How to look at the retina of the eye. Fundus – what does it show? How is ophthalmoscopy performed?

Fundus examination almost always involves ophthalmoscopy. Why is it carried out? This examination method allows you to identify many diseases and pathologies. Many ailments are detected precisely thanks to this method, since the organs of vision are primarily affected, for example, diabetes mellitus, kidney failure, hypertension, syphilis, tuberculosis, etc.

Why and when is the fundus checked?

A similar procedure must be carried out periodically even if there are no complaints about vision. This is especially necessary for pregnant women, because they are at risk for developing diseases that can be detected using ophthalmoscopy. In addition, regular examinations by an ophthalmologist are necessary for people suffering from diabetes and other pathologies that negatively affect the retina.

The retina can be affected by inflammation or retinopathy (non-inflammatory pathology). For example, in patients with diabetes, it is the latter condition that most often occurs. The fundus of the eye suffers from an aneurysm, as the vessels partially lose their ability to expand. As a result, a person's vision deteriorates. It is also necessary to check the fundus of the eye to ensure that retinal detachment does not occur. This pathology is not accompanied by unpleasant symptoms, but significantly impairs vision.

Usually this pathological condition manifests itself as a veil and fog before the eyes. Ophthalmoscopy allows us to identify this problem in adults and children, because retinal irregularities indicate precisely this.

This diagnostic method allows us to identify diseases of the visual system, in particular the retina, caused by genetic predisposition. Vision system. In this case, the retina is destroyed gradually, and pigment accumulates in it. The latter phenomenon is a symptom of so-called night blindness. If such disorders occur, it is imperative to visit an ophthalmologist.

How do ophthalmologists check the fundus of the eye?

This procedure is quite simple. This process is almost the same for both adults and children.

1. As a rule, during the study, a special device is used - an ophthalmoscope - a concave round mirror with a small hole in the center.
2. A narrow beam of light passes through the latter, which allows you to view the fundus of the eye through the pupil. Sometimes before the procedure it is necessary to drop special medications into the eyes that dilate the pupil.
3. Enlarging the latter allows for a better look at the fundus, as a wider area is visible. In many private clinics, this examination is carried out using an electronic ophthalmoscope with a built-in light source (halogen).

How do doctors check the fundus of adults?

The procedure can be of two types: direct and reverse.

Both of these methods have their own characteristics, so most often they need to be used in tandem.

• Direct ophthalmoscopy allows you to examine the main areas of the fundus and, accordingly,
  such pathologies;
• Reverse, or indirect - a quick inspection of absolutely all areas. To make the research results more accurate, Vodovozov technology is used (use of multi-colored rays);
• Biomicroscopy is a research method using a slit light source;
• Laser ophthalmoscopy – more modern method, characterized by reliability. Most often, the need to use a laser arises in patients suffering from reduced transparency of the lens and vitreous body. The disadvantage of this method is the high cost, as well as the monochrome image.

How to check the fundus of infants and older children

Carrying out the procedure in children is fraught with some difficulties, since children cannot control their reflexes and, accordingly, close their eyes, thereby protecting them from light. That is why children, before the procedure, need to drip a solution of homatropine (1%) into their eyes, while fixing their head. If the child continues to close his eyes, the doctor is forced to use an eyelid dilator. Older babies are usually asked to focus their eyes on an object or toy.

The fundus of the eye in infants differs from that in adults. Normally, it is colored light yellow, does not have a macular reflex, the disc optic nerve has a clear outline, pale pink color with a grayish tint. The latter persists along with depigmentation of some areas of the fundus until the child reaches 2 years of age.

In children who suffered asphyxia during birth, small, irregularly shaped hemorrhages will be visible.

They resolve by about 6 days of life if located along the areola. Preretinal hemorrhages last much longer and may recur.

If during an examination the doctor discovers pallor of the disc, especially the temporal halves, optic nerve atrophy occurs.

This pathology is accompanied by narrowing of the arteries and clear outlines of the boundaries of the nerve. In the presence of cerebral lipoidosis, a dark red spot appears in the macula area. After your baby's vision is checked, he may suffer from myopia for some time. This is a completely normal phenomenon that will disappear after the drug that dilates the pupil is removed from the body.

Contraindications to ophthalmoscopy

Like any other medical procedure, fundus examination has its contraindications.

1. As a rule, the event is prohibited for those who suffer from diseases accompanied by lacrimation and photophobia. These two conditions do not allow normal examination, making examination difficult. There is a category of patients who have narrow pupils that cannot be dilated even with the help of medications. In such situations, the procedure is ineffective and practically useless.
2. In some cases, this diagnostic method is prohibited for people with heart and vascular diseases.
   For this reason, before being examined by an ophthalmologist, it is recommended to visit a cardiologist. It is not advisable to conduct the study in case of pathological “sealing” of the pupil (miosis).
3. Also, an obstacle to diagnosis may be insufficient transparency of the lens and vitreous body.

The listed contraindications are not categorical, because direct harm from the procedure does not cause anyone. Even a sore eye can tolerate a narrowly focused light source.

Where can you check the fundus of the eye?

