The fundus of the eye is normal in adults. Ophthalmoscopy. Fundus examination How eye pressure is measured

Ophthalmoscopy is one of the main objective and most important methods for examining the inner membranes of the eye. The method was discovered and put into practice by Hermann von Helmholtz in 1850 on the basis of an eye mirror developed by him - an ophthalmoscope. Over the 150 years of its existence, the method of ophthalmoscopy has improved significantly and is currently one of the main methods for studying the internal environments of the eye and the fundus.
The technique of ophthalmoscopic examination of the fundus is mastered in the course of the doctor's practical work; it is described in detail in ophthalmology manuals and textbooks on eye diseases. In this regard, there is no need for a detailed description here.
The fundus of the eye consists of several layers, very different in color and transparency. The bottom of the eye is formed by: white sclera, dark red choroid, thin, light-retaining retinal pigment epithelium, transparent retina with the vasculature of the central artery and central retinal vein. The color of the fundus is made up of shades of light rays. The normal retina, when examined in white light, almost does not reflect light rays, remains transparent and practically invisible. All these different structures of the inner membranes of the eye and the optic disc make a certain contribution to the formation of the ophthalmoscopic picture of the fundus, which, depending on the many elements that make it up, varies significantly in the norm and, especially, in pathology. In this regard, during ophthalmoscopy, one has to resort to various types of illumination, the use of various magnifications, to examine the patient not only with a narrow, but also with a medically dilated pupil (carefully if the patient has glaucoma).
The study of the fundus should be carried out according to a specific plan: first, an examination of the area of ​​​​the optic nerve head, then the macular region of the retina, and finally, the peripheral parts of the fundus. It is desirable to examine the macular region and the periphery of the fundus with a wide pupil. During the study, a search is made for pathological changes in the fundus, the study of the structure of the detected foci, their localization, measurement by area, distance and depth. After that, the doctor gives a clinical interpretation of the changes found, which allows, in combination with data from other studies, to clarify the diagnosis of the disease.
The study of the fundus is carried out using special devices - ophthalmoscopes, which can be of varying complexity, but work on the same principle. A clear image of the inner shells of the eye (fundus) is obtained only when the line of illumination of the fundus is aligned with the visual line of the observer or the lens of a photo and television camera.
Devices for studying the fundus can be divided into simple (mirror) ophthalmoscopes and electric ophthalmoscopes (manual and stationary). There are two types of ophthalmoscopy: reverse ophthalmoscopy and direct ophthalmoscopy.

Reverse ophthalmoscopy

When working with a mirror ophthalmoscope, an extraneous light source is required (a table lamp with a power of 100-150 W with a frosted glass bulb). When examining the fundus with a mirror ophthalmoscope and a magnifying glass, the doctor sees an imaginary image of the fundus area in an enlarged and inverse form. During ophthalmoscopy with a magnifying glass of +13.0 diopters, the degree of magnification of the considered area of ​​the fundus (about 5 times) is greater than with a magnifying glass of +20.0 diopters, but the area under consideration is smaller. Therefore, for a more detailed examination of the fundus, a magnifying glass of +13.0 or +8.0 diopters is used, and for survey ophthalmoscopy, you can use a magnifying glass of +20.0 diopters.

Direct ophthalmoscopy

With the help of an electric ophthalmoscope, it is possible to examine the fundus in direct form (without a magnifying glass). At the same time, the structures of the fundus are visible in a direct and enlarged (approximately 14-16 times) form.
Electric ophthalmoscopes have their own illuminator, powered either from the mains through a transformer or from portable batteries. Electric ophthalmoscopes have disks or tapes with corrective lenses, color filters (red, green, blue), a device for slit illumination and transillumination (diaphanoscopy) of the eye.
Ophthalmoscopic picture of a normal fundus (study in white achromatic light)
During fundus ophthalmoscopy, as mentioned above, attention should be paid to the optic nerve head, retinal blood vessels, the macular region and, as far as possible, to the peripheral sections of the fundus.
The outer (temporal) half of the disk looks lighter than the inner (nasal). This is due to the fact that the nasal half of the disc contains a more massive bundle of nerve fibers and is better supplied with blood than the temporal half of the disc, where the layer of nerve fibers is thinner and the whitish tissue of the cribriform plate shines through them. The temporal margin of the disc is more sharply defined than the nasal margin.
The variability of the color of the optic nerve head in the norm should be distinguished from its pathological changes. A paler color of the temporal half of the disc does not yet mean the development of atrophy of the nerve fibers of the optic nerve. The intensity of the pink color of the disk depends on the pigmentation of the fundus, characteristic of blondes, brunettes, brown-haired people.
The optic disc is usually round or, less commonly, a vertical oval. The horizontal size of the disc is normally 1.5-1.7 mm. With ophthalmoscopy, its dimensions appear much larger due to the magnification of the image.
In comparison with the general level of the fundus of the eye, the optic nerve head can be located with its entire plane at the level of the fundus or have a funnel-shaped depression in the center. A recess (physiological excavation) is formed due to the kink of nerve fibers from retinal ganglion cells at the edge of the scleral-choroidal canal. In the area of ​​the excavation, the whitish tissue of the cribriform plate of the sclera is translucent, so the bottom of the excavation looks especially light. Physiological excavation is usually located in the center of the disc, but sometimes shifts to the temporal edge, and therefore has a paracentral location. Physiological excavation differs from pathological excavation (for example, glaucomatous excavation) in two main features: a shallow depth (less than 1 mm) and the obligatory presence of a rim of normally stained disc tissue between the edge of the disc and the excavation edge. The ratio of the size of the physiological excavation to the size of the disc can be expressed as a decimal fraction: 0.2-0.3.
With a congestive disc, on the contrary, edema and bulging of the disc tissue into the vitreous body are observed, which is the main symptom of intracranial hypertension, often caused by brain tumors. The color of the disk becomes grayish. The phenomena of the expressed venous stagnation are noted.
In the process of ophthalmoscopic examination of the fundus, after examining the area of ​​​​the optic nerve head, attention is paid to the state of the retinal vasculature. The vascular network of the fundus is represented by the central artery and the central vein of the retina. From the middle of the disc or somewhat medially, the central retinal artery emerges, which is accompanied by the central retinal vein that enters the disc. Retinal arteries are markedly different from veins. Arteries are thinner than veins, lighter and less tortuous. The ratio of arteries to veins is 3:4 or 2:3. Larger arteries and veins have vascular reflexes due to the reflection of light from a column of blood in a vessel. Quite often in the field of a disk the venous pulse is normally noted.
It should be taken into account that the bottom of the eye is the only place in the human body where ophthalmoscopy can directly observe the state of blood vessels and their changes, both arteries and veins, not only in case of ocular pathology, but also in general diseases of the body (hypertension, endocrine pathology, blood diseases, etc.). The pathology of the vascular system is accompanied by the appearance of a number of symptoms: copper wire symptom, silver wire symptom, Guist symptom, Gunn-Salus symptom, etc.
The size of the macula in an adult varies considerably, a large horizontal diameter can usually have a value of 0.6 to 2.5 mm.
The periphery of the fundus is best explored with a dilated pupil. With a high pigment content, the fundus looks dark (parquet fundus), with a low pigment content, it looks light (albinotic fundus).

Ophthalmoscopic picture of the fundus in pathological conditions

In pathology, various changes in the fundus of the eye are noted. These changes can involve retinal tissue, choroid, optic disc, retinal vessels. By genesis, changes can be inflammatory, dystrophic, tumor, etc. In the clinic, the qualitative and quantitative assessment of ophthalmoscopically visible changes in the fundus is very important, and the completeness of the examination and assessment of the condition largely depend on the qualifications of the doctor and the device with which the study is carried out.

Examination of the fundus of the eye in transformed light (ophthalmochromoscopy)

A valuable additional method for studying the details of the fundus is ophthalmochromoscopy, which allows you to examine the fundus in a different color (red, yellow, blue, purple and redless). In this case, it is possible to detect changes that remain invisible during conventional ophthalmoscopy in white light. Professor A. M. Vodovozov (1986, 1998) made a great contribution to the development of the method of ophthalmochromoscopy and its application in the clinic.
With ophthalmochromoscopy, a deep analysis of the structures of the fundus is based on the property of light rays with different wavelengths to penetrate tissues to different depths. Shortwave (blue, cyan) light rays are reflected mainly from the outer limiting membrane of the retina. These light rays are partly reflected by the retina and partly absorbed by it and the pigment epithelium.
Medium-wavelength (green, yellow) light rays are also partially reflected from the surface of the retina, but to a lesser extent than short-wavelength ones. Most of them are refracted in the retina, while the smaller part passes through the retinal pigment epithelium and is extinguished by the choroid.
Long-wave (orange, red) light rays are almost not reflected by the retina and, penetrating into the choroid, partially reflected, reach the sclera. Reflected from the sclera, long-wavelength rays again pass through the entire thickness of the choroid and the retina in the opposite direction (towards the observer).
Modern electro-ophthalmoscopes have a set of three colored glasses (red, green and blue), which allows ophthalmochromoscopy of the fundus.
Due to sufficient luminosity and the presence of a blue light filter, the ophthalmoscope can be used not only for ophthalmochromoscopy, but also for ophthalmofluoroscopy. Ophthalmochromoscopy has a number of advantages over conventional ophthalmoscopy in detecting pathological changes in the fundus.

