2,750 |
| В01.029.001.015 | Professor consultation Code: B01.029.001.015 |
1 | 3,300 ₽ |
| B01.029.001.016 | Consultation with Professor, Doctor of Medical Sciences V.V. Kurenkov Code: B01.029.001.016 |
1 | 5 500 ₽ |
| Service code | Service name | Qty services |
Price |
|---|---|---|---|
| A02.26.004 | Visometry, 2 eyes Code: A02.26.004 |
1 | 350 ₽ |
| A02.26.009 | Color perception study, 2 eyes Code: A02.26.009 |
1 | 200 ₽ |
| A02.26.010 | Strabismus angle measurement, 2 eyes Code: A02.26.010 |
1 | 450 ₽ |
| A02.26.013 | Determination of refraction using a set of trial lenses, 2 eyes Code: A02.26.013 |
1 | 550 ₽ |
| А02.26.013.001 | Determination of refraction using a set of trial lenses in conditions of cycloplegia, 2 eyes Code: A02.26.013.001 |
1 | 800 ₽ |
| A02.26.015 | Ophthalmotonometry, 2 eyes Code: A02.26.015 |
1 | 300 ₽ |
| A02.26.015.001 | Ophthalmotonometry (iCare device), 2 eyes Code: A02.26.015.001 |
1 | 650 RUR |
| А02.26.015.002 | Daily tonometry using an iCare expert tonometer (1 day) Code: A02.26.015.002 |
1 | 1,850 RUR |
| A02.26.015.003 | Ophthalmotonometry (IOP according to Maklakov), 2 eyes Code: A02.26.015.003 |
1 | 450 ₽ |
| A02.26.020 | Schirmer test Code: A02.26.020 |
1 | 600 ₽ |
| A02.26.023 | Accommodation study, 2 eyes Code: A02.26.023 |
1 | 350 ₽ |
| A02.26.024 | Determination of the nature of vision, heterophoria, 2 eyes Code: A02.26.024 |
1 | 800 ₽ |
| A03.26.001 | Biomicroscopy, 2 eyes Code: A03.26.001 |
1 | 900 ₽ |
| A03.26.012 | Examination of the posterior corneal epithelium, 2 eyes Code: A03.26.012 |
1 | 600 ₽ |
| A03.26.002 | Gonioscopy, 2 eyes Code: A03.26.002 |
1 | 850 ₽ |
| A03.26.003 | Examination of the periphery of the fundus using a three-mirror Goldmann lens, 2 eyes Code: A03.26.003 |
1 | 1,950 RUR |
| A03.26.003.001 | Examination of the periphery of the fundus using a lens, 2 eyes Code: A03.26.003.001 |
1 | 1,950 RUR |
| A03.26.011 | Keratopachymetry, 2 eyes Code: A03.26.011 |
1 | 800 ₽ |
| A03.26.005 | Biomicrography of the eye and its adnexa, 1 eye Code: A03.26.005 |
1 | 800 ₽ |
| A03.26.005.001 | Biomicrography of the fundus using a fundus camera, 2 eyes Code: A03.26.005.001 |
1 | 1 600 ₽ |
| A03.26.018 | Biomicroscopy of the fundus (central zone), 2 eyes Code: A03.26.018 |
1 | 700 ₽ |
| A03.26.019 | Optical examination of the retina using a computer analyzer (one eye), 1 eye Code: A03.26.019 |
1 | 1,650 RUR |
| A03.26.019.001 | Optical examination of the anterior part of the eye using a computer analyzer (one eye), 1 eye Code: A03.26.019.001 |
1 | 1 200 ₽ |
| A03.26.019.002 | Optical research posterior section eyes using a computer analyzer in angiography mode (one eye), 1 eye Code: A03.26.019.002 |
1 | 2 500 ₽ |
| A03.26.019.003 | Optical examination of the optic nerve head and nerve fiber layer using a computer analyzer, 1 eye Code: A03.26.019.003 |
1 | 2,000 ₽ |
| A03.26.019.004 | Optical examination of the posterior segment of the eye (optic nerve) using a computer analyzer, 1 eye Code: A03.26.019.004 |
1 | 3 100 ₽ |
| A03.26.020 | Computer perimetry (screening), 2 eyes Code: A03.26.020 |
1 | 1 200 ₽ |
| A03.26.020.001 | Computer perimetry (screening + thresholds), 2 eyes Code: A03.26.020.001 |
1 | 1,850 RUR |
| A04.26.002 | Ultrasound examination of the eyeball (B-scan), 2 eyes Code: A04.26.002 |
