Eye diseases. Method of external eye examination (the most important)

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Eye diseases. Method of external eye examination (the most important)

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7. Method of external examination of the eye

The study of the organ of vision begins with an external examination of the eye in natural light. In the region of the orbit, changes can be associated mainly with congenital pathology in the form of dermoid cysts, cerebral hernia or tumors (angiomas, sarcomas, etc.). Pay attention to the condition of the eyelids. In rare cases, there may be a congenital or acquired coloboma of the eyelids, their fusion (ankyloblepharon), congenital or as a result of a gross cicatricial process.

It is not uncommon to see congenital drooping of the upper eyelid (ptosis). There may be changes in the skin of the eyelids (hyperemia, subcutaneous hemorrhages, edema, infiltration) and the edges of the eyelids (scales and crusts at the base of the eyelashes, ulceration, cysts, etc.).

Usually, the eyelids fit snugly against the eyeball, but sometimes in chronic inflammatory processes of the mucous membrane, an eversion of the lower eyelid may occur, and with cicatricial changes in the mucous membrane and cartilage, eyelid torsion may occur. Sometimes in children in the first month of life, a congenital inversion of the lower eyelid is found, while the eyelashes are turned towards the cornea. With eversion of the lower eyelid, the lacrimal point, usually facing the eyeball and immersed in the lacrimal lake, lags behind somewhat, which leads to lacrimation and lacrimation.

On examination, pay attention to the correct growth of eyelashes. With ulcerative blepharitis, trachoma, chronic meibomitis, abnormal growth of eyelashes (trichiasis), baldness of the edges of the eyelids (madarosis) can be observed.

The state of the lacrimal ducts should be judged by the severity of the lacrimal openings, their position, the presence of discharge from them when pressed on the area of the lacrimal canaliculi (canaliculitis) or the lacrimal sac (dacryocystitis). Inspection of the lacrimal gland is carried out by pulling the upper eyelid up, while the subject should look at the tip of his nose. In some acute and chronic inflammatory processes (dacryoadenitis), the gland can be enlarged, sometimes through the mucous membrane you can see its cystic degeneration, abscesses, etc.

Pay attention to the position of the eyeballs in the orbit. Anterior displacement of the eye (exophthalmus) is possible, more often observed with retrobulbar hemorrhages, tumors. The value of the protrusion of the eye is determined by the exophthalmometer. The displacement of the eyeball back (enophthalmus) is observed with the degeneration of the bones of the orbit, Horner's syndrome. Most often in children there is a lateral deviation of the eyeball (strabismus). Check the range of motion of the eyeball. To do this, the subject needs to fix the doctor's finger moving in all directions with a fixed head position. This is how paresis of individual oculomotor muscles is detected, nystagmus is detected with extreme abduction of the eyeballs, as well as the predominance of one or another muscle group. In addition, this way they get an idea of the size of the eyeballs (buphthalmos, microphthalmos), the size of the cornea (micro and macrocornea), the depth of the anterior chamber, the size and reaction to light of the pupil, the state of the pupil area (mydriasis, coloboma), etc.

Author: Shilnikov L.V.

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