Changes in the fundus with etc. Chapter vi Pathological changes in the fundus of the eye in case of a disease of the whole organism, its individual systems and organs. Causes of changes in the fundus of the eye in old age

With hypertension of any genesis, changes in the vessels of the fundus are noted. The severity of these changes depends on the height of blood pressure and prescription of hypertension. In hypertension, there are three stages of changes in the fundus area, which successively replace each other:

stage of functional changes - hypertensive angiopathy of the retina;
stage of organic changes - hypertensive angiosclerosis of the retina;
stage of organic changes in the retina and optic nerve - hypertensive retinopathy and neuroretinopathy.

First, there is a narrowing of the arteries and an expansion of the veins, the walls of the vessels gradually thicken, primarily arterioles and precapillaries.

With ophthalmoscopy, the severity of atherosclerosis is determined. Walls are normal blood vessels the retinas are not visible during examination, but only a column of blood is visible, in the center of which a bright light strip passes. With atherosclerosis, the vascular walls thicken, the reflection of light on the vessel becomes less bright and wider. The artery is already brown, not red. The presence of such vessels is called the "copper wire" symptom. When fibrotic changes completely close the blood column, the vessel looks like a whitish tube. This is a symptom of "silver wire".

The severity of atherosclerosis is also determined by changes in the places of intersection of the arteries and veins of the retina. In healthy tissues at the intersection, a blood column is clearly visible in the artery and vein, the artery passes in front of the vein, they intersect at an acute angle. With the development of atherosclerosis, the artery gradually lengthens and, with a pulsation, begins to compress and unfold the vein. With first-degree changes, there is a conical narrowing of the vein on either side of the artery; with changes of the second degree, the vein bends S-shaped and reaches the artery, changes direction, and then returns to its usual direction behind the artery. With changes of the third degree, the vein in the center of the decussation becomes invisible. Visual acuity with all the above changes remains high. At the next stage of the disease, hemorrhages appear in the retina, which can be punctate (from the wall of the capillaries) and dashed (from the wall of the arteriole). With a massive hemorrhage, blood breaks from the retina into the vitreous body. This complication is called hemophthalmos. Total hemophthalmos often leads to blindness, since blood cannot be absorbed in the vitreous body. Small hemorrhages in the retina can gradually resolve. A sign of retinal ischemia is "soft exudate" - cotton-like whitish spots in the mesh rim. These are microinfarctions of the layer of nerve fibers, zones of ischemic edema associated with the closure of the lumen of the capillaries.

In malignant hypertension, as a result of high blood pressure, fibrinous necrosis of the vessels of the retina and optic nerve develops. At the same time, there is a pronounced edema of the optic disc and retina. Such people have reduced visual acuity, there is a defect in the field of view.

In hypertension, the vessels of the choroid are also affected. Choroidal vascular insufficiency is the basis for secondary exudative retinal detachment in toxicosis of pregnant women. In cases of eclampsia - a rapid increase in blood pressure - a generalized spasm of the arteries occurs. The retina becomes "wet", there is a pronounced retinal edema.

With the normalization of hemodynamics, the fundus quickly returns to normal. In children and adolescents, changes in retinal vessels are usually limited to the stage of angiospasm.

Currently, the diagnosis of "arterial hypertension" is established if the anamnesis indicates a stable increase in systolic blood pressure (above 140 mm Hg) and / or diastolic (above 90 mm Hg) pressure (normal 130 / 85). Even with a slight increase in blood pressure, untreated arterial hypertension leads to damage to target organs, which are the heart, brain, kidneys, retina, and peripheral vessels. With arterial hypertension, microcirculation is disturbed, hypertrophy of the muscular layer of the vascular wall, local spasm of the arteries, stagnation in the veins, and a decrease in the intensity of blood flow in the capillaries are noted.

Changes detected during ophthalmoscopic examination in some cases are the first symptoms of hypertension and can help in establishing the diagnosis. Changes in the retinal vessels in different periods of the underlying disease reflect its dynamics, help determine the stages of the development of the disease and make a prognosis.

Stages of changes in retinal vessels in arterial hypertension

To assess changes in the fundus caused by arterial hypertension, the classification proposed by M. L. Krasnov is used, according to which three stages of changes in retinal vessels are distinguished.

