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Eye diseases. Combined eye examination method (most important)

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9. Combined method of eye examination

The method consists in examining the illuminated place through a strong magnifying glass, with side illumination of the eye. Instead of a second loupe, you can use a binocular loupe that gives a magnification of 610 times. When examining the cornea, attention is paid to its size, shape, transparency, etc. If there are changes, the freshness of inflammatory infiltrates, their shape, depth of location, and areas of ulceration are determined. Pay attention to the ingrowth of superficial and deep vessels into the cornea, the smoothness, sphericity and luster of its surface. When examining the cornea, it is always necessary to examine its sensitivity. Most simply, it is determined by a piece of cotton wool with a thinned end, which, when touched to the cornea, causes a protective reflex (closing of the eyelids, withdrawal). To objectify the research, specially made hairs are used, as well as algesimetry.

To detect defects in the corneal epithelium, one drop of a 1% fluorescein solution is instilled into the conjunctival sac.

Then they examine the anterior chamber, fix attention on its depth, uniformity, transparency of moisture, the presence of blood, exudate in it, etc.

When examining the iris, its color is determined (the presence of heterochromia, areas of excessive pigmentation). The radial pattern of the iris, usually depending on the state of its trabecular tissue, is well expressed in light irises. They also clearly visible pigment fringe along the edge of the pupillary area. Detect congenital and acquired defects of the iris, its fusion with the cornea (synechia anterior), anterior lens capsule (synechia posterior). Unions can be single, along the edge of the pupil, and circular (synechia circularis, seclusio pupillae). They usually occur as a result of an inflammatory process in the vascular tract. In case of damage, detachments of the iris at the root (iridodialisis), tears and ruptures of the sphincter of the pupil are observed.

The study of the pupil begins with determining its shape, width, direct and friendly reaction to light. Different width of the pupils of the left and right eyes (anisocoria) is often a pathological phenomenon. The direct reaction of the pupil to light is checked by pointing a beam of light at it with a lens or an ophthalmoscope. In this case, the second eye is tightly closed with the palm of your hand. Pupillary reaction is considered alive if under the influence of light the pupil quickly and distinctly narrows, and sluggish if the pupil reaction is slow and insufficient. A change in the direct pupillary reaction may depend on a violation of the conduction of the motor descending path of the reflex or on disorders in the area of ​​\uXNUMXb\uXNUMXbthe connection of the optical and motor paths.

Examining the friendly reaction of the pupils, one eye is illuminated with an ophthalmoscope, following the reaction of the pupil of the other eye. In conclusion, the reaction of the pupils to the installation at a close distance, which takes place with the participation of accommodation and convergence, is checked. For this, the patient is asked to fix the object with his eyes, gradually approaching the eyes, and follow the reaction of the pupils, which are constricted at the same time.

Author: Shilnikov L.V.

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