How ophthalmic ophthalmoscopy is performed

Eye diseases can affect the structures of the anterior part: conjunctiva, cornea, lens, iris, ciliary muscles. Lesions of these parts of the eye, as a rule, are traumatic or infectious, because they are in direct contact with the external environment or are very close to it. However, in a number of lesion diseases affect internal structures: the retina, the optic nerve disk, blood vessels, the vitreous. In this case, for examination, an eye examination from the inside with examination of the fundus is required. In ophthalmology, one of the most effective and proven methods is ophthalmoscopy.

Method definition

In most cases, domestic ophthalmologists use a mirror ophthalmoscope - a device in the form of a concave metal mirror with a hole in the center. By directing a beam of light into the eye through the mirror through the pupil, the doctor has the opportunity to examine the internal structure of the eye and see the slightest deviations from the norm.

To dilate the pupil, the patient is instilled with drops specially designed for this purpose (Midratsil, Irifrin et al. ), especially in cases where it is necessary to examine the peripheral areas inside the eye. However, ophthalmoscopy can be performed with the usual size of the pupil.

Expansion of the pupil under the influence of Midratsila

The following types of ophthalmoscopy are used in the survey:

• Straight- is carried out at a distance close to the eye in dim light, while increasing the considered objects by 15 times. When the opacity of the lens does not work;
• Indirect- held at arm's length with the possibility of a wider inspection of peripheral areas. The image is turned upside down, because the survey uses a collecting lens. In this way, inspection is possible even with a turbid lens.

For examinations, different types of ophthalmoscopes can be used:

• Hand Helmholtz deviceUsed for direct ophthalmoscopy;
• The Goldman's Lensincreases the fundus and periphery several times;
• Manual electric applianceallows to make qualitative research thanks to built-in illumination;
• Headlight mirror SkepensaUsed for binocular inspection, with a high degree of accuracy;
• Slit Lampallows you to explore a three-dimensional image, and the latest models of the device allow you to take pictures;
• Electronic ophthalmoscopecan be used for any kind of inspection;
• Laser device- the most perfect development, which allows not only to take pictures of the necessary areas, but also to display an image on the monitor using a video camera.

  Manual ophthalmoscope

In addition to these types and types of research, a methodspectral survey,allowing using different color filters to achieve a more accurate and full detection of possible internal damage to the eyeball.

Application area

Ophthalmoscopy can be performed for the purpose of examining the internal eye structures at preventive examinations, as well as in the presence of patient complaints for discomfort or decreased visual acuity. There may be signs of the following diseases:

• With multiple sclerosis or neuritis of the optic nerve, paleness and atrophy of the optic disc can be observed;
• With increased intracranial pressure, the disease is a swollen disk with fuzzy boundaries;
• In chronic glaucoma, the optic nerve disc has a more recessed cup-like shape;
• With diabetic retinopathy, new blood vessels grow;
• With pigment retinitis, a characteristic symptom is the accumulation of retinal pigments.

Examination of the fundus can be carried out to detect pathological conditions of the eye structures, but often the direction of ophthalmoscopy is given by narrowly specialized specialists:

• Cardiologists or therapists- for the purpose of diagnosing the severity of hypertension or atherosclerotic changes;
• Angioedema and neurologists- to study the state of blood vessels and optic nerve in cervical osteochondrosis, stroke, neurological diseases;
• Gynecologists- to study the state of the retina in pregnant women;
• Endocrinologists- with diabetes mellitus for examination of the circulatory system of the eyes.

Procedure

As a rule, ophthalmoscopy is considered to be one of the most traditional and safe methods of examinations and is performed by a doctor during preventive examinations even in pregnant and premature infants.Prohibition to the procedure can be a very short list of pathological conditions of the eye:

• Lachrymation and photophobia, having the expressed character and caused by diseases of inflammatory or infectious nature;
• Miosis - "sealing"the pupil or its pathological constriction caused by the disease;
• Violation of the transparency of internal environments;
• Some diseases of the cardiovascular system.

  ophthalmoscopy

Contraindication is also a disease of glaucoma, because in this case you can not instill dilating pupils of the drop.