1 | 1 200 ₽ |
| A04.26.004.001 | Ultrasound biometry of the eye (A-method), 2 eyes Code: A04.26.004.001 |
1 | 900 ₽ |
| А04.26.004.002 | Ultrasound biometry of the eye with calculation of IOL optical power, 2 eyes Code: A04.26.004.002 |
1 | 900 ₽ |
| A05.26.007 | Optical biometrics of the eye, 2 eyes Code: A05.26.007 |
1 | 650 RUR |
| A12.26.007 | Load-unload tests to study the regulation of intraocular pressure, 2 eyes Code: A12.26.007 |
1 | 400 ₽ |
| A12.26.016 | Autorefractometry with a narrow pupil, 2 eyes Code: A12.26.016 |
1 | 350 ₽ |
| A12.26.018 | Videokeratotopography, 2 eyes Code: A12.26.018 |
1 | 1 200 ₽ |
| A23.26.001 | Selection spectacle correction vision, 2 eyes Code: A23.26.001 |
1 | 1 100 ₽ |
| A23.26.001.001 | Selection of spectacle vision correction (with cycloplegia) Code: A23.26.001.001 |
1 | 1,550 RUR |
| A23.26.001.002 | Selection of spectacle vision correction (during comprehensive examination) Code: A23.26.001.002 |
1 | 650 RUR |
| A23.26.001.003 | Selection of spectacle vision correction (with cycloplegia during a comprehensive examination) Code: A23.26.001.003 |
1 | 850 ₽ |
| A25.26.001 | Prescription of medications for diseases of the organ of vision Code: A25.26.001 |
1 | 900 ₽ |
| B01.029.002 | Repeated appointment (examination, consultation) with an ophthalmologist Code: B01.029.002 |
1 | 850 ₽ |
| DU-OFT-004 | Training in using SCL Code: DU-OFT-004 |
1 | 1 500 ₽ |
| DU-OFT-005 | Determining your dominant eye Code: DU-OFT-005 |
1 | 400 ₽ |
What tests 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 the patient’s complaints and collecting an anamnesis. And only after this they move on to hardware methods for 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 eyes (B-scan), computer keratotopography and careful (fundus) with a wide pupil, determination of the level of tear production, assessment of the patient’s field of vision. When ophthalmological pathology is detected, the scope of the examination is expanded for a specific study clinical manifestations for a specific patient. Our clinic is equipped with modern, highly professional ophthalmological equipment from companies such as ALCON, Bausch & Lomb, NIDEK, Zeiss, Rodenstock, Oculus, which allows us to conduct studies of any level of complexity.
In our clinic, special tables with pictures, letters or other signs are used to determine the patient’s visual acuity and refraction. Using an automatic phoropter NIDEK RT-2100 (Japan), the doctor, alternately changing diopter glasses, selects the most optimal lenses, providing best vision for the patient. In our clinic, we use NIDEK SCP - 670 halogen sign projectors with 26 test patterns and analyze the results obtained under narrow and wide pupil conditions. Computer refraction research is carried out on a NIDEK ARK-710A autorefractive meter (Japan), which allows you to most accurately determine the refraction of the eye and the biometric parameters of the cornea.
Intraocular pressure is measured using a non-contact tonometer NIDEK NT-2000. If necessary, measurement of intraocular pressure is carried out using a contact method - Maklakov or Goldman tonometers.
To examine the condition 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.