The first stage - hypertensive angiopathy - is characteristic of stage I of hypertension - the phase of functional vascular disorders. At this stage, narrowing of the arteries and dilation of the retinal veins occur, the ratio of the caliber of these vessels becomes 1:4 instead of 2:3, uneven caliber and an increase in the tortuosity of the vessels are noted, a symptom of arteriovenous decussation of the first degree (Salus-Gunn symptom) can be observed. Sometimes (in about 15% of cases) in the central parts of the retina there is a corkscrew-like tortuosity of small venules (Guist's symptom). All these changes are reversible; with normalization of blood pressure, they regress.

The second stage - hypertensive angiosclerosis of the retina - the stage of organic changes. There is an uneven caliber and lumen of the arteries, their tortuosity increases. In connection with the hyalinosis of the walls of the arteries, the central light strip (a reflex along the course of the vessel) becomes narrower, acquires a yellowish tint, which makes the vessel look like a light copper wire. Later, it narrows even more and the vessel takes the form of a silver wire. Some vessels are completely obliterated and are visible as thin white lines. The veins are somewhat dilated and tortuous. This stage of arterial hypertension is characterized by a symptom of arteriovenous decussation - a symptom of Salus-Gunn). A sclerosed elastic artery that crosses the vein pushes it down, causing the vein to bend slightly (Salus-Gunn I). With an arteriovenous decussation of the II degree, the bend of the vein becomes clearly visible, arcuate. It appears to be thinned in the middle (Salus-Hun II). Later, the venous arch at the place of intersection with the artery becomes invisible, the vein seems to disappear (Salyus-Gunn III). Bends of the vein can provoke thrombosis and hemorrhage. Newly formed vessels and microaneurysms can be observed in the region of the optic nerve head. In some patients, the disc may be pale, monochromatic with a waxy tint.

The stage of hypertensive angiosclerosis of the retina corresponds to the phase of a steady increase in systolic and diastolic blood pressure in stage IIA and IIB hypertension.

The third stage is hypertensive angioretinopathy and neuroretinopathy. In the fundus of the eye, in addition to changes in blood vessels, hemorrhages appear in the retina, its edema and white foci, similar to lumps of cotton wool, as well as small white foci of exudation, sometimes with a yellowish tint, areas of ischemia appear. As a result of a violation of neuroretinal hemodynamics, the state of the optic nerve head changes, its edema and blurred boundaries are noted. In rare cases, in severe and malignant hypertension, a picture of a congestive optic disc is observed, and therefore there is a need for differential diagnosis with a brain tumor.

Accumulation of small foci around yellow spot form the shape of a star. This is a sign of a poor prognosis not only for vision, but also for life.

The state of the retinal vessels depends on the level of arterial pressure, the value of peripheral resistance to blood flow and, to a certain extent, indicates the state of the contractility of the heart. With arterial hypertension, diastolic pressure in the central retinal artery rises to 98-135 mm Hg. Art. (at a rate of 31-48 mm Hg. Art.). In many patients, the field of vision changes, visual acuity and dark adaptation decrease, light sensitivity is disturbed.

In children and adolescents, changes in retinal vessels are usually limited to the stage of angiospasm.

The changes in the retinal vessels revealed by the ophthalmologist indicate the need for active treatment of hypertension.

Pathology of the cardiovascular system, including arterial hypertension, can cause acute circulatory disorders in the vessels of the retina.

Acute obstruction of the central retinal artery

Acute obstruction of the central retinal artery (CAS) and its branches may be due to spasm, embolism, or thrombosis of the vessel. As a result of obstruction of the central retinal artery and its branches, ischemia occurs, causing degenerative changes in the retina and optic nerve.

Spasm of the central retinal artery and its branches in young people is a manifestation of vegetative-vascular disorders, and in the elderly, an organic lesion of the vascular wall occurs more often due to arterial hypertension, atherosclerosis, etc. A few days or even weeks before the spasm, patients may complain of temporary fogging vision, the appearance of sparks, dizziness, headache, numbness of the fingers and toes. The same symptoms can occur with endarteritis, some poisonings, eclampsia, infectious diseases, with the introduction of anesthetics into the mucous membrane of the nasal septum, the removal of a tooth or its pulp. Ophthalmoscopy reveals narrowing of all or individual branches of the central retinal artery with ischemia around. Obstruction of the trunk of the central retinal artery occurs suddenly, more often in the morning, and is manifested by a significant decrease in vision, up to complete blindness. If one of the branches of the central retinal artery is damaged, visual acuity may be preserved. Defects are detected in the field of view.