Red light ophthalmoscopy

(module direct4)

The normal fundus is dark red in color. The optic disc also looks red, but its color is lighter than in normal light. The area of ​​the macula is poorly contoured. In red light, pigment spots and formations of the choroid are well detected, which acquire an intensely dark color. Defects in the pigment epithelium are also clearly visible.

Yellow light ophthalmoscopy

Normal fundus in yellow light has a brownish-yellow color. The optic disc becomes light yellow and becomes waxy. The contours of the disc are clearer than with white light ophthalmoscopy. Retinal vessels in yellow light acquire a dark brown hue. The macular area is poorly distinguishable.
In yellow light, subretinal hemorrhages are well distinguished, which look like dark brown spots. This distinguishes hemorrhage from pigmented formations: the pigment in yellow light fades, and the contrast of hemorrhage increases.

Blue light ophthalmoscopy

The normal fundus in blue light acquires a dark blue color. The optic disc in blue light has a light blue color, its contours look veiled. Nerve fibers of the retina are visible as thin light lines on a dark background. The vessels of the retina acquire a dark color. Arteries differ little in color from veins. The yellow spot of the retina looks almost black against the dark blue background of the fundus. The dark color of the macula is due to the absorption of blue rays by the yellow dye of the macula.
In blue light on the fundus, light, superficially located pathological foci, especially of the “cotton-like” type, are quite clearly visible. Subretinal and choroidal hemorrhages, clearly visible in yellow light, become indistinguishable in blue light.

Ophthalmoscopy in red light

Normal fundus in redless light has a bluish-greenish color. The optic disc in redless light acquires a light green color, its contours look fuzzy. In redless light, the pattern of retinal nerve fibers and pathological changes in it are clearly manifested. The retinal vessels appear dark against the bluish-greenish color of the fundus. The small vessels surrounding the macula and in the region of the optic disc are especially clearly manifested.
The yellow spot of the retina in redless light has a lemon yellow color. Only in redless light are the smallest (dust-like) retinal opacities in the macula clearly visible.

Purple light ophthalmoscopy

Magenta light is made up of a mixture of red and blue light rays. Normal fundus in purple light has a bluish-purple color. The optic disc in magenta light appears red-purple, lighter in color and rather sharply different from the bluish-purple color of the fundus. The temporal half has a slightly bluish tinge. Physiological disc excavation is colored blue. With atrophy of the optic nerve in purple light, the disc acquires a bluish color. This change in disc color is better perceived than with white light ophthalmoscopy and should be considered in cases of doubtful atrophy.
The vessels of the retina in purple light have a dark red color. Veins appear darker than arteries. Retinal vessels may be surrounded by red and blue bands. The yellow spot of the macular region is distinguished by its red color against the background of the purple color of the fundus.

Ophthalmoscopy in polarized light

This method of ophthalmoscopy is based on the property of the structures of the tissues of the fundus, which have optical anisotropy, i.e., birefringence. This is confirmed by the visual phenomenon of Haidinger ("brushes" of Haidinger), which are revealed in polarized light using a maculotester device. Ophthalmoscopy and photographing the fundus in polarized light can reveal anisotropic structures and changes in the fundus that are not visible with conventional ophthalmoscopy. Polarization ophthalmoscopy in our country was developed by R. M. Tamarova and D. I. Mitkokh (1966). To study the fundus, a FOSP-1 photo-ophthalmoscope device is used. There are also manual ophthalmoscopes with polaroids from the American company Bausch & Lomb and the English company Keeleg.
The picture of the fundus in polarized light does not differ from the usual one. However, when the polaroids are rotated, the plane of polarization of light changes and the details of the fundus are revealed, which have the ability to polarize light.
With ophthalmoscopy in polarized light, two types of peculiar light reflexes are normally found: one is in the region of the macula, the other is on the optic disc. The polarization figure in the area of ​​the macula has the form of two triangles of dark red color, with the tops facing the center of the foveola, and the base to the periphery of the macula. In shape, it resembles the figure of the "brush" of Haidinger. In the region of the optic nerve head in polarized light, a figure of a blurred light cross appears - yellowish on a red background of the fundus.
With lesions of the macula, especially those accompanied by swelling of the retinal area, the macular polarization figure goes out. In polarized light, edema of the optic disc is more easily detected in the initial stage of congestive disc and neuritis. With severe edema of the disc or atrophy of the optic nerve in polarized light, a cruciform figure on the disc does not occur.

Examination of the fundus with the help of stationary devices (clarifying ophthalmoscopy and scanning ophthalmography)

Stationary devices for studying the fundus include: a large reflexless ophthalmoscope, a slit lamp, fundus cameras, a Heidelberg retinal tomograph, an optic disc analyzer.

1. A large reflexless ophthalmoscope allows you to conduct a detailed study of the fundus at a magnification of 10, 20 and 27 times. At the same time, already in the process of ophthalmoscopic examination, it is possible to quantify the normal and pathological structures of the fundus. In pathology, this method allows you to determine the size of various foci in the fundus - inflammatory, degenerative, tumor, retinal breaks; an increase in size and prominence (prominence) of the optic nerve head.
2. The slit lamp is used for clarifying ophthalmoscopy of the fundus. Using the binocular eyepiece of a slit lamp, a direct, enlarged image of the fundus picture is obtained. Photo-slit lamps have cameras for photographing the fundus. For the same purpose, you can use the RETINOFOT device from Carl Zeiss.
3. Sapop has released a new model of the CR3-45NM camera for capturing the fundus without first dilating the pupil. The camera has a wide lens coverage angle of 45°. The TV monitor makes it easier to work with the camera and reduces patient fatigue during the examination. Along with the usual color photography on 35 mm film, a color photograph of the Polaroid system is also possible.
4. Examination of the fundus using a fundus camera is described in the section “Fluorescein angiography of the fundus”. In recent years, on the basis of television biomicroscopy, computer analysis and a number of other technical developments, ophthalmic devices for the study of the fundus have been created, manufactured and put into practice. Highly informative techniques are especially valuable for identifying initial changes in the optic nerve head and its evolution in various pathologies, and especially with an increase in intraocular and intracranial pressure.
5. Heidelberg retinal tomograph II (Germany). The device is a confocal scanning laser ophthalmoscope. Using this device, it is possible to carry out a computer quantitative analysis of various parameters of the optic nerve head: disk size, excavation size, excavation depth, disk protrusion above the fundus surface and other indicators. With the help of a retinal tomograph, it is possible to clarify the diagnosis of a congestive disc and follow the dynamics of its development.
6. Optical coherence tomography (Humphrey Instrument, USA) uses light to measure the thickness of the retinal nerve fiber layer and is the optical analogue of B-scanning ultrasound. Using the device, an axial scan of the retina is performed, which provides a measurement of the thickness of the retinal nerve fiber layer. The instrument operates in low coherence mode using infrared light (850) from a diode source.

R. J. Noecker, T. Ariz (2000) provide comparative data of three devices used to study the structures of the fundus: the optic nerve head and the retinal nerve fiber layer.

As can be seen from the above data, the possibilities for studying the fine structures of the fundus have now significantly expanded and deepened. This makes it possible to detect pathology at the early stages of the development of the disease and start rational treatment in a timely manner.

Ophthalmoscopy - examination of the fundus with the help of special instruments (ophthalmoscope or fundus lens), which allows you to evaluate the retina, optic nerve head, fundus vessels. Determine various pathologies: places of retinal breaks and their number; identify thinned areas that can lead to the emergence of new foci of the disease.

Studies can be carried out in various ways: in direct and reverse, with a narrow and wide pupil.

Ophthalmoscopy is included in the standard examination of an ophthalmologist and is one of the most important methods for diagnosing eye diseases.

In addition to eye diseases, ophthalmoscopy helps in the diagnosis of pathologies such as hypertension, diabetes, and many others, because. it is with this study that one can visually assess the state of human vessels.

Fundus examination

An ophthalmologist, by changing the position of the eye relative to the eye of the subject and forcing him to move his gaze in different directions, can also examine the rest of the fundus.

With the maximum dilated pupil, only a small area of ​​the fundus at the limbus 8 mm wide remains inaccessible to research. The general color of the fundus is made up of the color shades of the rays emerging from the examined eye and mainly reflected by the retinal pigment epithelium, the choroid, and partly by the sclera.

1 - uniform coloring of the fundus;
2 - parquet fundus;
3 - fundus with a small amount of pigment

The normal retina, when examined in achromatic light, reflects almost no rays and therefore remains transparent and invisible. Depending on the pigment content in the pigment epithelium and in the choroid, the color and general pattern of the fundus noticeably changes. Most often, the fundus appears uniformly colored red with a lighter periphery. In such eyes, the pigment layer of the retina hides the pattern of the underlying choroid. The more pronounced the pigmentation of this layer, the darker the fundus looks.