The procedure is carried out both in private clinics and in public ones medical institutions. In a regular clinic, all you need is a medical card and a referral to an ophthalmologist. In private medical centers Typically, no documentation is required.

The fundus is one of the vulnerable parts of the eye, since most pathologies affect this place. Some are characterized by a clearly visible clinical picture, others are known for long incubation periods.

Examination of the fundus is a priority today, since most diseases can lead to complete blindness.

Fundus of the eye: how to check

In this article we will talk about the fundus of the eye: how they check it, why and why it is done, and also who can and who should not do it.

About the fundus

In fact it represents back wall of the eye. It can be examined in detail during inspection. Doctors are interested in three things:

• choroid;
• retina;
• nipple (initial section) of the optic nerve.

Two pigments are responsible for the color of this part of the eye - choroidal and retinal. Their number is not constant. It depends, for example, on the race of the person. In representatives of the Negroid race, the bottom is usually painted a darker color, while in the Caucasoid race it is lighter. In addition, the color intensity varies depending on the density of the layer of these pigments. If it decreases, then the choroidal vessels are clearly visible in the human fundus.

The optic disc (in the future, for convenience, the abbreviation ONH will be used) is a circle or oval of a pinkish color. Its diameter is up to one and a half millimeters in cross section. In the very center there is a small funnel that can be seen almost with the naked eye. This funnel is where the central vein and retinal artery enter.

Closer to the back of the optic disc, you can see, although not so strongly, a “bowl”-shaped depression. This is the excavation, the place through which the retinal nerve fibers pass. If we compare the color of the medial part and the excavation, the latter will be paler.

Normal fundus

It is normal for the retina to be different colors. The color itself and its change depend on the following factors:

• the number and density (if we talk about the location) of vessels;
• the volume of blood circulating in them.

During the examination, for example, the retina acquires a reddish tint.

There are times when the retina takes on a color resembling dark red or dark brown. This is due to the pigment epithelium, which is located between the top layer and the layer in which there are many capillaries.

If the amount of pigment decreases, then we are talking about a “parquet effect”. It is clearly visible in the retinal drawing. There are wide stripes and dark areas mixed in there.

The optic nerve, when in normal condition, resembles a round pink spot. This spot has a pale temporal part. All this is on a red background. It is worth noting that the color of the disc can change. The number of capillaries plays a decisive role in this. However, what remains unchanged is the change in color of the disc as a person ages. The older you get, the paler you are.

The following factors also influence the change in shade.

1. Increased pigment density.
2. Development of hypertension and other diseases.

If during the examination a semi-ring is discovered in the area of ​​the optic disc, the doctor may note detachment of the choroid from the edge of the nerve.

Why and when are they checked?

The human body is literally entangled in a network of blood vessels. In the fundus they are extremely sensitive to most common pathologies. A change in their condition indicates the presence of diseases not related to the eyes. Nevertheless, They are the ones who are able to provide all the necessary information and point to the root cause of the bad condition. This is one of the reasons why the fundus of the eye especially needs a detailed examination - ophthalmoscopy.

This procedure is not carried out constantly, but periodically. It is worth undergoing even if there are no vision complaints. Ophthalmoscopy will be extremely necessary for pregnant women, since they are at risk. In addition, those who suffer from diabetes and other eye pathologies, the presence of which can be confirmed by examining the retina, should also visit an ophthalmologist.

Inflammation is another cause of retinal damage. Non-inflammatory pathology is usually observed in patients with diabetes. Due to the partial loss of the ability of blood vessels to expand, signs of an aneurysm in the fundus begin to appear, which leads to a weakening of visual acuity.

Checking the fundus of the eye should also be carried out to prevent. Despite the absence unpleasant symptoms, this pathology can greatly impair the patient’s vision.

Typically, retinal detachment is manifested by blurred vision and the presence of a veil, narrowing the range of vision. This pathology can be detected during ophthalmoscopy in both children and adults, since its main symptom is the uneven location of the retina.

Ophthalmoscopy reveals various diseases of the organ of vision, in particular congenital defects. If there is a disease transmitted to the child from parents or the older generation, the child experiences gradual destruction of the retina due to the accumulation of pigment in it. Before he becomes completely blind, he exhibits the symptom of “night blindness.” This symptom is a good reason to visit an ophthalmologist, and this must be done without fail.

Ophthalmoscopy – quick and effective method detection of many pathologies, such as:

• malignant neoplasms;
• damage to blood vessels or the optic nerve;
• retinal detachment, which can be detected even in the first stages;

Macular edema is a separate case. It appears due to secondary retinopathy in the primary disease – diabetes mellitus. Also, the occurrence of this pathology can be caused by eye injuries or various types of inflammation of the choroid.

Interesting! The macula is the area of ​​the retina responsible for central vision. Outwardly it resembles a yellow spot.

Conduct this procedure adults need it once a year, and children need it in the first, fourth and sixth years of life, and then every two years.

It is dangerous for the following persons:

• women (during the entire pregnancy period);
• newborns (as a rule, we are talking about premature babies);
• people suffering from diabetes or kidney inflammation, as well as hypertension.