Embolism of the central retinal artery

Embolism of the central retinal artery and its branches is more often observed in young people with endocrine and septic diseases, acute infections, rheumatism, trauma. Ophthalmoscopy of the fundus reveals characteristic changes in the region of the central fossa - a cherry spot - a symptom of "cherry stone". The presence of a spot is explained by the fact that in this area the retina is very thin and a bright red choroid shines through it. The optic nerve disc gradually turns pale, and its atrophy occurs. In the presence of the cilioretinal artery, which is an anastomosis between the central retinal artery and the ciliary artery, there is additional blood flow in the area of the macula and the "cherry pit" symptom does not appear. Against the background of general ischemia of the retina, the papillomacular region of the fundus may have a normal color. In these cases, central vision is preserved.

With an embolism of the central retinal artery, vision is never restored. With a short-term spasm in young people, vision can return completely, with a long-term spasm, an unfavorable outcome is possible. The prognosis for elderly and middle-aged people is worse than for young people. When one of the branches of the central retinal artery is blocked, ischemic retinal edema occurs along the affected vessel, vision is only partially reduced, and the corresponding part of the visual field is lost.

Treatment of acute obstruction of the central retinal artery and its branches consists in the immediate appointment of general and local vasodilators. Under the tongue - a tablet of nitroglycerin, under the skin - 1.0 ml of a 10% caffeine solution, inhalation of amyl nitrite (2-3 drops per cotton wool), retrobulbar - 0.5 ml of a 0.1% solution of atropine sulfate or a solution of prikol (10 mg per one administration, daily for several days), 0.3-0.5 ml of a 15% solution of complamin. Intravenously - 10 ml of a 2.4% solution of aminophylline, intramuscularly - 1 ml of a 1% solution of nicotinic acid as an activator of fibrinolysis, 1 ml of a 1% solution of dibazole, 2 ml of a 2% solution of papaverine hydrochloride, 2 ml of 15% complamine.

1% solution of nicotinic acid (1 ml), 40% glucose solution (10 ml) is also administered intravenously, alternating it with a 2.4% solution of aminophylline (10 ml). If the patient has general diseases (cerebrovascular accident, myocardial infarction), anticoagulant therapy is indicated. With thrombosis of the central retinal artery resulting from endarteritis, retrobulbar injections of fibrinolysin with heparin are given against the background of intramuscular administration of heparin at a dose of 5000-10,000 IU 4-6 times a day under the control of blood clotting and prothrombin index. Then, anticoagulants of indirect action are prescribed inside - finilin 0.03 ml 3-4 times on the first day, and subsequently - 1 time per day.

Inside take eufillin 0.1 g, papaverine 0.02 g, dibazol 0.02 g, no-shpu 0.04 g, nihexin 0.25 g 2-3 times a day, trental 0.1 g 3 times a day.

Intramuscular administration of a 25% solution of magnesium sulfate, 5-10 ml per injection, is shown. Antisclerotic drugs (iodine preparations, methionine 0.05 g each, miscleron 0.25 g 3 times a day), vitamins A, B 6 , B, 2 and C are prescribed in usual doses.

Thrombosis of the central retinal vein

Thrombosis of the central retinal vein (CRV) occurs mainly in hypertension, atherosclerosis, diabetes mellitus, more often in the elderly. In young people, the cause of thrombosis of the central retinal vein can be a general (influenza, sepsis, pneumonia, etc.) or focal (more often diseases of the paranasal sinuses and teeth) infection. Unlike acute obstruction of the central retinal artery, thrombosis of the central retinal vein develops gradually.

In the stage of prethrombosis, venous congestion appears in the fundus. The veins are dark, dilated, tortuous, arteriovenous decussations are clearly defined. When performing angiographic studies, a slowdown in blood flow is recorded. With incipient thrombosis, the retinal veins are dark, wide, tense, along the course of the veins there is a transudative edema of the tissue, on the periphery of the fundus along the terminal veins there are pinpoint hemorrhages. In the active stage of thrombosis, a sudden deterioration occurs, and then a complete decrease in vision. With ophthalmoscopy, the optic disc is edematous, the borders are washed away, the veins are dilated, tortuous and intermittent, often immersed in the edematous retina, the arteries are narrowed, hemorrhages of various sizes and shapes are observed.