The pigment layer of the retina may contain little pigment and then the choroid appears through it. The fundus appears bright red. It shows choroidal vessels in the form of densely intertwined orange-red stripes converging to the equator of the eye. If the choroid is rich in pigment, then its intervascular spaces take the form of elongated spots or triangles. This is the so-called spotty, or parquet, fundus (fundus tabulatus). In cases where there is little pigment in both the retina and the choroid, the fundus of the eye, due to the stronger translucence of the sclera, looks especially bright. Against this background, the optic nerve papilla and retinal vessels are more sharply contoured and appear darker. The choroidal vessels are clearly visible. The macular reflex is poorly expressed or absent.

Weakly pigmented fundus is most common in albinos, which is why it is also called albino. It is similar in color to the albino eye fundus of newborns. But their optic papilla is pale gray with indistinct contours. The veins are wider than usual. Macular reflex is absent. From the second year of life, the fundus of the eye of children almost does not differ from the fundus of adults.

Pathological changes in the vascular and retinal membranes are distinguished by considerable diversity and can manifest themselves in the form of diffuse opacities, limited foci, hemorrhages and pigmentation.

Diffuse opacities of larger or smaller sizes give the retina a dull gray color and are especially pronounced in the region of the optic nerve papilla.

Localized retinal lesions may vary in shape and size and may be light white, light yellow, or bluish yellow in color. Located in the layer of nerve fibers, they take a dashed shape; in the region of the yellow spot form a figure resembling a star.

The round shape and pigmentation of the foci are observed when the process is localized in the outer layers of the retina. Fresh focal changes in the choroid are darker than retinal and less clearly defined. As a result of the subsequent atrophy of the choroid, the sclera is exposed in these areas and they take on the appearance of white, sharply limited foci of various shapes, often surrounded by a pigmented rim. Retinal vessels usually pass over them.

Hemorrhages of the choroid are relatively rare and, being covered by the pigment epithelium, are poorly distinguishable. Fresh retinal hemorrhages have a cherry-red color and vary in size: from small, punctate extravasates to large, occupying a vast area of ​​the fundus. When localized in the layer of nerve fibers, hemorrhages appear as radial strokes or triangles with their apex facing the optic nerve papilla. Preretinal hemorrhages are round or transversely oval. In rare cases, hemorrhages resolve without a trace, but more often they leave behind whitish, gray or pigmented atrophic foci.

Disc (nipple) of the optic nerve during ophthalmoscopy

The most prominent part of the fundus is the nipple (disc) of the optic nerve, and the study usually begins with it. The nipple is located medially from the posterior pole of the eye and enters the ophthalmoscopic field of view if the examined person turns the eye to the nose by 12–15°.

The optic nerve papilla most often has the shape of a circle or a vertical oval and very rarely a transverse oval shape. Astigmatism of the examined eye can distort the true shape of the nipple and give the doctor a false impression of its shape. A similar distortion of the shape of the nipple can also be observed as a result of errors in the examination technique, when, for example, during reverse ophthalmoscopy, the magnifying glass is placed too obliquely to the line of observation.

The horizontal size of the nipple is on average 1.5–1.7 mm. Its visible dimensions, like other elements of the fundus, are much larger during ophthalmoscopy and depend on the refraction of the eye under study and the method of examination. The optic nerve papilla can be located with its entire plane at the level of the fundus of the eye (flat nipple) or have a funnel-shaped depression in the center (excavated nipple). The recess is formed due to the fact that the nerve fibers leaving the eye begin to bend at the very edge of the scleral-choroidal canal. A thin layer of nerve fibers in the central region of the optic papilla makes the underlying whitish lamina cribrosa more visible, and therefore the excavation site appears particularly light. Often here you can find traces of holes in the lattice plate in the form of dark gray dots.

Sometimes physiological excavation is located paracentrally, somewhat closer to the temporal edge of the nipple. From pathological types of excavations, it is distinguished by a small depth (less than 1 mm) and the main obligatory presence of a rim of normally colored nipple tissue between its edge and the excavation edge. A pronounced depression at the site of the optic nerve papilla can be observed in congenital colobomas. In such cases, the nipple is often surrounded by a white rim with pigment inclusions and seems somewhat enlarged. A significant difference in the level of the nipple and the retina leads to a sharp bending of the vessels and creates the impression that they do not appear in the middle of the nipple, but from under its edge.

Rarely encountered defects (pits) in the tissue of the nipple and pulpy, myelinated fibers, which look like bright white shiny elongated spots, are also associated with an anomaly of development. They can sometimes be located on the surface of the nipple, cover it; with inattentive examination, they can be mistaken for a bizarre nipple.

Against the red background of the fundus, the optic nerve papilla stands out with its clear boundaries and pink or yellowish-red color. The color of the nipple is determined by the structure and ratio of the anatomical elements that form it: arterial capillaries, grayish nerve fibers and the whitish cribriform plate underlying them. The nasal half of the nipple contains a more massive papillomacular bundle of nerve fibers and is better supplied with blood, while in the temporal half of the nipple the layer of nerve fibers is thinner and the whitish tissue of the cribriform plate is more visible through it. Therefore, the outer half of the optic papilla almost always looks lighter than the inner half. For the same reason, due to the greater contrast with the background of the fundus, the temporal edge of the nipple is outlined more sharply than the nasal one.

However, the color of the nipple and the clarity of its borders vary markedly. In some cases, only extensive clinical experience and dynamic monitoring of the state of the fundus make it possible to distinguish the normal variant from the pathology of the optic nerve papilla. Such difficulties arise, for example, with the so-called false neuritis, when the normal nipple has fuzzy contours and appears to be hyperemic. Pseudoneuritis mostly occurs in moderate and high hypermetropia, but can also be observed in myopic refraction.

Often, the optic nerve papilla is surrounded by a white (scleral) or dark (choroidal, pigmented) ring.

The first ring, also called the cone, is usually the rim of the sclera, visible as a result of the hole in the choroid through which the optic nerve passes is wider than the hole in the sclera. Sometimes this ring is formed by glial tissue surrounding the optic nerve. The scleral ring is not always complete and may be sickle or crescent shaped.

As for the choroidal ring, it is based on the accumulation of pigment along the edge of the hole in the choroid. In the presence of both rings, the choroidal ring is located more peripherally than the scleral one; often it occupies only part of the circumference.

Changes in the optic disc in various diseases

For diseases of the optic nerve , mainly proceeding in the form of inflammation or stagnation, the nipple may become red, grayish-red or cloudy red in color and the shape of an elongated oval, irregular circle, kidney-shaped or hourglass. Its dimensions, especially with stagnation, often exceed the usual 2 times or more. The borders of the nipple become fuzzy, blurry. Sometimes the outlines of the nipple cannot be caught at all, and only the vessels emerging from it make it possible to judge its location in the fundus.

Atrophic changes optic nerve accompanied by whitening of the nipple. A gray, grayish-white or grayish-blue nipple with sharp borders is observed with primary atrophy of the optic nerve; a dull white nipple with fuzzy contours is characteristic of secondary optic nerve atrophy.

There are 2 types of pathological excavation of the optic nerve papilla

1. atrophic, characterized by a whitish color, regular shape, slight depth, gentle edges and a slight bend in the vessels at the edge of the nipple.
2. glaucomatous, characterized by a grayish or grayish-green color, it is much deeper, with undermined edges. Bending over them, the vessels seem to break off and at the bottom of the excavation, due to the deep occurrence, they are less distinguishable. They are usually displaced to the nasal edge of the nipple. Around the latter, a yellowish rim (halo glaucomatosus) is often formed.

In addition to excavations of the nipple, there is also a bulging, protrusion of it into the vitreous body. Particularly pronounced bulging of the nipple is with congestion in the optic nerve (the so-called mushroom nipple).

Vessels visible in the fundus

From the middle of the nipple of the optic nerve or a little medially from the middle comes out central retinal artery(a. centralis retinae). Next to her, laterally, enters the nipple central retinal vein(v. centralis retinae).

On the surface of the nipple, the artery and vein divide into two vertical branches - top And lower(a. et v. centralis superior et inferior). Each of these branches, leaving the nipple, again divides into two branches - temporal And nasal(a. et v. temporalis et nasalis). In the future, the vessels tree-like break up into smaller and smaller branches and spread along the fundus of the eye, leaving the yellow spot free. The latter is also surrounded by arterial and venous branches (a. et v. macularis), directly extending from the main vessels of the retina. Sometimes the main vessels divide already in the optic nerve itself, and then several arterial and venous trunks immediately appear on the surface of the nipple. Occasionally, the central retinal artery, before leaving the nipple and making its usual path, twists in a loop and protrudes somewhat into the vitreous body (prepapillary arterial loop).

Distinguishing arteries from veins with ophthalmoscopy

arteries thinner, lighter than them and less crimped. Light stripes stretch along the lumen of larger arteries - reflexes formed due to the reflection of light from a column of blood in a vessel. The trunk of such an artery, as if divided by the indicated stripes, seems to be double-circuit.

Vienna wider than arteries (their calibers are respectively 4:3 or 3:2), painted in cherry red, more convoluted. The light strip along the course of the veins is much narrower than along the course of the arteries. On large venous trunks, the vascular reflex is often absent. Often there is a pulsation of the veins in the region of the nipple of the optic nerve.