Extraordinary ophthalmoscopy is performed for the following pathologies:

• weakened vision and changes in color perception;
• traumatic brain injury;
• decreased visual acuity in the dark;
• vestibular apparatus disorder;
• frequent and severe headaches, as well as
• blindness.

In case of retinal detachment, for which emergency ophthalmoscopy is prescribed, there are no contraindications. If the patient’s front part of the eye is inflamed, which causes tears to constantly flow and sensitivity to light increases, then obstacles arise to conducting an examination of the fundus of the eye, and in this case the best solution would be to postpone this procedure until recovery.

Ophthalmoscopy is one of the standard procedures of a modern ophthalmologist, which, despite its simplicity, is nevertheless quite informative. It happens that the data obtained as a result of ophthalmoscopy is required for study by other doctors. Let's look at examples.

Table No. 1. Doctors and reasons for their interest in the results of ophthalmoscopy.

Research methods

Do not forget that before each procedure of this kind, the patient needs to consult an ophthalmologist, since the information obtained on the Internet is for informational purposes only. If we talk about ophthalmoscopy techniques, there are only two of them:

• straight;
• reverse.

Direct ophthalmoscopy allows the ophthalmologist to obtain an image in which the affected areas can be examined in detail. This is achieved by zooming using an electric ophthalmoscope. Reverse ophthalmoscopy (so called because of the inverted image obtained due to the special structure of the optics of the ophthalmoscope) helps to determine general state fundus.

At the same time, there is another, less popular one. An ophthalmologist can examine the patient using a Goldmann lens. With it he is able to enlarge the image of the fundus.

Rays of different colors, ranging from red to yellow-green, help the ophthalmologist to detect invisible details of the fundus. If an accurate image of the retinal vessels is needed to evaluate their condition in the future, the doctor may order fluorescein angiography.

Basics of the procedure

The mechanism for carrying it out is quite simple. The procedure is the same for both adults and children.

First, the ophthalmologist uses a special diagnostic device called ophthalmoscope. It is a round concave mirror. It has a small hole in the center. Through it, a narrow beam of light enters the fundus of the eye. Thanks to this doctor, everything can be seen “through the pupil.”

Secondly, if necessary, the doctor drops it into the patient’s eyes medications intended to dilate the pupil, which will facilitate the procedure of examining the fundus. The fact is that the wider the pupil, the more visible in the fundus.

Interestingly, most private clinics already practice the use of an electronic ophthalmoscope, which has a built-in halogen lamp.

Video: Malysheva about the fundus

Testing in adults

Typically, adults undergo two possible procedures– direct or reverse ophthalmoscopy. Both of them have their own characteristic features, and the effectiveness of the examination increases significantly if they are used together. Direct ophthalmoscopy will allow you to examine in detail the main areas of the fundus, and reverse ophthalmoscopy will help you quickly examine absolutely everything.

To obtain high-quality and accurate results, doctors use the following methods:

• biomicroscopy, which uses light from a slit source;
• multi-colored rays using Vodovozov technology;
• laser ophthalmoscopy, which is an improved and yet reliable procedure.

The need for the last of these methods arises in people suffering from clouding of the vitreous body and lens. It should be noted that the disadvantages of laser ophthalmoscopy are the price and the black and white image, in which little will be visible.

Video: Fundus examination

Checking in children

While this procedure is quite easy to carry out in adults, the situation is worse with children. Ophthalmoscopy is associated with certain difficulties. For example, reflexes to light. Adults can control them, while children cannot. They close their eyes. This way they protect them from light beams.

Because of this, before the procedure, a 1% solution of homatropine is instilled into their eyes. At this moment the head is fixed. If the child closes his eyes after this, the doctor uses an eyelid dilator. An alternative option is to focus your gaze on an object.

The appearance of the fundus in infants differs greatly from the picture familiar to doctors. Unlike adults, young children's color is mainly light yellow. The optic disc is clearly visible, but the macular reflex is absent. Outwardly it is pale pink, but there are tints of grayish color. They persist until the child reaches two years of age.

Children who suffered asphyxia at birth have small hemorrhages. Their shape is wrong. Somewhere on the sixth day of life they disappear, but provided that they were located along the areolas. Other types (we are talking about preretinal ones) are observed much longer. They are recurrent symptoms, meaning they can appear again.

If a loss of color of the optic disc is detected, the doctor diagnoses optic nerve atrophy. It causes a narrowing of blood vessels (particularly arteries) and the appearance of clearly defined boundaries.

After an ophthalmoscopy, the baby may suffer from myopia for some time. It's quite normal. You just need to wait until the body completely eliminates the drug used by the doctor.

Video: Checking a child's vision

Contraindications

Ophthalmoscopy is not usually done for people who have medical conditions that cause them to be highly sensitive to light and cry constantly. It is better for them to wait, since they can complicate the procedure and ultimately neutralize its benefits. People with small pupils that cannot be dilated even with medication will also not benefit from this test.

Cloudy lens, as well as vitreous will prevent the doctor from correctly assessing the situation with the patient’s fundus.

People with heart pathologies are not allowed to undergo ophthalmoscopy. As a rule, either a therapist or a cardiologist informs the patient about this.