With complete thrombosis, hemorrhages are located throughout the retina, and with branch thrombosis, they are localized only in the basin of the affected vessel. Thrombosis of individual branches often occurs in the area of arteriovenous decussations. After a while, foci form white color- accumulation of protein, degeneration. Under the influence of treatment, hemorrhages can partially resolve, resulting in improved central and peripheral vision.

In the central zone of the fundus, after complete thrombosis, newly formed vessels often appear, which have increased permeability, as evidenced by the free release of fluorescein during angiographic examination. Complications of the late period of thrombosis of the central retinal vein are recurrent preretinal and retinal hemorrhages, hemophthalmos associated with newly formed vessels.

After thrombosis of the central retinal vein, secondary hemorrhagic glaucoma, retinal degeneration, maculopathy, proliferative changes in the retina, and optic nerve atrophy often develop. Thrombosis of individual branches of the central retinal vein is rarely complicated by secondary hemorrhagic glaucoma, dystrophic changes in the central region of the retina appear much more often, especially with damage to the temporal branch, since it drains blood from the macular retina.

With obstruction of the retinal veins in patients with hypertension, it is necessary to reduce blood pressure and increase perfusion pressure in the vessels of the eye. To lower blood pressure, it is necessary to give a tablet of clonidine, and to increase perfusion pressure in the vessels of the eye, reduce edema in the area of venous congestion and reduce extravasal pressure on the intraocular vessels, ethacrynic acid 0.05 g and diacarb 0.25 g 2 times a day are recommended within 5 days, as well as installation of a 2% solution of pilocarpine. Plasma inogen has a beneficial effect. Heparin and corticosteroids are injected parabulbarno, rheopolyglucin and trental are injected intravenously, heparin is administered intramuscularly, the dose of which is set depending on the blood clotting time: it should be increased by 2 times compared to the norm. Then indirect anticoagulants (phenylin, neodecoumarin) are used. Of the symptomatic agents, angioprotectors (prodectin, dicinone), drugs that improve microcirculation (complain, theonicol, trental, cavinton), antispasmodic drugs (papaverine, no-shpa), corticosteroids (dexazone retrobulbar and under the conjunctiva), vitamins, antisclerotic drugs are recommended. IN late dates(after 2-3 months) laser coagulation of the affected vessels is carried out using the results of fluorescein angiography.

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It is important to know!

Retinoblastoma is the most common malignant neoplasm in pediatric ophthalmology. This is a congenital tumor of the embryonic structures of the retina, the first signs of which appear at an early age. Retinoblastoma can occur sporadically or be inherited.

Angiopathy of the fundus is a pathological disorder in the blood vessels of the eyes, provoked by a disorder of nervous regulation. This disorder is not classified as an independent disease, but only as a symptomatic manifestation of other pathological processes in which blood vessels are affected.

Violation of the function of blood vessels and changes in their walls can lead to visual impairment, including retinal dystrophy, myopia, blurred vision. As a result of the course of the disease, the death of tissues that receive blood from the affected vessels can occur. In the advanced stage, the disease can provoke blindness.

It is important to determine the presence of the disease in a timely manner, to diagnose and treat in order to prevent the development of serious complications.

Features of the disease

Angiopathy (ICD 10: H35) is a pathological change in the veins and arteries penetrating the fundus of the eye. Such changes can be triggered by a deterioration in vascular tone or their organic lesions.

It should be noted that angiopathy does not belong to an independent disease, but only acts as a sign of primary pathology. That is, there are certain disorders that provoke problems with blood vessels.

In the early stages, the pathology is a completely reversible condition. If the cause of the lesion is eliminated in a timely manner, then retinopathy will pass on its own without additional treatment. However, if the disease is not recognized in time or treatment is not prescribed, then angiopathy will only progress over time. As a result, such a manifestation leads to a gradual loss of vision up to the onset of complete blindness.

Classification

During the appointment, the doctor not only establishes the diagnosis, but also determines the type of angiopathy of the fundus vessels. Among the main types of such pathology, it is necessary to highlight, such as:

hypotonic;
hypertensive;
dystonic;
mixed;
background;
diabetic;
traumatic;
venous.

The hypertensive type of angiopathy of the fundus is formed with prolonged hypertension, a similar pathology is provoked by blood-filled vessels. This leads to various kinds of degenerative changes in the retina. In this case, visual acuity often decreases, and there is a feeling of fogging. The condition of the person begins to gradually worsen.

