Eye diseases. Method of examining the eye using side lighting (most important)

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Eye diseases. Method of examining the eye using side lighting (most important)

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8. Method of examining the eye using side lighting

The method of lateral, or focal, illumination is used to study the condition of the mucous membrane of the eyelids and the anterior part of the eyeball (the mucous membrane of the eyeball, sclera, cornea, anterior chamber, iris and pupil), as well as the lens. The study is carried out in a darkened room. The lamp is placed to the left and in front of the patient. The doctor illuminates the patient's eyeball, throwing a focused beam of light from the lamp onto its individual sections using a lens of 13,0 or 20,0 diopters. The mucous membrane of the lower eyelid becomes accessible for inspection when the edge of the eyelid is pulled down. This requires the patient to look up.

When examining the mucous membrane, attention should be paid to all its parts (cartilage, the region of the transitional fold and the lower half of the eyeball). At the same time, the presence of edema, infiltration, cicatricial changes, foreign bodies, films, discharge, color, surface (follicles, papillae, polyposis growths), mobility, translucence of the ducts of the meibomian glands, etc. are determined.

For a thorough examination of the conjunctiva of the upper eyelid, it is necessary to turn it out. At the same time, the patient is asked to look down, and at this time, with the thumb of the left hand, the eyelid is pulled up so that the ciliary edge of the eyelid moves away from the eyeball. With the thumb and forefinger of the right hand, they grab it closer to the base of the eyelashes and try to raise the edge of the eyelid up, while simultaneously pressing the upper edge down with the thumb or forefinger of the left hand. With the thumb of the left hand in this position, the everted eyelid is held until the examination is completed.

When examining the mucous membrane of the upper fornix, which remains invisible during normal eversion, it is necessary to additionally slightly press through the lower eyelid on the eyeball. In this case, in the region of the palpebral fissure, there is a protrusion of the upper transitional fold loosely connected with the underlying tissues. For a more thorough examination of the upper fornix, especially if foreign bodies are suspected in this section of the conjunctiva, a double eversion is performed using an eyelid lifter.

The mucous membrane of the eyeball is also examined under focal illumination. Fix attention on the state of its vessels, transparency, the presence of changes (inflammation, neoplasms, cicatricial changes, pigmentation, etc.). A white or bluish sclera usually shines through the mucous membrane. With the defeat of the cornea, sclera and choroid of an inflammatory nature, the vessels located in the sclera or in the thickness of the sclera around the limbus expand.

Pay attention to the condition of the limb. It can be expanded (with glaucoma), thickened (with spring catarrh), infiltrated (with trachoma). The vessels of the conjunctiva of the eyeball can enter it (with trachoma, scrofula). Especially carefully with the help of focal illumination examine the cornea.

Author: Shilnikov L.V.

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