Precautionary measures

As stated earlier, ophthalmoscopy is a simple, safe and effective diagnostic method. However, it is worth remembering the following points if you want to maintain eye health for a long time:

• if the doctor used drops before the examination, then the patient’s vision is temporarily impaired and it is better for him not to drive for three to four hours;

• you should not focus your gaze while the drops are in effect - there is no point in doing this, but your eyes will hurt;
• due to the light from the ophthalmoscope, spots appear before the patient’s eyes. It’s better for him to just wait it out - they will pass in half an hour or an hour;
• When going outside after an ophthalmoscopy, the patient should wear sunglasses for the first time. High photosensitivity resulting from the examination procedure can cause pain and unpleasant discomfort in the eyes. However, there is no reason to worry - the phenomenon is temporary and will pass.

Results

The danger of damage to the fundus of the eye is the irreversible consequence in the advanced stage of the damage - complete blindness, which cannot be cured. Various degenerative and destructive changes to which this area of ​​the eye is subjected form before other signs of body diseases. It is for this reason that it would be better for the patient to find time for an ophthalmoscopy, so as not to regret in the future about the missed opportunity to be cured.

This procedure will detect dangerous pathologies at the beginning of development, as well as prevent their further development.

Ophthalmoscopy is one of the main objective and most important methods for studying the inner membranes of the eye. The method was discovered and put into practice by Hermann von Helmholtz in 1850 on the basis of the eye mirror he developed - the ophthalmoscope. Over the 150 years of its existence, the ophthalmoscopy method has significantly improved and is currently one of the main ways to study the internal environments of the eye and fundus.
The technique of ophthalmoscopic examination of the fundus is mastered during the practical work of a doctor; it is described in detail in manuals on ophthalmology and textbooks on eye diseases. In this regard, there is no need to describe it in detail here.
The fundus 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 vascular network of the central artery and central retinal vein. The color of the fundus is made up of shades of light rays. A 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 nerve head make a certain contribution to the formation of the ophthalmoscopic picture of the fundus, which, depending on the many elements composing it, varies significantly in normal conditions and, especially, in pathology. In this regard, during ophthalmoscopy it is necessary to resort to various types lighting, use of various magnifications, examine the patient not only with a narrow, but also with a medically dilated pupil (caution if the patient has glaucoma).
The fundus examination should be carried out according to a specific plan: first, examination of the optic disc region, then the macular region of the retina, and, finally, the peripheral parts of the fundus. It is advisable to examine the macular area and the periphery of the fundus with a wide pupil. The study involves searching for pathological changes in the fundus, studying the structure of detected lesions, their localization, and measuring area, distance and depth. After this, 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 examination 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 membranes of the eye (fundus) is obtained only by combining the line of illumination of the fundus with the visual line of the observer or the lens of a photo and television camera.
Instruments for examining the fundus of the eye can be divided into simple (mirror) ophthalmoscopes and electric ophthalmoscopes (hand-held and stationary). There are two methods of ophthalmoscopy: reverse ophthalmoscopy and direct ophthalmoscopy.

Reverse ophthalmoscopy

When working with a mirror ophthalmoscope, an external light source is required (100-150 W table lamp with a frosted glass bulb). When examining the fundus using a mirror ophthalmoscope and a magnifying glass, the doctor sees a virtual image of the fundus area in an enlarged and reverse view. With ophthalmoscopy with a magnifying glass of +13.0 diopters, the degree of magnification of the area of ​​the fundus under consideration (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 general ophthalmoscopy, a magnifying glass of +20.0 diopters can be used.