Angiopathy of the fundus of the hypotonic type occurs as a result of reduced vascular tone and stagnation of blood in them. This pathology provokes thrombosis of capillaries. In this case, hemorrhage occurs in the retina and eyeball. As a result of changes, vision is greatly reduced.

The mixed type of pathology is provoked by the presence of systemic diseases that affect the vessels, and the capillaries of the fundus suffer in the first place. Such a violation is mainly observed in people over 30 years of age. It can lead to severe impairment of vision or its complete loss. The main manifestations are the appearance of pain, veils before the eyes, hemorrhages in the retina.

Diabetic angiopathy of the fundus vessels occurs mainly in diabetics. An insufficient amount of insulin in diabetes provokes a violation of glucose metabolism. At the same time, blood vessels throughout the body are greatly narrowed and affected. The eyes are affected first of all, which manifests itself in the form of myopia and even blindness.

Background eye angiopathy appears against the background of other diseases. With this type of pathology, dangerous dystrophy processes occur in the retina. It can be provoked by traumatic lesions, hypertension, diabetes, high blood pressure, work with constant eye strain.

Venous angiopathy occurs as a complication of other diseases associated with circulatory disorders. In this case, the blood flows much more slowly, which leads to hemorrhage and the formation of blood clots. Gradually, the veins become tortuous and somewhat dilated. As a result, blurred vision or myopia develops.

Traumatic angiopathy begins to develop as a result of compression chest, injuries of the brain, neck, as well as edema after concussion.

Angiopathy of the fundus in a child is often considered the norm. Often such a diagnosis is made immediately after the birth of the baby. However, pathology can signal the presence of congenital neurological problems. Often it is formed after various head injuries during difficult childbirth. At the same time, clouding of the eyes and the manifestation of a pronounced vascular network are noticeable.

Main reasons

Among the main causes of angiopathy of the fundus, it is necessary to highlight such as:

Hypertension.
Diabetes.
Vasculitis.
Osteochondrosis.
Injuries.
Diseases of the circulatory system.
Congenital vascular pathologies.
Elderly age.
Atherosclerosis.

Regardless of the causes of the pathology, angiopathy of the fundus vessels develops in the same way and, in the absence of timely treatment, can lead to complete loss of vision. When injured, the violation occurs only on one side. In all other cases, angiopathy of both eyes is observed. The diabetic and hypertensive form of pathology progresses especially rapidly.

Characteristic features

The main danger of eye angiopathy lies in its almost asymptomatic course. Often, pathology is detected quite by accident during an examination by an ophthalmologist. When the signs become clearly visible, then this stage of the disease requires a long and expensive treatment. Be sure to consult a doctor if you experience symptoms such as:

a sharp deterioration in vision;
frequent redness of the eyes;
the appearance of dots and veils before the eyes;
decrease in the field of view;
feeling of pulsation;
frequent eye diseases.

The first signs of the course of the pathology rarely cause concern, and the person practically does not go to the doctor, so the disease continues to progress. The most common symptoms of angiopathy of the fundus of the eye, occurring in later stages, are, such as:

decreased visual acuity and clarity;
deterioration in color sensitivity;
the appearance of dots before the eyes.

In the presence of systemic diseases, angiopathy can occur due to vascular fragility. In this case, the patient has minor bleeding or hemorrhage.

Now it is quite possible to determine the presence of pathology at the initial stage. With angiopathy of the retina, the fundus is examined in a complex manner, for this, methods such as:

ophthalmoscopy;
laser tomography;
visometry;
tonography;
computer perimetry.

Additionally, radiography, dopplerography and MRI may be required. This allows you to compose optimal scheme conducting therapy.

Angioscopy is diagnosed quite simply, it is much more difficult to find the main cause of its occurrence. To examine the vessels of the fundus, doctors perform ophthalmoscopy, which can be direct or indirect. No special preparation is required. In some cases, the doctor instills drops to dilate the pupil in order to see the fundus much better.

Features of treatment

After the diagnosis, the doctor prescribes treatment, which largely depends on the characteristics of the course of the disease and the cause that provoked it. Initially, you need to eliminate provoking factors. With prolonged hypertension, the doctor prescribes drugs that lower the pressure to the optimal level. If the pathology was provoked by diabetes, then you need to take medications that control sugar levels. In the presence of atherosclerosis of the vessels, the use of statins is required.