All patients undergoing a full ophthalmological examination are required to undergo an examination of the fundus, including areas of its extreme periphery, under conditions of maximum pupil dilation. This makes it possible to identify dystrophic changes in the retina, diagnose its breaks 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 are used (Midrum, Midriacil, Cyclomed). If changes are detected in the retina, we prescribe preventive laser coagulation using a special laser. Our clinic uses the best and modern models: YAG laser, diode laser NIDEK DC-3000.
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 its thickness.
One of the anatomical manifestations of refractive error (myopia,) is a change in the length of the eye. This is one of the most important indicators, which in our clinic is determined using a non-contact method using the IOL MASTER device from ZEISS (Germany). This is a combined biometric device, the research results of which are also important for calculating IOLs for cataracts. Using this device, during one session, the length of the eye axis, the radius of curvature of the cornea and the depth of the anterior chamber of the eye are measured immediately one after another. 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 generally accepted clinical methods of ophthalmological 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. Using the A-method (one-dimensional imaging system), the thickness of the cornea, the depth of the anterior chamber, the thickness of the lens and inner membranes of the eye, as well as the length of the eye are measured. The B-method (two-dimensional imaging system) allows you to assess the condition of the vitreous body, diagnose and evaluate the height and extent of choroid and retinal detachment, identify and determine the size and localization of ocular and retrobulbar neoplasms, as well as detect and determine the location of a foreign body in the eye.
Visual field examination
Another necessary method for diagnosing vision is visual field testing. The purpose of determining the field of view (perimetry) is:
- diagnosis of eye diseases, in particular glaucoma
- dynamic observation to prevent the development of eye diseases.
Also, using hardware techniques, it is possible to measure the contrast and threshold sensitivity of the retina. These studies provide the possibility of 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 lining of the eye is. This unique technique allows you to get an idea of the structure of the retina throughout its entire 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 accessible to the resolving abilities of the human eye.
The operating principle 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 study. The examination takes a few minutes, does not cause visual fatigue and does not require direct contact of the device’s sensor with the eye. Similar devices for vision diagnostics 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 obtain a unique opportunity to monitor the dynamics of treatment based not on the subjective impression of the doctor, but on clearly defined digital values of retinal thickness.
The study provides comprehensive information about the condition of the optic nerve and the thickness of the layer of nerve fibers around it. High-precision measurement of the latter parameter guarantees the identification of the earliest signs of this terrible disease, even before the patient notices the first symptoms. Considering the ease of implementation and the absence of unpleasant sensations during the examination, we recommend repeating control examinations on the scanner for glaucoma every 2-3 months, for diseases of the central zone of the retina - every 5-6 months.
Repeated examination allows you to determine the activity of the pathology, clarify the correctness of the chosen treatment, and also correctly inform the patient about the prognosis of the disease, which is especially important for patients suffering from macular holes, since the likelihood of a similar process developing in a healthy eye can be predicted after a tomograph study. Early, “preclinical” diagnosis of fundus changes in diabetes mellitus is also possible with this amazing device.
What happens after hardware research is completed?
After completing hardware tests (vision diagnostics), the doctor carefully analyzes and interprets all the information received about the condition 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 to the patient in detail.
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 exists large number a variety of 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.
Despite the fact that the process of a full 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 dilates the pupil. This helps to see more of the lens for a better examination. 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 they 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 the ophthalmologist.
- Comprehensive vision diagnostics.
- Professional equipment and high-quality consumables.
- Reasonable price for the services provided.
- and choice of treatment method.
- The presence of a special database where all information about any patient is stored.
- Individual approach and appointment of required examinations.
- Surgery followed by rehabilitation.
- 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. Integrated approach to this issue will help to 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 ;
- condition of the optic nerve;
- measuring the depth of the cornea of the eye, etc.
Also, the list of comprehensive examinations must include an ultrasound of the internal structures of the eye to check for 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 concerns diabetes mellitus or 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 the results obtained during the examination can be adequately interpreted.