Direct ophthalmoscopy

Using an electric ophthalmoscope, it is possible to examine the fundus directly (without a magnifying glass). In this case, the structures of the fundus are visible in direct and enlarged (about 14-16 times) form.
Electric ophthalmoscopes have their own illuminator, powered either from an electrical network 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 (examination in white achromatic light)
During ophthalmoscopy of the fundus, as mentioned above, you should pay attention to the optic disc, blood vessels retina, macular area and, as far as possible, on peripheral parts fundus.
The outer (temporal) half of the disc appears lighter than the inner (nasal) half. 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 is visible through them. The temporal edge of the disc is more sharply outlined than the nasal edge.
The normal color variability of the optic nerve head should be distinguished from its pathological changes. A paler color of the temporal half of the disc does not mean the development of atrophy of the nerve fibers of the optic nerve. The intensity of the pink color of the disc depends on the pigmentation of the fundus, which is typical for blondes, brunettes, and brown-haired people.
The optic disc is usually round in shape or, less commonly, in the form of a vertical oval. The normal horizontal size of the disc is 1.5-1.7 mm. With ophthalmoscopy, its size appears significantly larger due to image magnification.
In comparison with the general level of the fundus, the optic nerve disc can be located with its entire plane at the level of the fundus or have a funnel-shaped depression in the center. The depression (physiological excavation) is formed due to the bending of nerve fibers from retinal ganglion cells at the edge of the scleral-choroidal canal. In the area of ​​excavation, the whitish tissue of the cribriform plate of the sclera is visible, so the bottom of the excavation looks especially light. The physiological excavation is usually located in the center of the disc, but sometimes moves to the temporal edge, and therefore has a paracentral location. Physiological excavation differs from pathological (for example, glaucomatous) by two main features: shallow depth (less than 1 mm) and the obligatory presence of a rim of normally colored disc tissue between the edge of the disc and the edge of the excavation. The ratio of the size of physiological excavation to the size of the disc can be expressed as a decimal fraction: 0.2-0.3.
With a stagnant disc, on the contrary, swelling and protrusion of disc tissue into the vitreous are observed, which is the main symptom of intracranial hypertension, often caused by brain tumors. The color of the disc becomes greyish. Phenomena of pronounced venous stagnation are noted.
During an 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 central vein of the retina. The central retinal artery emerges from the middle of the disk or slightly inward, which is accompanied by the central retinal vein entering the disk. Retinal arteries are noticeably different from veins. Arteries are thinner than veins, lighter in color and less tortuous. The calibers of arteries in relation to veins are related as 3:4 or 2:3. More major arteries and veins have vascular reflexes, formed due to the reflection of light from a column of blood in the vessel. Often, a venous pulse is normally observed in the disc area.
It should be taken into account that the fundus of the eye is the only place in the human body where ophthalmoscopically one can directly observe the state of the vessels and their changes, both arteries and veins, not only in case of eye pathology, but also in general diseases of the body (hypertension, endocrine pathology, blood diseases, etc.). Pathology vascular system is accompanied by the appearance of a number of symptoms: copper wire symptom, silver wire symptom, Gwist symptom, Hun-Salus symptom, etc.
The size of the macula in an adult varies significantly; the large horizontal diameter can usually range from 0.6 to 2.5 mm.
It is better to examine the periphery of the fundus with a dilated pupil. With a high pigment content, the fundus of the eye appears dark (parquet fundus), and with a low pigment content, it appears light (albino 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, the choroid, optic nerve head, and retinal vessels. According to the genesis, changes can be inflammatory, dystrophic, tumor, etc. In the clinic, qualitative and quantitative assessment of ophthalmoscopically visible changes in the fundus of the eye 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)

Valuable additional method studying the details of the fundus is ophthalmochromoscopy, which allows you to examine the fundus in different colors (red, yellow, blue, purple and redless). In this case, it is possible to identify changes that remain invisible with conventional ophthalmoscopy in white light. Professor A. M. Vodovozov (1986, 1998) made a great contribution to the development of the ophthalmochromoscopy method and its application in the clinic.
With ophthalmochromoscopy, in-depth analysis of the structures of the fundus of the eye is based on the property of light rays with different wavelengths to penetrate tissue to different depths. Short-wavelength (blue, cyan) light rays are reflected predominantly from the outer limiting membrane of the retina. These light rays are partially reflected by the retina, and partially 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, and a smaller part passes through the retinal pigment epithelium and is absorbed by the choroid.
Long-wavelength (orange, red) light rays are almost not reflected by the retina and, penetrating the choroid, are partially reflected and reach the sclera. Reflecting from the sclera, long-wave rays again pass through the entire thickness of the choroid and the retina in the opposite direction (towards the observer).
Modern electroophthalmoscopes have a set of three colored glasses (red, green and blue), which allows for fundus ophthalmochromoscopy.
Due to sufficient aperture 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 identifying pathological changes in the fundus.

Red light ophthalmoscopy

(module direct4)

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

Ophthalmoscopy in yellow light

The normal fundus of the eye appears brownish-yellow in yellow light. The optic disc becomes light yellow and waxy. The contours of the disc are clearer than with white light ophthalmoscopy. In yellow light, the retinal vessels take on a dark brown tint. The macular area is poorly visible.
In yellow light, subretinal hemorrhages, which look like dark brown spots, are clearly visible. This distinguishes hemorrhage from pigmented formations: the pigment in yellow light fades, and the contrast of hemorrhage increases.

Blue light ophthalmoscopy

The normal fundus of the eye appears dark blue in blue light. The optic disc in blue light has a light blue color, its contours look veiled. The retinal nerve fibers are visible as thin light lines on a dark background. The retinal vessels become dark in color. Arteries differ little from veins in color. 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 pigment of the macula.
In blue light, light, superficially located pathological foci, especially the “cotton wool” type, are quite clearly visible in the fundus. Subretinal and choroidal hemorrhages, clearly visible in yellow light, become indistinguishable in blue light.

Ophthalmoscopy in red-free light

The normal fundus of the eye in red-free light has a bluish-greenish color. The optic disc in red-free light acquires a light green color, its contours look unclear. In red-free light, the pattern of the retinal nerve fibers and pathological changes in it. The retinal vessels appear dark against the bluish-greenish color of the fundus. Small vessels surrounding the macula and in the area of ​​the optic nerve head are especially clearly visible.
The macula macula of the retina is lemon-yellow in red-free light. Only in red-free light are the smallest (dust-like) opacities of the retina in the macula area clearly visible.