In the eyes with high hypermetropia, the tortuosity of the vessels is more pronounced than in the eyes with myopic refraction. Astigmatism of the examined eye, not corrected with glasses, can create a false impression of the uneven caliber of the vessels. In many parts of the fundus of the eye, a decussation of arteries with veins is visible, and both an artery and a vein can lie in front.

Vascular changes in various diseases

A change in the caliber of blood vessels occurs as a result of violations of vascular innervation, pathological processes in the walls of blood vessels and varying degrees of their blood supply.

1. For inflammation of the retina: vasodilatation, especially veins.
2. With arterial thrombosis: the veins are also dilated, while the arteries are constricted.
3. With spasm of the arteries: the transparency of their walls is not violated
4. With sclerotic changes: along with the narrowing of the lumen of the vessels, there is a decrease in their transparency. In severe cases of such conditions, the vascular reflex acquires a yellowish tint (a symptom of copper wire). Along the edge of vessels that reflect light more strongly, white stripes appear. With a significant narrowing of the arteries and compaction of their walls, the vessel takes the form of a white thread (a symptom of a silver wire). Often, small vessels become more tortuous and uneven in thickness. Corkscrew-shaped tortuosity of small veins occurs in the region of the macula (Relman-Guist symptom). In places where the vessels cross, compression of the underlying vein by the artery can be observed (a symptom of Gunn-Salus).

Pathological phenomena also include the occurrence of arterial pulsation, especially noticeable at the site of the bending of the vessels on the papilla of the optic nerve.

Yellow spot on ophthalmoscopy

In the posterior pole of the eye lies the most functionally important region of the retina - the yellow spot (macula lutea). It can be seen if the subject directs his gaze to the light "flare" of the ophthalmoscope.

But at the same time, the pupil narrows sharply, which makes it difficult to study. It is also interfered with by light reflexes that occur on the surface of the central part of the cornea.

Therefore, when examining this area of ​​the retina, it is advisable to use non-reflex ophthalmoscopes, resort to pupil dilation (where possible) or direct a less bright beam of light into the eye.

With conventional ophthalmoscopy (in achromatic light), the yellow spot looks like a dark red oval, bordered by a shiny stripe - the macular reflex. The latter is formed due to the reflection of light from a roller-like thickening of the retina along the edge of the macula.

The macular reflex is better expressed in young people, especially in children, and in eyes with hyperopic refraction.

The macula lutea is surrounded by separate arterial branches, somewhat reaching its periphery.

The size of the yellow spot varies markedly. So, its larger horizontal diameter can have a value from 0.6 to 2.9 mm. In the center of the yellow spot is a darker round spot - the central fossa (fovea centralis) with a shiny bright dot in the middle (foveola). The diameter of the central fossa averages 0.4 mm.

Depends on the presence of capillaries. The thickness of their layer is equivalent to the thickness of the layer of nerve fibers, and therefore fine the color gradation is different: from almost red in the nasal part to pale pink in the temporal part. In young people, the color is often yellow-pink; in children under 1 year old, the color of the disc is pale gray.

In case of pathology, the optic disc can be decolorized, hyperemic, bluish-gray. Monotony of color - abnormal development of the optic disc (often with amblyopia) is observed with tapetoretinal dystrophy, in old age.

Borders.

Clear ok or obscured by pathology. The ophthalmoscopic border of the disc is the edge of the choroid. When there is an underdevelopment of the choroid, an oblique position of the disc or stretching of the posterior pole of the eye with myopia (myopic cone) - the choroid moves away from the edge of the disc.

The senile halo is a peripapillary zone of atrophy without noticeable disorders of visual functions.

Dimensions.

Note normal size (true size 1200-2000 microns), enlarged or reduced. In hypermetropic eyes, the discs are usually visually smaller, in emmetropic eyes they are larger. With age, the size of the disc does not change, but part of the supporting tissue atrophies, this atrophy is manifested by flattening of the optic disc.

Form. Normally round or slightly oval.

The central recess (vascular funnel, physiological excavation) is the place of entry and exit of retinal vessels. Formed by 5-7 years. The maximum diameter is normally 60% of the disk diameter (DD), the area is 30% of the total disk area. In some cases, excavation is absent and the central part of the disk is occupied by glial and connective tissue (Kunt's meniscus) and retinal vessels. Sometimes (in 6% of emmetropes) physiological excavation reaches the depth of the cribriform plate of the sclera and the latter is visible as a white oval with dark dots.

Pathological excavation (glaucoma) differs in size, depth, progressive course up to a breakthrough to the edge of the ONH (the ratio of diameters E / D from 0.3 to 1.0), the presence of parallax of the vessels along the edge of the disk.

Level in relation to the plane of the fundus.

Fine the nasal, upper, and lower portions of the optic disc are somewhat elevated compared to the surrounding retinal tissue (vitreous prominence), and the temporal portion is at the same level as the retina.

Atypical optic disc ("oblique disc") - occurs in 1% of cases in healthy eyes. Due to the oblique course of the ONH in the scleral canal, such a disk has a narrowed shape in the horizontal meridian, a flat position of the entire temporal side, and an undermined nasal edge of the excavation.

Edema of the optic disc:

Inflammatory (neuritis-papillitis),

Circulatory (anterior ischemic neuropathy, disc vasculitis - incomplete CVD thrombosis),

Hydrodynamic (stagnant disk).

Pseudostagnant disk- in ¼ of patients with hypermetropia, it can also be caused by drusen. The reason is the hypertrophy of glial tissue in the central depression of the disc during fetal development. The degree of expression is different. Often this is an increase in the saturation of the pink color, some blurring of the nasal, upper and lower borders in the normal state of the retinal vessels. To exclude pathology, dynamic observation is necessary with the control of visual functions, control of the size of the blind spot (not enlarged here).

Underdevelopment of the papillomacular sector of the disc: The optic disc is bean-shaped. The temporal sector is absent, pigment deposition is noted in this area.

disc entry coloboma- in the region of the disc, a wide hole 2-2.5 DD in size, surrounded by pigment, is visible. At the bottom of the hole, which is 3-4 diptries below the level of the retina, a pink disk is visible. The central vessels climb along the lateral surface of this cavity to the surface of the retina. Visual functions, as a rule, are not disturbed.

Myelin sheaths of fibers in the disc area and retina (in 0.3% of people). Normally, in humans, the border of their distribution is the cribriform plate. Ophthalmoscopically, myelin fibers with clear boundaries, coming from the depths of the disk, resemble white flames. Retinal vessels are lost in these tongues. Vision is not affected.

Disc inversion- the reverse arrangement, while the vessels of the retina are located in the temporal half of the disk, and not the nasal one.

Symptom of Kestenbaum- a decrease in the number of vessels on the disk less than 7 (symptom of optic nerve atrophy).

Disc drusen- abnormal hyaline bodies in the form of yellowish-white nodules located on the surface of the disc or in its tissue. Discs with drusen are not hyperemic, the borders can be scalloped, there is no exudate and venous stasis. Physiological excavation is smoothed, the edges are blurred, uneven. In doubtful cases, fluorescein angiography.

Evulsion- tearing out of the optic nerve from the scleral ring. Ophthalmoscopically, a hole is seen instead of a disc.

avulsion- rupture, detachment of the disc from the scleral ring. The disk remains in place. Visual acuity = 0.

Omnubelation- periodic fogging, transient loss of vision, manifested by an increase in intracranial pressure.

In newborns, it is light yellow, corresponding in size to the area of ​​the optic disc. By the age of 3-5 years, the yellowish background decreases and the macular area almost merges with the pink or red background of the central zone of the retina. Localization is determined mainly by the avascular central zone of the retina and light reflexes, located approximately 25 0 temporal to the ONH. The macular reflex is determined mainly up to 30 years, then gradually fades away.

Retina

Transparency.

Fine transparent (even a layer of pigment epithelium). The thickness at the optic disc is 0.4 mm, in the area of ​​the macula 0.1-0.03 mm, at the dentate line 0.1 mm. The background of the fundus is pink. It is necessary to examine the near, middle and extreme periphery.

The first zone, otherwise - the posterior pole - a circle, the radius of which is equal to twice the distance from the optic disc to the foveola. The second - the middle zone - a ring located outward from the first zone to the nasal part of the dentate line and passing through the temporal part in the equatorial region. The third zone is the rest of the retina anterior to the second. She is the most prone to retinopathy.

Parquet fundus- uneven red color, which shows the stripes formed by the vessels and darker areas between them. This is due to a small amount of retinal pigment and a large amount of choroid pigment (normal variant).

Aspid fundus- the background is slate gray. The norm for people of the dark race.

Albinotic fundus: pale pink color (little pigment in the retinal pigment epithelium and choroid and the sclera is visible). The vascular pattern of the choroid is clearly visible.

"Thinning of the retina"- this ophthalmological term is incorrect in principle, since even the absence of the retina does not lead to a change in the color of the fundus. If large and medium vessels of the choroid are visible through the retina, this means that the retinal pigment epithelium layer and the vascular choriocapillary layer have died.

A) caliber.