Vision diagnostic methods
At the 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 a wide variety of eye problems, for which innovative techniques are used. 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 purpose, special tables with letters, pictures or other signs are used. The most common in this case is considered to be, although recent 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, the test 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. Similar diagnostics vision is very important in the development of glaucoma. In practice similar study carried out by contact or non-contact means. 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 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, the vitreous body and the 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.
By time similar technique Examination of the eye condition 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 of the visual organ. It is worth noting that similar procedure It is performed without direct contact with the patient, therefore it 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 research will have to take a position near special device, which will fix your 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 subsequent 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 for this method is the presence of a maximum that makes it possible to examine the hard-to-reach peripheral parts of the retina. Thanks to an ophthalmoscope, doctors are able to identify retinal dissection and peripheral dystrophy, as well as fundus pathology that does not manifest itself clinically. To dilate the pupil, you just need to use some short-acting mydriatic.
Of course, this list of existing methods for diagnosing visual problems is far from complete. There are a number of specific procedures that can be used to detect only 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 old undergo pyrometry in the form of a 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.
- Moscow eye clinic.
- Konovalov Ophthalmological Center.
- MNTK "Eye Microsurgery".
- Excimer Medical Center.
- 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.
■ Patient complaints
■ Clinical examination
External examination and palpation
Ophthalmoscopy
■ Instrumental examination methods
Biomicroscopy Gonioscopy
Echoophthalmography
Entoptometry
Fluorescein angiography of the retina
■ Examination of the organ of vision in children
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 quickly enough 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 part of the 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 fossa 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
Psies occur when primary lesions are present cortical centers vision (for example, 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 sockets, 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 with increased sensitivity of the 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 inspection always begins with healthy eye, and in the absence of complaints (for example, during a preventive examination) - from 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 skin, eyelashes, anterior and posterior ribs, intercostal space, lacrimal openings and excretory ducts of the 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:
For general diseases (kidney disease and cardiovascular system) and allergic Quincke's edema the process is bilateral, the skin of the eyelids is pale;
In inflammatory processes of the eyelid or conjunctiva, 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 a chronic inflammatory process or a previous disease of the eyelids and conjunctiva.
Palpebral fissure. Normal length 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 is a drooping of the upper eyelid that 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 superior 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 the upper edge of the cartilage down (Fig. 4.1).
Rice. 4.1.Stages of upper eyelid eversion
Normally, the conjunctiva of the eyelids and transitional folds is pale pink, smooth, shiny, with vessels 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(protrusion of the eye anteriorly) is observed in thyrotoxicosis, trauma, orbital tumors. To differentiate these conditions, reposition of the protruding eye is performed. For this purpose, the doctor thumbs presses through the eyelids on the patient’s eyeballs 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 may be at extensive education in the orbit, imbalance of the tone of the extraocular muscles, disruption of the integrity of the orbital walls, 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 the dyes into the conjunctival sac, a probe with a cotton swab is inserted under the inferior turbinate. 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, while 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. Ingrowth of blood vessels into the cornea occurs under pathological conditions. Minor defects
Rice. 4.4.Side (focal) lighting method
You of the corneal epithelium are 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 the 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.
Pupil at side lighting visible as a black circle. 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 “lively” if, under the influence of light, the pupil quickly narrows, and “sluggish” if the pupillary 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 different shapes and magnitude. 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 technique, ophthalmoscopy is distinguished in reverse and direct form. This study 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. During 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, the right part is visible from the left (that is, the opposite, which explains the name of the method) (Fig. 4.5).
Rice. 4.5.Ophthalmoscopy in indirect form: 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 on 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 observation, photo and telerecording 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 angle of the anterior chamber (tumors, foreign bodies, etc.). Especially
It is important to determine the degree of openness of the anterior chamber angle, according to which wide, medium width, narrow and closed angles are distinguished.
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 and choroidal detachment, 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 linear speed and the 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
An idea of the functional state of the retina 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 rapid fatigue and the inability to fix their gaze for a long 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.
