Eye diseases. Diagnosis of fundus pathology (most important)

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Eye diseases. Diagnosis of fundus pathology (most important)

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29. Diagnosis of fundus pathology

If patients complain of deterioration in visual acuity, changes in peripheral vision, loss in visual fields (scotomas), blurred vision at dusk (hemeralopia, or night blindness), impaired color perception, then pathology of the retina can be assumed.

When clarifying the data on the picture of the fundus in children and adults, it should be borne in mind that in newborns the fundus is light, the optic nerve head is grayish-pink, its boundaries are not entirely clear, there may be pigment deposits at the optic nerve head, the macular reflex is absent, the ratio the caliber of arteries and veins is 1:2.

In pathological conditions of the retina, due to various reasons, a variety of changes can be observed in the fundus:

1) edema and retinal detachment;

2) clouding and ischemia;

3) atrophic foci;

4) tumor formations;

5) change in the caliber of vessels;

6) preretinal, retinal and subretinal hemorrhages.

To judge the location in the retina of foci of hemorrhages, one should be guided by their shape, size, color, location in relation to the vessels of the retina.

The foci located in the layer of nerve fibers have the form of strokes or an oblong (linear) shape. In the region of the macula, in the layer of Henle, the foci are arranged radially, form a "star" pattern, and have a yellowish-white color. In the middle layers of the retina, the foci have a rounded or irregular shape, a yellowish or bluish tint. If the focus is located so that it covers the vessels of the retina, then it is located in the inner layer of the retina. In cases where the focus is located behind the vessels of the retina, it is located in the middle or outer layers of it.

The presence of pigment in the focus speaks in favor of damage to the neuroepithelial layer and choroid. The defeat of the inner layers of the retina is accompanied by swelling of the optic disc, its hyperemia. At the same time, the disk tissue is opaque, its borders are blurred, the retina in the peripapillary zone is opaque.

Retinal hemorrhages have the form of lines, strokes located radially around the optic nerve head. Larger hemorrhages are triangular in shape with the apex facing the optic nerve head.

Dotted hemorrhages of round and oval shape are located in the middle and outer layers of the retina. Hemorrhages in the area of the optic nerve head or in the area of the macula, which are ovoid, dark in color, or cup-shaped with a dark lower half and a lighter upper layer, are characteristic of preretinal localization. The ischemic retina is matte white, without a sharp border. The edematous retina looks dull, cloudy, and the retinal vessels are not clearly visible. For a detailed examination of the fundus, patients should dilate their pupils with mydriatics.

Author: Shilnikov L.V.

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