Note the state of the caliber of the vessels (arteries and veins): normal caliber, narrowed, dilated, obliterated. With narrowing of the arteries, note the arteriovenous ratio.

normal difference in the ratio of caliber A and B is most pronounced in newborns 1:2, decreases with age - in adults 2:3 and increases again in the elderly.

B) The course of blood vessels.

Note: normal, pathological tortuosity, arteriovenous decussation.

The CAS and the CVS have 4 branches each, supplying blood to 4 quadrants of the retina - the upper and lower temporal, upper and lower nasal. Vessels pass in the layer of nerve fibers, small branches branch out to the outer mesh layer. Before the first branching, the vessels are called the vessels of the first order, from the first to the second - the vessels of the second order, etc.

In order to detect and prevent pathological processes in the eyes in time, it is necessary to monitor the pressure and be able to measure it.

General information and table of eye pressure norms

To maintain blood microcirculation in the eyes, which ensures the functioning of the retina and metabolic processes, normal pressure inside the eyes is necessary. This indicator is individual for each person and is generally considered normal when it does not go beyond the reference indicators. Each age group has its own average parameters. Knowing them, you can understand why vision is deteriorating, and what to do about it. A table of intraocular pressure values ​​by age and measurement methods will help you monitor the indicators:

IOP in young people

Balanced eye pressure is a sign of the absence of ophthalmic diseases. At a young age without the presence of pathologies, the indicator fluctuates very rarely, most often due to eye strain at work. For everyday intraocular pressure, the norm in adults varies between 10-20 mm. mercury column. Deviations may indicate beginning processes in the retina or optic nerve, the first signs of which are a blurred image, eye pain and headache. If the symptoms persist for more than a week, it is better to be examined by an optometrist.

IOP after 60 years

Until the age of 40, in people without ophthalmic pathologies, vision remains good, but then it begins to gradually deteriorate due to aging of the body. Anatomical features are such that eye pressure in women changes faster, and they are exposed to eye ailments more often. Ophthalmotonus and the norm of eye pressure in men change more smoothly. At the age of 50, the pressure levels off and, in the absence of congenital or acquired eye diseases, reaches the norm of 10-23 mm. mercury column. Changes are spasmodic and are caused by exacerbation of chronic diseases. In women, an increase in pressure in the eyes occurs after the age of 40 during menopause, when the level of estrogen in the blood drops. At the age of 60, the retina transforms in patients, which entails an increase in pressure up to 26 mm. mercury column according to Maklakov, the occurrence of cataracts and glaucoma.

Normal for glaucoma

An upward change in IOP indicates the processes of changes in the microcirculation of blood in the eye, and serves as a harbinger of glaucoma. Both at the initial stage of the disease, and during its progress, the removal of pressure indicators must necessarily take place twice a day - in the morning and in the evening to compile an objective picture. For elderly people with the terminal stage, measurements are taken 3-4 times a day. The average norm of eye pressure in glaucoma is fixed in the range from 20 to 22 mm Hg. At the last stage, the norm reaches 35 mm Hg.

Ways to measure pressure

The patient cannot determine the norm of intraocular pressure on his own; for this, special medical devices are needed. The most common values ​​in numbers are natural pressure or the result of measurements using the Maklakov method. In all cases, the evidence is based on the response of the eye to the force applied to it. According to the principles of influence, the measurement can be different - contact and non-contact. In the first case, the ocular surface is in contact with the measuring device, in the second case, a directed air flow acts on the eye. The hospital may offer the following methods of tonometry:

• according to Maklakov;
• electronograph;
• device "Pascal";
• contactless tonometry;
• pneumotonometer;
• ICare tonometer;
• Goldman device.

The tonometry procedure is painless and causes minimal discomfort. An experienced ophthalmologist in some cases can determine the increase in pressure by pressing his fingers on the eyeball, however, in the diagnosis and treatment of glaucoma, ultra-precise measurements are necessary, because an error of even one millimeter of mercury can lead to serious consequences.

Daily tonometry

In people suffering from glaucoma or other ophthalmic ailments, IOP monitoring should be regular. Therefore, in order to make an accurate diagnosis and adjust treatment, in some cases, patients are assigned daily tonometry. The procedure is prolonged for 7-10 days and consists in fixing eye parameters three times a day, preferably at equal intervals. All marks are recorded in the observation diary, then the doctor displays the maximum and minimum deviation from the norm.

Indicators of change

Many patients think about hypertension too late, attributing its primary symptoms to everyday causes - fatigue and overexertion, prolonged stay in lenses. But the timely detection of deviations can serve as evidence of other disease processes in the body. It accompanies hormonal disorders and diseases of the cardiovascular system.

Ocular hypotension

A decrease in IOP in modern medicine is rare and leads to complications up to blindness. Low eye pressure is dangerous because it occurs without pronounced symptoms. Patients go to the doctor, already partially losing their sight. You can stop the process of blindness, but not return vision to its original mark. In order to detect low blood pressure in time, it is necessary to undergo a scheduled medical examination every 5-6 months. Timely treatment can prevent the development of the disease and maintain visual acuity.

Low eye pressure is no less dangerous than high pressure. If it is observed for more than a month, then a sudden loss of vision may occur.

Ophthalmohypertension

Increased pressure in the eye is observed frequently and has different meanings depending on the gender and age of patients. The disease can be traced across all ages. The most aggressively manifested is the disturbed norm of eye pressure in women, especially in the elderly, causing changes in the fundus of the eye. Children are also susceptible. They have headache, tired eyes syndrome, sometimes pain when blinking. In the absence of timely treatment, ophthalmohypertension gives complications to the cardiovascular and hormonal systems, leads to glaucoma and cataracts.

Ways to normalize eye pressure

• At an early stage of the disease, Azopt proves to be effective in treatment.

In the chronic stage, hypertension leads to glaucoma and requires surgical intervention, so it is very important to normalize intraocular pressure at an early stage in detecting abnormalities. You can achieve a positive effect with the help of special eye drops, such as Azopt, Travatan, Timolol and others. A doctor should prescribe a medicine, it is better not to engage in self-medication with the use of medications. At home, the patient is able to perform a number of prescriptions that will help maintain vision by reducing hypertension:

There are cases when it is possible to restore normal intraocular pressure in a person only by a surgical method. Without surgery, the disease will worsen, turn into terminal glaucoma and lead to blindness. One operation is not enough, a number of adjustments are necessary to ensure the normalization of the movement of fluids inside the eye and relieve excessive stress on the functional parts of the organ.

Copying site materials is possible without prior approval in case of installing an active indexed link to our site.

The information on the site is provided for general information purposes only. We recommend that you consult a doctor for further advice and treatment.

The fundus of the eye is normal in adults

The norm of fundus pressure is of great importance for a person. In the device of the eye, a lot depends on it: very high or low pressure can cause poor vision and other irreversible processes. To understand what eye pressure looks like, you need to imagine a balloon. The pressure is what keeps it in shape. In the eye, the pressure feeds the spherical shell and thus keeps its shape. Pressure is formed by the inflow and outflow of fluids. If there are more fluids than needed, the pressure is considered elevated. And if vice versa - reduced.

Normal eye pressure:

In an adult, the pressure is in the range of mm. mr. Art. This is a normal indicator.

The normal level of eye pressure preserves the processes of metabolism, microcirculation in the eyes. It maintains the optical properties of the retina.

As such, there are no pressure standards. Normal pressure depends on the characteristics of the organism.

Stabilize the pressure with the help of special drugs.

To rule out problems with eye pressure, visit an ophthalmologist regularly.

Eye pressure deviations:

Heart disease can cause high eye pressure.

High pressure can appear from the anatomical features of the structure of the eye.

Symptoms of increased eye pressure are usually absent. The disease in this case is complicated and flows into glaucoma. The disease is not cured. There is an option to support development on a particular form. In the vast majority of cases, glaucoma ends in blindness.

Various deviations of pressure from the norm lead to the disappearance of thin cells of the retina and optic nerve. They also cause metabolic disturbances. Increased pressure may be accompanied by a headache, a feeling of heaviness in the pupils, darkening in the eyes.

It is important to pay attention to the appearance of the disease in a timely manner. Deviations from the norm of eye pressure may be associated with hormonal disorders. In such cases, it is necessary to undergo an examination.

Low blood pressure is rare. It is no less dangerous than high. Low blood pressure can cause vision loss.

Eye pressure is measured using a tonometer. The process is unpleasant, but does not cause severe pain.

Eye pressure - the norm and measurement. Symptoms and treatment of high eye pressure at home

An important indicator in the diagnosis of ophthalmic diseases or disorders of visual function is pressure in the eyes, or intraocular pressure (IOP). Pathological processes cause its decrease or increase. Untimely treatment of the disease can cause glaucoma and loss of vision.

What is eye pressure

Eye pressure is the amount of tone that occurs between the contents of the eyeball and its shell. About 2 cubic meters enter the eye every minute. mm of liquid and the same amount flows. When the outflow process is disturbed for a certain reason, moisture accumulates in the organ, causing an increase in IOP. In this case, the capillaries through which the liquid moves are deformed, which exacerbates the problem. Physicians classify such changes into:

• transient type - an increase for a short time and normalization without medication;
• labile pressure - a periodic increase with an independent return to normal;
• stable type - a constant excess of the norm.