Treatment of angiopathy should be carried out in a complex manner using conservative and surgical techniques. To improve the effectiveness of therapy, consultation with other specialists is required. When conducting conservative therapy, drugs are used:

to improve blood microcirculation;
preventing thrombosis;
reducing the permeability of the eye vessels;
vitamin therapy.

Drugs are prescribed only by the attending physician, self-medication is unacceptable, as it can cause irreparable harm to health. An integral part of the therapy are physiotherapy sessions, in particular, laser irradiation and magnetic resonance therapy. If the vasopathy continues to progress more and more, then surgical intervention is performed.

Medical therapy

The basis of treatment is the elimination of the underlying disease. With the active development of disorders in the vessels, ophthalmic therapy is additionally prescribed. Eye drops are required for angiopathy, which help to normalize blood circulation in the vessels. In particular, such means as "Vazonit", "Trental", "Emoxipin", "Arbiflex" are used. These drugs are contraindicated during pregnancy and for the treatment of children (may be prescribed in the most extreme cases). Eye drops for angiopathy help to normalize vision and eliminate existing symptoms.

Also required drugs that prevent thrombosis, such as "Lospirin", "Trombonet", "Aspirin". It is imperative to take a course of vitamin therapy, and also require drugs that strengthen and tone the walls of blood vessels, for example, Calcium Dobesilate, Parmidin.

The duration of therapy, the treatment regimen, as well as the drugs used are selected individually for each patient. All therapeutic measures are determined by the attending physician. During pregnancy, there is a risk of rupture or dangerous damage to the vessels of the retina during labor and childbirth. Therefore, angiopathy becomes an indication for caesarean section.

Techniques traditional medicine must be used in combination with traditional treatment. Before taking non-traditional remedies, a doctor's consultation is required to prevent the occurrence of complications. Treatment is carried out with the help of decoctions and infusions of medicinal herbs.

To cleanse the vessels, you need to prepare an infusion of birch buds, yarrow, immortelle. You need to mix the herbs in equal proportions, then take 1 tbsp. l. the finished mixture, pour 0.5 liters of boiling water and leave to infuse for 15 minutes. Then strain the finished product and dilute with boiled water to the original volume. Take one part of the medicine at bedtime, and the second early in the morning. The course of therapy lasts 10 days.

To strengthen the vessels, you need to mix the mountaineer, horsetail, hawthorn. You need to take 2 tsp. finished product, pour 200 ml of boiling water and leave to infuse for 30 minutes. Infusion should be taken in 1 tbsp. l. 3 times a day. The course of therapy is 20 days.

Possible Complications

Violation of the functioning of blood vessels can lead to various kinds of dystrophic changes in the retina. In addition to visual impairment or myopia, such a pathology can lead to its complete loss. If timely treatment is not carried out, then this can provoke such complications as:

rapid deterioration of vision;
glaucoma;
hemorrhages in the retina;
progression of myopia;
cataract;
decreased functioning of the optic nerve;
retinal disinsertion;
complete blindness.

In the advanced stages of the course of the disease, treatment may not be effective enough. It is important to recognize the course of the pathology in time, until irreparable dangerous changes in the retina begin to occur.

Forecast

The prognosis for angiopathy directly depends on the correctness and timeliness of the treatment. If you pay attention to the presence of a problem in time, then the pathological processes occurring in the vessels of the eyes can be stopped or prevented from developing complications.

However, in advanced stages, angiopathy can lead to partial or complete loss of vision. In addition, there is high risk retinal detachments. In this case, the treatment is carried out by laser coagulation.

Carrying out prevention

Angiopathy of the retina occurs in the case of existing health problems, which is why it is very important to take care of your body as a whole. Optometrists advise not to overload the eyes with prolonged sitting at the computer, reading books, needlework. For better functioning of the organs of vision, it is necessary to pause for people of mental labor, as well as to carry out special gymnastics for the eyes.

Since at the initial stages of the course of the disease it does not manifest itself in any way, it is important to conduct a comprehensive preventive examination by an ophthalmologist every year. The condition of the affected vessels is often irreversible, and over time, such a pathology can lead to complete blindness.

People over 40 years of age and those who have any chronic diseases should regularly visit a doctor. Choosing the right method of therapy and lifestyle correction allows you to stop the progression of the disease.