Purple light ophthalmoscopy

Purple light is made up of a mixture of red and blue light rays. The normal fundus under magenta light is bluish-purple in color. The optic disc in purple light appears red-purple, lighter and quite sharply different from the bluish-purple color of the fundus. The temporal half has a slightly bluish tint. Physiological disc excavation is colored blue. With optic nerve atrophy, the disc becomes bluish in purple light. This change in disc color is perceived better than with white light ophthalmoscopy and should be performed in cases of doubtful presence of atrophy.
Retinal vessels appear dark red in purple light. Veins appear darker than arteries. The retinal vessels may be surrounded by red and blue stripes. The macula macula is distinguished by its red color against the purple background of the fundus.

Ophthalmoscopy in polarized light

This method of ophthalmoscopy is based on the property of fundus tissue structures that have optical anisotropy, i.e. birefringence. This is confirmed by the visual phenomenon of Haidinger (“Haidinger’s brushes”), which are revealed in polarized light using a maculotest device. Ophthalmoscopy and fundus photography in polarized light can reveal anisotropic structures and changes in the fundus that are not visible with conventional ophthalmoscopy. Polarizing ophthalmoscopy in our country was developed by R. M. Tamarova and D. I. Mitkokh (1966). To examine the fundus of the eye, the FOSP-1 photoophthalmoscope device is used. There are also hand-held ophthalmoscopes with polaroids from the American company Bausch & Lomb and the English company Keeler.
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 details of the fundus of the eye are revealed that have the ability to polarize light.
When ophthalmoscopy in polarized light, two types of peculiar light reflex are normally detected: one in the area of ​​the macula, the other on the optic nerve head. The polarization figure in the macula area looks like two dark red triangles, with their apexes facing the center of the foveola and their bases facing the periphery of the macula. In shape it resembles the figure of Heidinger’s “brush”. In the area of ​​the optic nerve head, in polarized light, a figure of a blurred light cross appears - yellowish in color on the 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. Polarized light makes it easier to detect papilledema in initial stage congestive disc and neuritis. With severe disc swelling or optic nerve atrophy, a cruciform figure does not appear on the disc in polarized light.

Examination of the fundus using stationary instruments (specifying ophthalmoscopy and scanning ophthalmography)

Stationary instruments for examining the fundus include: a large non-reflex ophthalmoscope, a slit lamp, fundus cameras, a Heidelberg retinal tomograph, and an optic nerve head analyzer.

1. A large non-reflex ophthalmoscope allows for detailed examination of the fundus at 10, 20 and 27 times magnification. In this case, already in the process of ophthalmoscopic examination, it is possible to quantitatively assess the normal and pathological structures of the fundus of the eye. 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, magnified image of the fundus is obtained. Photoslit lamps have cameras for photographing the fundus of the eye. For the same purpose, you can use the RETINOFOT device from Carl Zeiss.
3. The Sapop company has released a new model of the CR3-45NM camera for photographing the fundus of the eye without first dilating the pupil. The camera has a wide lens coverage angle of 45°. The television monitor makes it easier to operate the camera and reduces patient fatigue during the examination. Along with ordinary color photography on 35 mm film, color photography with the Polaroid system is possible.
4. Examination of the fundus using a fundus camera is described in the section “Fluorescein angiography of the fundus.” Behind last years Based on television biomicroscopy, computer analysis and a number of other technical developments, ophthalmological devices for examining the fundus of the eye 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 increased 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: the size of the disc, the amount of excavation, the depth of excavation, the distance of the disc above the surface of the fundus and other indicators. Using a retinal tomograph, it is possible to clarify the diagnosis of a congestive disc and monitor 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 equivalent of B-scanning ultrasound. The device uses an axial scan of the retina, which measures the thickness of the retinal nerve fiber layer. The device operates in low coherence mode using infrared light (850) from a diode source.

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

As can be seen from the data presented, the possibilities of studying the fine structures of the fundus have now significantly expanded and deepened. This makes it possible to identify pathology in the early stages of disease development and promptly begin rational treatment.

The fundus of the eye is examined by specialists during a routine examination or for various ophthalmological disorders. This department is an important component of the visual apparatus; its condition helps to establish the diagnosis as accurately as possible. Fundus examination is carried out in adults and children and provides information about many diseases.

What is the fundus

The fundus of the eye refers to the back of the eye, visible when using special devices. Important structures are visualized in this area:

• retina;
• choroid;
• optic disc.

The central part of the optic nerve head combines the central retinal artery and vein, which are divided into large and small “branches”. The area of ​​the posterior pole of the eye contains the macula (macula).

The fundus of the eye is characterized by increased vulnerability and susceptibility to various pathologies. The coloring of this area of ​​the eye is provided by two pigments - choroidal and retinal, the amount of which varies in different people.

One of the factors influencing fundus color is race. In Caucasians this structure is light, while in representatives of the Negroid race it is darker in color.

Indications for examination

The fundus of the eye is checked to identify a wide variety of pathologies developing in the area of ​​the visual apparatus. The procedure is performed during preventive examinations, in pregnant women and premature infants. Other indications for the study are:

The examination is prescribed for hypertension, myopia, farsightedness, astigmatism, strabismus, and other eye pathologies. The procedure does not take much time, is safe and painless.

Research methods

To determine the condition of the fundus, angiography and ophthalmoscopy are most often used. Both procedures are considered quite informative and do not harm the human visual system.