A decrease in IOP (hypotension of the eye) is rare, but very dangerous. It is difficult to determine the pathology, because the disease is hidden. Patients often seek specialized care when there is a clear loss of vision. Among the possible causes of this condition: eye injuries, infectious diseases, diabetes mellitus, hypotension. The only symptom of a violation can be dry eyes, lack of shine in them.

How is eye pressure measured?

There are several methods that are carried out in a hospital setting to find out the patient's condition. It is impossible to determine the disease on your own. Modern ophthalmologists measure eye pressure in three ways:

Attention! Vision Recovery Secrets!

How I restored my vision in 2 weeks!

Elena Malysheva told about a unique remedy for restoring vision!

• tonometry according to Maklakov;
• pneumotonometer;
• electronograph.

The first technique requires local anesthesia, since a foreign body (weight) acts on the cornea, and the procedure causes little discomfort. The weight is placed in the center of the cornea, after the procedure, prints remain on it. The doctor takes prints, measures them and decrypts them. To determine the ophthalmotonus using the Maklakov tonometer began more than 100 years ago, but the method is considered highly accurate today. Doctors prefer to measure indicators with this equipment.

Pneumotonometry operates on the same principle, only the air jet has an effect. The study is carried out quickly, but the result is not always accurate. Electronograph - the most modern equipment for measuring IOP is contactless, painless and safe. The technique is based on increasing the production of intraocular fluid and accelerating its outflow. In the absence of equipment, the doctor can perform a check using palpation. By pressing the index fingers on the eyelids, based on tactile sensations, the specialist draws conclusions about the density of the eyeballs.

Eye pressure is normal

Ophthalmotonus is measured in millimeters of mercury. For a child and an adult, the norm of intraocular pressure varies from 9 to 23 mm Hg. Art. During the day, the indicator may change, for example, in the evening it can be lower than in the morning. When measuring ophthalmotonus according to Maklakov, the norm figures are slightly higher - from 15 to 26 mm. rt. Art. This is due to the fact that the weight of the tonometer puts additional pressure on the eyes.

Intraocular pressure is normal in adults

For middle-aged men and women, IOP should be between 9 and 21 mm Hg. Art. You should be aware that during the day, the norm of intraocular pressure in adults may change. Early mornings are highest, evenings are lowest. The oscillation amplitude does not exceed 5 mm Hg. Art. Sometimes excess of the norm is an individual feature of the body and is not a pathology. It is not necessary to reduce it in this case.

The norm of intraocular pressure after 60 years

With age, the risk of developing glaucoma increases, so after the age of 40 it is important to undergo an examination of the fundus, measure the ophthalmotonus and take all the necessary tests several times a year. The aging of the body affects every system and organ of a person, including the eyeball. The norm of intraocular pressure after 60 years is slightly higher than at a young age. An indicator of up to 26 mm Hg is considered normal. Art., if it is measured with a Maklakov tonometer.

Increased intraocular pressure

Discomfort and vision problems in most cases are caused by increased intraocular pressure. This problem often occurs in older people, but young men and women, and sometimes even children, can suffer from ailments with such symptoms. The definition of pathology is available only to a doctor. The patient may notice only symptoms that should be the reason for a visit to a specialist. This will help to cure the disease in a timely manner. How the doctor will reduce the indicators depends on the degree of the disease and its features.

Increased eye pressure - causes

Before prescribing pathology therapy, the ophthalmologist must establish the causes of increased eye pressure. Modern medicine identifies several main factors by which IOP can increase:

• functional disturbance in the work of the body, as a result of which the release of fluid in the organs of vision is activated;
• malfunctions of the functions of the cardiovascular system, due to which hypertension occurs and ophthalmotonus increases;
• heavy load in physical or psychological terms;
• stressful situations;
• as a result of an illness;
• age-related changes;
• chemical poisoning;
• anatomical changes in the organs of vision: atherosclerosis, hyperopia.

Eye pressure - symptoms

Depending on the intensity of the increase in ophthalmotonus, various symptoms may occur. If the increase is insignificant, then it is almost impossible to detect a problem if you do not conduct an examination. Symptoms in this case are unexpressed. With significant deviations from the norm, the symptoms of eye pressure can manifest themselves as follows:

• headache with localization at the temples;
• pain when moving the eyeball in any direction;
• high eye fatigue;
• feeling of heaviness in the organs of vision;
• oppressive feeling in the eyes;
• visual impairment;
• discomfort when working at a computer or reading a book.

Eye pressure symptoms in men

Deviations from the norm of ophthalmotonus occur equally among the two sexes of the planet's population. Symptoms of eye pressure in men are no different from the symptoms characteristic of women. In persistent acute conditions, the patient has the following symptoms of intraocular pressure:

• impaired twilight vision;
• progressive deterioration of vision;
• headache with migraine character;
• reduction of the radius of vision in the corners;
• rainbow circles, "flies" before the eyes.

Eye pressure symptoms in women

Ophthalmologists do not divide the symptoms of ophthalmotonus into female and male. Symptoms of eye pressure in women do not differ from the signs that signal a violation in men. Additional symptoms that may appear with the problem include:

How to relieve eye pressure at home

Ophthalmotonus is treated in different ways: pills and eye drops, folk remedies. The doctor will be able to determine which methods of therapy will give good results. You can relieve eye pressure at home and normalize the performance of a person, provided that the problem is not high and the function of the eye is preserved, you can use simple measures:

• daily exercise for the eyes;
• limit computer work, reduce time spent watching TV and other activities that strain your eyesight;
• use drops that moisturize the eyes;
• walk outdoors more often.

Drops to reduce intraocular pressure

Sometimes ophthalmologists offer to lower the performance with the help of special drops. Lowering IOP should only be done after consulting a doctor. The pharmacological industry offers a variety of drops from intraocular pressure, the action of which is aimed at the outflow of accumulated fluid. All drugs are divided into the following types:

• prostaglandins;
• carbonic anhydrase inhibitors;
• cholinomimetics;
• beta blockers.

eye pressure pills

As an additional measure in the treatment of increased ophthalmotonus, specialists prescribe drugs for oral administration. The medicine for eye pressure is designed to remove excess fluid from the body, improve blood circulation in the brain and metabolic processes in the body. When using diuretics in therapy, potassium preparations are prescribed, since the substance is washed out of the body when taking such drugs.

Folk remedies for eye pressure

Traditional healers also know how to reduce intraocular pressure. There are many recipes from natural ingredients that help get rid of high IOP. Treatment with folk remedies allows you to bring down the indicators to normal and does not allow them to rise over time. Folk remedies for eye pressure include the following measures:

1. Brew meadow clover, insist 2 hours. Drink a decoction of 100 ml at night.
2. Add 1 pinch of cinnamon to a glass of kefir. Drink with an increase in IOP.
3. Freshly brewed eyebright decoction (25 g of grass per 0.5 boiling water) should be cooled, strained through cheesecloth. Make lotions throughout the day.
4. 5-6 sheets of aloe wash and cut into pieces. Pour the vegetable component with a glass of boiling water and boil for 5 minutes. The resulting decoction is used to wash the eyes 5 times a day.
5. Natural tomato juice helps to get rid of increased ophthalmotonus if you drink it 1 glass a day.
6. Peeled potatoes (2 pcs.) Grate, add 1 teaspoon of apple cider vinegar. Mix the ingredients, leave for 20 minutes. After putting the gruel on gauze and use as a compress.

Video: how to check eye pressure

The information presented in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and give recommendations for treatment based on the individual characteristics of a particular patient.

How to assess intraocular pressure

The fundus is the back part of the inner wall of the eyeball. When examining it with an ophthalmoscope, the doctor sees the condition of the vessels, the optic disk (optic disc) and the retina. Intraocular pressure (IOP) is measured by a doctor with a special tonometer. Then he analyzes the results of diagnostic procedures and evaluates the force with which the fundus pressure is produced by the vitreous body. The norm for an adult or a child is different. However, the IOP should correspond to the level mm Hg. Art. (mercury column), then the visual organ will function correctly.

How is intraocular pressure measured?

During tonometry, the ophthalmologist may use one of several contact or non-contact diagnostic methods. It depends on the model of the tonometer that the doctor has. Each meter has its own standard IOP rate.

Most often, the fundus is examined by the Maklakov method.

In this case, a person lies down on a couch, he is given local anesthesia - an ophthalmic antiseptic drug is instilled into his eyes, for example, a solution of Dikain 0.1%. After removing the tear, a colored weight is carefully placed on the cornea and prints are made on the platform of the tonometer. The value of intraocular pressure is estimated by the clarity and diameter of the remaining pattern. According to Maklakov, for adults and children, normal IOP is within the limits of mm Hg.

Relationship between IOP and fundus pressure

Intraocular pressure is determined by the amount of aqueous humor in the chambers and the volume of circulating blood in the episcleral veins. IOP directly affects all membranes and structures of the visual organ from the inside.