Vascular pathologies of the eyes should never be ignored. If you have eye problems, you should definitely consult a doctor. Only a qualified ophthalmologist should treat angiopathy.

By following preventive measures, you can prevent the formation of a dangerous pathology.

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. That's why 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 deviation from the norm and the slightest change 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 different opinions, not visible.

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 be detected this species diagnostics? They are the following:

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.
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.
cancer . An experienced eye doctor can detect not only signs oncological disease brain, but also other organs. And on early stage when the patient is still pain free. Therefore, we can safely say that timely ophthalmoscopy can save a person's life.
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.
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.

Article author: Anna Golubeva

The frequency of damage to the fundus in patients with hypertension, according to various authors, varies from 50 to 95%. This difference is partly due to age and clinical differences in the studied group of patients, but mainly due to the difficulty of interpreting the initial changes in the retinal vessels in hypertension.

Doctors attach great importance to such changes in the early diagnosis of GB, determining its stage and phase, as well as the effectiveness of the therapy.

Errors in diagnosis may be associated with significant individual variations in retinal vessels in healthy people, and some of the variants (relatively narrow arteries, increased tortuosity of the vessels, the "crossover" symptom) may be misinterpreted as hypertensive changes.

Retinal and optic nerve vessels

1 - ONH
2 - funnel of the optic nerve with the central vessels of the retina;
3 - n. nasal arteriole;
4 - n. nasal venule;
5 - n. temporal venule;
6 - n. temporal arteriole;
7 - yellow spot with c. fossa;
8 - c. temporal arteriole;
9 - c. temporal venule;
10 - in. nasal arteriole;
11 - c. nasal vein.

The central retinal artery in its orbital section has a structure typical of medium-sized arteries. After passing through the cribriform plate of the sclera, the thickness of the vascular wall is halved due to the thinning (from 20 to 10 microns) of all its layers. Inside the eye, the artery divides repeatedly dichotomously. Starting from the second bifurcation, its branches lose their characteristic features of arteries and turn into arterioles.

The supply of the intraocular part of the optic nerve is carried out mainly (with the exception of the neuroretinal layer of the optic nerve head) from the posterior ciliary arteries. Posterior to the cribriform plate of the sclera, the optic nerve is supplied with centrifugal arterial branches coming from the central retinal artery and centropetal vessels extending from the ophthalmic artery.

The capillaries of the retina and optic disc have a lumen with a diameter of about 5 µm. They start from precapillary arterioles and join into venules. The endothelium of the capillaries of the retina and the optic nerve forms a continuous layer with tight junctions between cells.

Retinal capillaries also have intramural pericytes, which are involved in the regulation of blood flow. The only blood collector for both the retina and the optic disc is the central retinal vein.

The adverse effect of various factors on the retinal circulation is smoothed out due to vascular autoregulation, which ensures optimal blood flow using local vascular mechanisms. Such blood flow ensures the normal course of metabolic processes in the retina and optic nerve.

Pathomorphology of retinal vessels in hypertension

Pathological changes in the initial transient stage of the disease are hypertrophy of the muscle layer and elastic structures in small arteries and arterioles.

Stable hypertension leads to

hypoxia,
endothelial dysfunction,
plasma impregnation of the vascular wall, followed by hyalinosis and arteriolosclerosis.

In severe cases, fibrinoid necrosis of arterioles is accompanied by thrombosis, hemorrhages and microinfarctions of the retinal tissue.

retinal vessels

Two vascular trees are clearly visible in the fundus: arterial and venous. It should be distinguished:

the expression of each
branch features,
the ratio of the caliber of arteries and veins,
the degree of crimping of individual branches,
the nature of the light reflex on the arteries.

The severity and richness of the arterial tree depend on the intensity of blood flow in the central artery, refraction, and the state of the vascular wall. The more intense the blood flow, the better the small arterial branches are visible and the more branched the vascular tree. In hypermetropia, retinal vessels appear wider and brighter on ophthalmoscopy than in emmetropia, while in myopia they become paler. Age-related thickening of the vascular wall makes small branches less noticeable, and arterial tree fundus in the elderly looks depleted.