Preparation of the patient

Before the procedure, the patient is measured by intraocular pressure, in order to avoid examination in an acute attack of glaucoma. When the results are obtained within the norm, the patient is instilled with dilating pupils.If IOP is increased, the examination can be performed without the use of medication, but in this case, it is often impossible to obtain information about the state of peripheral parts of the eye.

Tonometry of the eye

It is recommended to take glasses during the examination, although in some cases the patient does not take them off on the advice of the doctor. With regard to contact lenses, it is believed that they do not interfere with the procedure, but it is better to clarify this point with the doctor.

Procedure

Depending on the type of survey conducted, the execution technique may vary slightly.

Indirect Monocular:

• In a slightly darkened room on the left and slightly behind the patient, a lamp with a capacity of 60-100 watts is installed. The doctor is at a distance of about 40 cm from the patient;
• For research is used in most casesHelmholtz mirrorandbiconvex lens. To obtain the image, the ray of light reflected in the mirror, the pupil of the patient and the pupil of the doctor should be on the same straight line;
• The doctor gets the image inverted, magnified 4-5 times. At the request of the doctor, the patient looks up and down and left-to-right, thus allowing the examination of the peripheral parts of the fundus;
• To examine the right eye of the patient, the doctor holds the device in his right hand and examines the right eye, and vice versa.

  Helmholtz Mirror

Direct ophthalmoscopy:

• For the procedure, a manual electric ophthalmoscope, ophthalmoscopic nozzle for slit lamp or nonreflex ophthalmoscope;
• The doctor sits in front of the patient, sending a light ray to the pupil, begins to approach the eye a short distance (no more than 4 cm);
• The image when using this method is increased by 15-20 times, allowing you to consider the most inconspicuous changes;
• The disadvantage of the method is the limitation of the possibilities for examination of the peripheral portions of the fundus.

During the procedure, the doctor serially examines the area of ​​the optic nerve disk, then the central part of the retina and only then inspects the peripheral parts.

Rehabilitation period

After the procedure, especially with the use of medications, the patient is possible temporary feelings of discomfort associated with the forced dilatation of the pupil and violation of this severity view.

These sensations can be observed within 2 hours after instillation of drugs,therefore, patients with severe visual acuity should take some care after leaving the room.

results

When the diagnosis is made based on the results of the examination, the doctor should compare the condition of the fundus and adjacent areas in a patient with an existing image of the structure of a healthy eye and based on this done conclusion.

The following defects can be detected:

• Retinal detachment;
• Neoplasm in the optic nerve;
• Optic nerve damage resulting from glaucoma;
• Hemorrhages or white deposits in the retina;
• Vascular damage and microscopic bleeding;
• Luster of the lens (cataract).

If the survey was conducted using electronic devices connected to a computer, it is possible to obtain images, as well as the derivation of diagrams for several indicators when comparing the data obtained with regulatory values.

Advice to patients

Before carrying out the examination, the doctor should be informed of the possibleallergic reactions to medications, as well as about the treatment to be taken at this time.Some drugs are able to affect IOP, and in the conduct of direct ophthalmoscopy, it is necessary to measure this beforehand, before dropping the dilating pupil preparations.

If you still dripped such drops, you should follow certain precautions:

• Do not drive for at least 2 hours;
• Do not focus a strong look,because it can cause discomfort and even pain;
• Wear sunglasses- this can protect your eyes from bright lighting, which can cause discomfort.

Video

conclusions

Ophthalmoscopy is one of the most informative methods for examining the internal structures of the eye, allowing the conclusion is not only about the state of the eye, but also to diagnose some common diseases associated with the nervous and vascular systems.

Examination of the fundus is absolutely safe and painless and is used in the most diverse age groups with minimal restrictions. Thanks to an ophthalmoscopy carried out in time, one can get information about the diseases at the earliest stages and get rid of them with the least time and health.

Read also how to measure intraocular pressure.