As for such concepts as fundus pressure or its norm, they do not exist in ophthalmology. These phrases mean IOP, its effect on the sclera with the cornea and the vitreous body, which presses on the back of the shell from the inside. That is, normal, weak (below 10 mm Hg) and high (more than 30 mm Hg) pressure force of the vitreous body mass on the retina, vessels, optic disc located in the fundus area is possible. The higher or lower the level of IOP compared to the norm, the stronger the deformation of the structural elements.

With prolonged high intraocular pressure under continuous pressure, the retina, blood vessels and nerve are flattened, and they may break.

With a low level of IOP, the vitreous body does not fit snugly against the wall. This can cause a shift in visual fields, retinal detachment and other functional disorders of the organ.

Some subjective symptoms of deviations or fluctuations in intraocular pressure can be confused with signs of jumps in arterial or intracranial pressure, spasms of cerebral vessels. For example, a migraine that gives pain to the eye occurs with vegetovascular dystonia, hypertension, as well as the formation of neoplasms inside the cranial cavity. To confirm or refute these diseases, ophthalmoscopy and / or tonometry is required.

Fundus changes in hypertension

The pressure will return to normal! Just don't forget once a day.

In arterial hypertension, more than 50% of patients are diagnosed with damage to small vessels and capillaries during diagnosis. Changes in the fundus of the eye in hypertension are analyzed in terms of severity, degree of tortuosity, the ratio of the sizes of veins and arteries, as well as their reaction to light. Their condition depends on the speed of blood flow and the tone of the vascular walls.

Changes in the fundus with hypertension:

• in the place of branching of the retinal arteries, the acute angle disappears, which straightens almost to;
• small veins around the macula (macula lutea) become corkscrew-shaped tortuosity;
• arterioles narrow, the branches of the arterial tree are less noticeable, they are thinner compared to the venous network;
• there are symptoms of decussation of the Gunn-Salus vessels (squeezing of the vein by the artery);
• hemorrhages (hemorrhages) in the retina;
• the presence of swelling of the nerve fibers, in which characteristic white cotton-like foci appear;
• the back wall of the eyeball is hyperemic, swollen, darker in color retina and disc.

The ophthalmologist also evaluates visual functions. With hypertension, dark adaptation decreases, the area of ​​the blind spot expands, and the field of view narrows. The study of the fundus helps to diagnose hypertension at an early stage.

Classification of changes in the organ of vision in hypertension

The systematization of pathological changes in the eyes against the background of hypertension was last carried out by L. M. Krasnov in 1948. It is his classification that is used by ophthalmologists working in countries that were previously part of the USSR.

Krasnov L. M. divided the development of hypertension into three stages:

1. Hypertensive angiopathy.
2. Hypertensive angiosclerosis.
3. Hypertensive retinopathy.

At the first stage, a change in the pressure of the fundus primarily affects the functioning of the retinal vessels, causing their spasms, narrowing, partial squeezing, increasing tortuosity. With hypertensive angiosclerosis, the symptoms of the previous stage are aggravated, the permeability of the walls of blood vessels increases, and other organic disorders appear. In the third stage, the lesion already covers the retinal tissue. If the optic nerve is damaged in the process, then the pathology develops into neuroretinopathy.

Excessively elevated IOP significantly reduces the duration of each stage, causing changes in the organ of vision in a short time. The process can affect both eyes. Often, laser coagulation of the retina is required to eliminate violations.

Fundus pressure symptoms

With each disease, there are certain subjective and objective signs inherent in a particular pathology.

In the early stages, deviations of IOP from the norm for a person may be subtle, or there are no symptoms at all.

In order not to miss the onset of pathological processes, doctors recommend undergoing ophthalmoscopy every 12 months, and tonometry every 3 years.

In between examinations, self-diagnosis of the level of IOP can be done, evaluating the shape, firmness and elasticity of the eyeball by lightly pressing a finger on it through closed eyelids. If the organ is too hard and does not bend under the hand, there is any painful discomfort, then there is a rather high pressure in it. The finger seems to have fallen inward, and the eye itself is softer than usual - the IOP is too low. In both cases, an urgent consultation with an ophthalmologist is required.

Symptoms of high pressure in the fundus:

Many of our readers for the TREATMENT OF HYPERTENSION actively use the well-known method based on natural ingredients, discovered by Elena Malysheva. We definitely recommend checking it out. Read more.

• bursting pain or discomfort inside the organ of vision;
• redness of the sclera;
• heaviness of the eyelids;
• distortion of the picture, loss of several fragments from it, other visual impairments.

Signs of low IOP include sunken eyes in the sockets (as in dehydration), dryness of the conjunctiva, and disappearance of shine on the protein and cornea. With weak pressure on the fundus, vision is also impaired, the viewing angle may change. With any deviation of IOP, eye fatigue increases. Other symptoms of disturbances and the degree of damage are visible when using ophthalmic devices.

Conclusion

The pressure of the fundus, the norm of IOP, the optic nerve, the choroid, the retina, and other structural elements of the sensory organ are closely interconnected. Dysfunction of the ciliary body, impaired circulation of blood or aqueous humor can lead to failure of the entire system, disease or irreversible processes. To maintain visual acuity, it is recommended to undergo scheduled examinations by an ophthalmologist in a timely manner.

The fundus of the eye and its pathologies

In fact, the fundus is what the back of the eyeball looks like when viewed on examination. Here you can see the retina, choroid and optic nerve papilla.

The color is formed by retinal and choroidal pigments and can vary in people of different color types (darker in brunettes and blacks, lighter in blondes). Also, the intensity of the color of the fundus is affected by the density of the pigment layer, which can vary. With a decrease in the density of the pigment, even the vessels of the choroid become visible - the choroid of the eye with dark areas between them (picture "Parkert").

The optic nerve disc looks like a pinkish circle or an oval up to 1.5 mm in cross section. Almost in its center you can see a small funnel - the exit point of the central blood vessels (the central artery and retinal vein).

Closer to the lateral part of the disk, one can rarely see another depression like a bowl, it represents a physiological excavation. It looks slightly paler than the medial part of the optic disc.

Normal fundus, on which the optic nerve papilla (1), retinal vessels (2), fovea (3) are visualized

The norm in children is a more intense color of the optic disc, which becomes paler with age. The same is observed in people with myopia.

Some people have a black circle around the optic disc, which is formed by an accumulation of melanin pigment.

The arterial vessels of the fundus look thinner and lighter, they are more straight. Venous are larger in size, in a ratio of approximately 3: 2, more convoluted. After leaving the optic nerve papilla, the vessels begin to divide according to the dichotomous principle almost to the capillaries. In the thinnest part, which can be determined by the study of the fundus, they reach a diameter of only 20 microns.

The smallest vessels gather around the macula and form a plexus here. Its greatest density in the retina is achieved around the macula - the area of ​​​​best vision and light perception.

The very same area of ​​the macula (fovea) is completely devoid of blood vessels, its nutrition is carried out from the choriocapillary layer.

Age features

The fundus of the eye in normal newborns has a light yellow color, and the optic disc is pale pink with a grayish tint. This slight pigmentation usually disappears by the age of two. If a similar picture of depigmentation is observed in adults, then this indicates atrophy of the optic nerve.

The afferent blood vessels in a newborn have a normal caliber, and the outlet ones are slightly wider. If childbirth was accompanied by asphyxia, then the fundus of the eye in children will be dotted with small dotted hemorrhages along the arterioles. Over time (within a week) they resolve.

With hydrocephalus or another cause of increased intracranial pressure, the veins in the fundus are dilated, the arteries are narrowed, and the boundaries of the optic disc are blurred due to its edema. If the pressure continues to increase, then the optic nerve papilla swells more and more and begins to push through the vitreous body.

Narrowing of the fundus arteries accompanies congenital atrophy of the optic nerve. His nipple looks very pale (more in the temporal regions), but the boundaries remain clear.

Changes in the fundus in children and adolescents can be:

• with the possibility of reverse development (no organic changes);
• transient (they can only be assessed at the time of their appearance);
• non-specific (there is no direct dependence on the general pathological process);
• predominantly arterial (no changes in the retina characteristic of hypertension).

With age, the walls of blood vessels thicken, which makes small arteries less visible and, in general, the arterial network seems more pale.

The norm in adults should be assessed with an eye to concomitant clinical conditions.

Research methods

There are several methods for checking the fundus. An ophthalmological examination aimed at examining the fundus of the eye is called ophthalmoscopy.

Examination by an ophthalmologist is performed by magnifying the illuminated areas of the fundus with a goldmann lens. Ophthalmoscopy can be carried out in direct and reverse form (the image will be inverted), which is due to the optical design of the ophthalmoscope device. Reverse ophthalmoscopy is suitable for general examination, the devices for its implementation are quite simple - a concave mirror with a hole in the center and a magnifying glass. Direct use if necessary, a more accurate examination, which is performed by an electric ophthalmoscope. To identify structures invisible in ordinary lighting, the fundus is illuminated with red, yellow, blue, yellow-green rays.

Fluorescent angiography is used to obtain an accurate picture of the vascular pattern of the retina.

Why does the eyeball hurt?

The reasons for the change in the picture of the fundus may relate to the position and shape of the ONH, vascular pathology, inflammatory diseases of the retina.