Before diagnosis, pupil dilation is performed using mydriatics (Atropine, Tropicamide). Only after this the examination shows the norm or abnormalities in the visual system in adults and children.

Angiography

In the process of performing angiography, the specialist is able to clarify how the vessels are filled with blood and study the state of blood flow in the fundus of the eye. After inducing mydriasis, a fluorescent dye is injected into the patient's vein. Next, the examinee places his head in the diagnostic device’s clamp, and the specialist takes pictures of the ocular structures using a special camera.

The reasons for performing angiography are:

• High myopia.
• Pathologies of the retina of the organs of vision.
• Hereditary eye diseases.
• Anomalies of retinal vessels.
• Tumors (melanoma, angioma).

Some patients may develop allergic reactions to the substance used (sodium fluorescein), manifested by skin rashes, pulse irregularities, breathing problems, sharp decrease blood pressure. To avoid the appearance negative reactions, before diagnosis, patients are examined for contraindications.

Ophthalmoscopy

Ophthalmoscopy is a procedure prescribed during a standard examination by an ophthalmologist or if any pathology is suspected. The method is based on the principle of reflection of light rays.

To conduct the examination, the doctor uses a special device (ophthalmoscope). A beam of light emanating from this device passes through the pupil and enters the retinal area, helping the doctor to examine in detail the various eye structures.

There are two types of ophthalmoscopy - direct and reverse. Direct is carried out using an electrical apparatus. To perform the reverse, you need a mirror ophthalmoscope with two magnifying glasses.

The study is carried out in a darkened room and takes on average 5–10 minutes. During the test, the patient must keep his eyes open and perform movements at the doctor’s command (look straight, up, right, left, at the ear of the specialist conducting the diagnosis).

Ophthalmoscopy takes place without pain, however, after the procedure, discomfort may occur due to exposure of the eyeballs to bright light. After completing the examination, dark spots may be present in the field of vision, disappearing after some time.

Features of testing in children and pregnant women

Angiography should be performed no earlier than 14 years of age. If there are serious indications, the procedure may be prescribed at an earlier age. If the child reacts painfully to the stages of the examination, anesthesia is used.

Fluorescein can be used to examine the visual organs during pregnancy and lactation. After the procedure you will need to stop for 48 hours. breast-feeding. The body will need this time to eliminate the dye in the urine.

Ophthalmoscopy is prescribed to patients of all ages and categories. Children early age undergo diagnostics in the presence of parents. If the child cannot keep his eyes open during the examination, an eyelid dilator is used.

Contraindications for the study and precautions

Angiography is prohibited in the following situations:

• with hypersensitivity to sodium fluorescein;
• if the patient has an implanted lens;
• with opacities of the cornea, vitreous body, and moisture in the anterior ocular region (such disorders make it impossible to record the light radiation of the dye);
• in case of insufficient ability of the kidneys to filter blood and clean it from dye;
• after a recent heart attack (for six months).

The procedure is also contraindicated for glaucoma, thrombophlebitis, manifested by the formation of blood clots in the venous lumens. Angiography is not prescribed for people with bronchial asthma, epileptic seizures, mental disorders, minors, persons over 65 years of age.

Unlike the previous method, ophthalmoscopy does not have an extensive list of contraindications. The examination is not carried out only if the patient is prohibited from administering mydriatic solutions to the organs of vision. Such restrictions apply to persons with angle-closure glaucoma, suspected trauma, neurological disorders, or who have an outdated model of artificial lens.

Both procedures require mandatory pupil dilation. After the diagnosis has been completed, patients are advised to refrain from driving for several hours. While the state of mydriasis persists, it is necessary to protect the organs of vision from the bright sun with the help of darkened glasses.

What the study shows

If the characteristics of the fundus are normal, the specialist discovers:

• clear vitreous body of the eye;
• slight excavation of the optic nerve disc in comparison with its diameter;
• a yellow spot with good light reflexes.

The normal fundus of the eye contains a transparent retina, the optic nerve, which resembles a round pink spot.

In myopic patients, ophthalmoscopy reveals an enlarged optic disc. In farsighted people, this part of the eye is reduced. With astigmatism, this structure has an irregular round or oval shape.

If during angiography there is no glow in certain areas eyeball, there is a suspicion of vasoconstriction or blood clot formation. Penetration of the dye into the retinal structure indicates damage to the blood-retinal barrier associated with detachment or inflammation of the pigment membrane.

Based on the changes in patients, it is possible to judge not only ophthalmological problems. Some abnormalities indicate pathologies in the cardiovascular or nervous system.

In fact, the fundus is what the back of the eyeball looks like when viewed upon examination. Here the retina, choroid and optic nerve nipple are visible.

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

The optic disc appears as a pinkish circle or 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 (central artery and vein of the retina).

Closer to the lateral part of the disc, another cup-like depression can rarely be seen; 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 coloration 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 ones are larger in size, in a ratio of approximately 3:2, and more convoluted. After the optic nerve leaves the nipple, the vessels begin to divide according to a dichotomous principle, almost to the capillaries. At the thinnest part that can be determined by fundus examination, they reach a diameter of only 20 microns.