Vascular diseases

The fundus of the eye most often suffers from hypertension or eclampsia during pregnancy. Retinopathy in this case is a consequence of arterial hypertension and systemic changes in arterioles. The pathological process proceeds in the form of myeloelastofibrosis, less often hyalinosis. The degree of their severity depends on the severity and duration of the course of the disease.

The result of an intraocular examination can establish the stage of hypertensive retinopathy.

First: small stenoses of arterioles, the beginning of sclerotic changes. There is no hypertension yet.

Second: the severity of stenosis increases, arterio-venous decussations appear (the thickened artery presses on the underlying vein). Hypertension is noted, but the state of the body as a whole is normal, the heart and kidneys do not suffer yet.

Third: permanent angiospasm. In the retina, there is an effusion in the form of "lumps of cotton wool", small hemorrhages, edema; pale arterioles look like a "silver wire". The indicators of hypertension are high, the functionality of the heart and kidneys is impaired.

The fourth stage is characterized by the fact that the optic nerve swells, and the vessels undergo a critical spasm.

Arterial hypertension can be an indirect cause of thrombosis or spasm of the retinal veins and the central retinal artery, tissue ischemia and hypoxia.

Examination of the fundus for vascular changes is also required in case of a systemic disorder of glucose metabolism, which leads to the development of diabetic retinopathy. An excess of sugar in the blood is detected, osmotic pressure rises, intracellular edema develops, the walls of the capillaries thicken and their lumen decreases, which causes retinal ischemia. In addition, there is the formation of microthrombi in the capillaries around the foveola, and this leads to the development of exudative maculopathy.

With ophthalmoscopy, the picture of the fundus has characteristic features:

• microaneurysms of retinal vessels in the area of ​​stenosis;
• an increase in the diameter of the veins and the development of phlebopathy;
• expansion of the avascular zone around the macula, due to the overlap of capillaries;
• the appearance of a hard lipid effusion and soft cotton-like exudate;
• microangiopathy develops with the appearance of clutches on the vessels, telangiectasias;
• multiple small hemorrhages at the hemorrhagic stage;
• the appearance of an area of ​​neovascularization with further gliosis - the growth of fibrous tissue. The spread of this process gradually can lead to tractional retinal detachment.

Pathology of the optic nerve head can be expressed as follows:

• megalopapilla - the measurement shows an increase and blanching of the optic disc (with myopia);
• hypoplasia - a decrease in the relative size of the optic disc in comparison with the vessels of the retina (with hypermetropia);
• oblique ascent - the optic disc has an unusual shape (myopic astigmatism), the accumulation of retinal vessels is displaced towards the nasal region;
• coloboma - an optic disc defect in the form of a notch, causing visual impairment;
• symptom of "morning glow" - mushroom-shaped protrusion of the optic disc into the vitreous body. Ophthalmoscopy descriptions also indicate chorioretinal pigmented rings around an elevated optic disc;
• congestive nipple and edema - an increase in the nipple of the optic nerve, its blanching and atrophy with an increase in intraocular pressure.

The pathologies of the fundus include a complex of disorders that occur in multiple sclerosis. This disease has a multiple etiology, often hereditary. When this occurs, the destruction of the myelin sheath of the nerve against the background of immunopathological reactions develops a disease called optic neuritis. There is an acute decrease in vision, central scotomas appear, color perception changes.

On the fundus, one can detect a sharp hyperemia and edema of the optic disc, its borders are erased. There is a sign of atrophy of the optic nerve - blanching of its temporal region, the edge of the ONH is dotted with slit-like defects, indicating the onset of atrophy of the nerve fibers of the retina. Also noticeable is the narrowing of the arteries, the formation of muffs around the vessels, macular degeneration.

Treatment for multiple sclerosis is carried out with glucocorticoid preparations, since they inhibit the immune cause of the disease, and also have an anti-inflammatory and stabilizing effect on the vascular walls. For this purpose, injections of methylprednisolone, prednisolone, dexamethasone are used. In mild cases, corticosteroid eye drops such as Lotoprednol can be used.

Inflammation of the retina

Chorioretinitis is caused by infectious-allergic diseases, allergic non-infectious, post-traumatic conditions. In the fundus, they are manifested by many rounded formations of light yellow color, which are located below the level of the retinal vessels. The retina at the same time has a cloudy appearance and a grayish color due to the accumulation of exudate. With the progression of the disease, the color of the inflammatory foci in the fundus may approach whitish, as fibrous deposits form there, and the retina itself becomes thinner. Retinal vessels practically do not change. The outcome of inflammation of the retina is cataract, endophthalmitis, exudative, in extreme cases - atrophy of the eyeball.

Diseases affecting the vessels of the retina are called angiitis. Their causes can be very diverse (tuberculosis, brucellosis, viral infections, fungal infections, protozoa). In the picture of ophthalmoscopy, vessels surrounded by white exudative muffs and stripes are visible, areas of occlusion, cystic edema of the macula zone are noted.

Despite the severity of diseases that cause pathologies of the fundus, many patients initially begin treatment with folk remedies. You can find recipes for decoctions, drops, lotions, compresses from beets, carrots, nettles, hawthorn, black currants, mountain ash, onion husks, cornflowers, celandine, immortelle, yarrow and pine needles.

I would like to draw attention to the fact that by taking home treatment and delaying a visit to the doctor, you can miss the period of development of the disease, at which it is easiest to stop it. Therefore, you should regularly undergo an ophthalmoscopy with an ophthalmologist, and if a pathology is detected, carefully follow his appointments, which you can supplement with folk recipes.

The fundus of the eye is often examined for various diseases. This, in fact, is the only "window" that allows you to look inside the body without surgical intervention and identify many pathologies in the initial stages. Therefore, this topic will be of interest to many people.

The concept of the fundus and how it is explored

The fundus is internal, which is visible with ophthalmoscopy. This technique makes it possible to examine in detail with magnification the inner surface, with the optic nerve disk located on it, and blood vessels. The fundus of the eye during such a study has a red color, against this background the optic nerve (circle or pink oval), vessels and yellow spot stand out. The most informative are the following indicators:

• color of the optic disc;
• the clarity of its boundaries;
• the number of veins and arteries (the norm is from 16 to 22);
• presence of pulsation.

Any deviations from the norm and the slightest changes can tell a lot to an experienced ophthalmologist. And very often, after the diagnosis, he gives referrals to other specialists. As for the ophthalmoscopy procedure itself, it is completely harmless to humans, and there is no deterioration in vision after such a diagnosis, contrary to various opinions.

It is a standard procedure when visiting an ophthalmologist and, perhaps, the most informative method for detecting eye diseases.

How is ophthalmoscopy performed?

Before the procedure, a special drug is instilled in, which. This is done in order to better examine the bottom of the eye. This procedure has practically no contraindications. And the most common indications for conduction are visual impairments, or simply when the eye hurts.

What can tell changes in the fundus of the eye? By the type of vessels in it, one can to some extent judge the state of the blood vessels of the brain. And the optic disc will also tell about diseases of the central nervous system. Sometimes such a diagnosis can reveal a disease whose symptoms are expressed only in changes in the retina. These are very serious illnesses, such as, for example, brain tumors.

That is why doctors regularly refer patients for such an examination who have violations in the work of the following organs and systems:

• cardiovascular;
• endocrine;
• nervous system;
• metabolic disorders.

This manipulation is carried out using an ophthalmoscope - a round concave mirror, in the center of which there is a small hole. However, now such a procedure is performed using electronic devices, which, if necessary, can even photograph the fundus.

What ailments are pathological changes talking about?

Ophthalmoscopy provides doctors with a lot of information. What ailments can this type of diagnosis reveal? They are the following:

1. diabetes . One of the very first signs of this disease, when nothing else hurts, and the person feels fine, may be a slight bleeding in the retina. With early detection of such a phenomenon, the chances are significantly increased that the disease will not go into a stage when changes in the body become irreversible.
2. arterial hypertension. With hypertension, the doctor can detect a number of symptoms in the fundus, for example, narrowing of the fundus vessels. This phenomenon, otherwise called angiopathy, indicates a malfunction in the human cardiovascular system. And very often these transformations are the first sign that manifests itself in hypertension.
3. cancer . An experienced eye doctor can detect not only signs of oncological diseases of the brain, but also other organs. Moreover, at an early stage, when the patient still has no pain. Therefore, we can safely say that timely ophthalmoscopy can save a person's life.
4. multiple sclerosis. Inflammation of the optic nerve may be a harbinger of this serious disease. According to some studies, this symptom appears very first in 75% of cases.
5. rheumatoid arthritis. This insidious disease may not manifest itself for a long time, but will manifest itself when the changes affect the cardiovascular system and become irreversible. It is during the study of the fundus that this disease can be detected at a very early stage. This diagnosis will reveal inflammation of the choroid, which will be a characteristic symptom of arthritis.

Summarizing

A person who does not have any pain should still visit an ophthalmologist once a year and conduct an examination.

People with vision problems, with hypertension or other chronic diseases, this procedure should be done even more often - at least once every six months.

The fundus of the eye is a mirror of many ailments. It gives the very first information about them. Early diagnosis of such diseases is very important, because it will contribute to their rapid cure or symptom relief.