The smallest vessels gather around the macula area 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 area of ​​the macula (fovea) itself is completely devoid of blood vessels; its nutrition comes from the choriocapillaris layer.

Age features

The fundus of the eye in newborns is normally light yellow in 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 pattern of depigmentation is observed in adults, this indicates optic nerve atrophy.

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

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

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

Changes in the fundus of the eye in children and adolescents can be:

• with the possibility of reverse development (no organic changes);
• transient (they can only be assessed at the moment of their appearance);
• nonspecific (no direct dependence on the general pathological process);
• predominantly arterial (without changes in the retina characteristic of hypertension).

With age, the walls of blood vessels thicken, causing small arteries to become less visible and, in general, the arterial network to appear paler.

The norm in adults should be assessed taking into account the accompanying clinical conditions.

Research methods

There are several methods for checking the fundus. Ophthalmological examination, aimed at studying the fundus of the eye, is called ophthalmoscopy.

An examination by an ophthalmologist is performed by magnifying the illuminated areas of the fundus with a Goldmann lens. Ophthalmoscopy can be performed in forward and reverse view (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 is used when a more accurate examination is needed, which is carried out with an electric ophthalmoscope. To identify structures invisible in normal lighting, illumination of the fundus with red, yellow, blue, yellow-green rays is used.

Fluorescein angiography is used to obtain an accurate picture of the retinal vascular pattern.

Why does the fundus of the eye hurt?

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

Vascular diseases

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

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

First: slight stenosis of arterioles, the beginning of sclerotic changes. There is no hypertension yet.

Second: the severity of stenosis increases, arteriovenous crossovers appear (the thickened artery puts pressure on the underlying vein). Hypertension is noted, but the condition of the body as a whole is normal, the heart and kidneys are not yet affected.

Third: constant vasospasm. In the retina there is effusion in the form of “lumps of cotton wool”, small hemorrhages, swelling; pale arterioles have a “silver wire” appearance. Hypertension levels 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 blood vessels undergo critical spasm.

If the pressure is not reduced in time, then over time, occlusion of the arterioles causes a retinal infarction. Its outcome is atrophy of the optic nerve and death of cells in the photoreceptor layer of the retina.

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

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

During ophthalmoscopy, the fundus picture 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 capillary closure;
• the appearance of a hard lipid effusion and soft cotton-like exudate;
• microangiopathy develops with the appearance of couplings on the vessels, telangiectasias;
• multiple small hemorrhages at the hemorrhagic stage;
• the appearance of an area of ​​neovascularization with further gliosis - the proliferation of fibrous tissue. The spread of this process can gradually lead to tractional retinal detachment.

DZN

Pathology of the optic nerve disc can be expressed in the following:

• megalopapilla - measurement shows an increase and pallor of the optic disc (with myopia);
• hypoplasia – a decrease in the relative size of the optic disc in comparison with the retinal vessels (with hypermetropia);
• oblique ascension – the optic disc has an unusual shape (myopic astigmatism), the accumulation of retinal vessels is shifted to the nasal region;
• coloboma – a defect of the optic disc 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 - enlargement of the optic nerve nipple, its pallor and atrophy with increased intraocular pressure.

Pathologies of the fundus include a complex of disorders that arise when multiple sclerosis. This disease has multiple etiologies, often hereditary. In this case, the myelin sheath of the nerve is destroyed against the background of immunopathological reactions, and a disease called optic neuritis develops. An acute decrease in vision occurs, central scotomas appear, and color perception changes.

In the fundus one can detect sharp hyperemia and swelling of the optic disc, its boundaries are erased. There is a sign of optic nerve atrophy - blanching of its temporal region, the edge of the optic disc is dotted with slit-like defects, indicating the onset of atrophy of the retinal nerve fibers. Narrowing of the arteries, formation of couplings around the vessels, and macular degeneration are also noticeable.

Treatment for multiple sclerosis is carried out with glucocorticoid drugs, since they inhibit the immune cause of the disease, and also have an anti-inflammatory and stabilizing effect on the vascular walls. Injections of methylprednisolone, prednisolone, and dexamethasone are used for this purpose. In mild cases you can use eye drops with corticosteroids, for example Lotoprednol.

Retinal inflammation

Chorioretinitis can be caused by infectious-allergic diseases, allergic non-infectious, post-traumatic conditions. In the fundus, they appear as many rounded formations of light yellow color, which are located below the level of the retinal vessels. The retina has a cloudy appearance and a grayish color due to the accumulation of exudate. As the disease progresses, the color of inflammatory foci in the fundus may approach whitish, as fibrous deposits form there and the retina itself becomes thinner. The retinal vessels remain virtually unchanged. The outcome of retinal inflammation is cataract, endophthalmitis, exudative, and in extreme cases, atrophy of the eyeball.

Diseases affecting the retinal vessels are called angiitis. Their causes can be very diverse (tuberculosis, brucellosis, viral infections, mycoses, protozoa). The ophthalmoscopy picture shows vessels surrounded by white exudative couplings and stripes, areas of occlusion and cystic edema of the macula area are noted.

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

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