In hypertension, the arterial tree often looks poor due to tonic contraction of the arteries and sclerotic changes in their walls. Venous vessels, on the contrary, often become more pronounced and acquire a darker, more saturated color. It should be noted that in some cases, provided that the elasticity of the vessels is preserved, in patients with hypertension, not only venous, but also arterial plethora is observed. Changes in the arterial and venous vascular bed are also manifested in a change in the arteriovenous ratio of retinal vessels. Normally, this ratio is approximately 2:3; in hypertensive patients, it often decreases due to narrowing of the arteries and dilated veins.

Narrowing of the retinal arterioles is not an obligatory symptom. Pronounced narrowing, which can be determined clinically, occurs in only half of the cases. Quite often only separate arterioles are narrowed. Characterized by the unevenness of this symptom. It is manifested by the asymmetry of the state of the arteries in paired eyes, the narrowing of only individual vascular branches, and the uneven caliber of the same vessel. In the functional phase of the disease, these symptoms are caused by unequal tonic contraction of blood vessels, in the sclerotic phase - by uneven thickening of their walls.

Much less often than the narrowing of the arteries, with hypertension, their expansion is observed. Sometimes both narrowing and dilation of arteries and veins can be seen in the same eye and even on the same vessel. In the latter case, the artery takes the form of an uneven chain with swellings and interceptions.

One of the frequent symptoms of hypertensive angiopathy is a violation of the normal branching of the retinal arteries. Arteries usually branch dichotomously at an acute angle. Under the influence of increased pulse beats in hypertensive patients, this angle tends to increase, and it is often possible to see branching of the arteries at a right and even obtuse angle (“bull horns symptom”). The greater the branching angle, the greater the resistance to blood flow in this zone, the stronger the tendency to sclerotic changes, thrombosis and disruption of the integrity of the vascular wall. High blood pressure and large pulse amplitude are accompanied by an increase not only in lateral, but also longitudinal stretch vascular wall, which leads to elongation and tortuosity of the vessel. In 10–20% of patients, tortuosity of the perimacular venules is also observed (Guist symptom).

Significant significance for the diagnosis of hypertonic fundus is the symptom of the Gunn-Salus chiasm. The essence of the symptom lies in the fact that at the site of intersection with the compacted artery of the venous vessel, a partial squeezing of the latter occurs.

There are three clinical degrees of this symptom.

The first degree is characterized by a narrowing of the lumen of the vein under the artery and near the junction of the vessels.
A feature of the second degree is not only partial squeezing of the vein, but also its displacement to the side and into the thickness of the retina (“arc symptom”).
The third degree of decussation of the vessels is also characterized by a symptom of the arch, but the vein under the artery is not visible and seems to be completely compressed. The symptom of crossover and venous compression is one of the most frequent in hypertension. However, this symptom can also be found in retinal arteriosclerosis without vascular hypertension.

Symptoms pathognomonic for retinal arteriosclerosis in hypertension include the appearance of side bands (cases) along the vessel, symptoms of copper and silver wire. The appearance of white side stripes is explained by the thickening and decrease in the transparency of the vascular wall. The streaks are visible along the edge of the vessel, as there is a thicker wall layer and a thinner layer of blood compared to the central part of the vessel. At the same time, the light reflection from the anterior surface of the vessel becomes wider and less bright.

copper wire symptom It is found mainly on large branches and is distinguished by an expanded light reflex with a yellowish tint. The symptom indicates sclerotic changes in the vessel with a predominance of elastic hypertrophy or plasma impregnation of the vascular wall with lipoid deposits.

Silver wire symptom appears on arterioles of the second or third order: the vessel is narrow, pale, with a bright white axial reflex, often it seems to be completely empty.

Retinal hemorrhages

Hemorrhages in the retina in hypertension occur by diapedesis of erythrocytes through the altered wall of microvessels, rupture of microaneurysms and small vessels under the influence of high blood pressure or as a consequence of microthrombosis.

Especially often hemorrhages occur in the layer of nerve fibers near the optic disc. In such cases, they look like radial strokes, stripes or flames. In the macular zone, hemorrhages are located in the layer of Henley and have a radial arrangement.

Much less often, hemorrhages are found in the outer and inner plexiform layers in the form of spots. irregular shape.

Retinal exudates

For hypertension, the appearance of soft exudates resembling cotton wool is especially characteristic. These greyish-white, loose-looking anteriorly protruding lesions appear predominantly in the parapapillary and paramacular zones.

They arise quickly, reach their maximum development within a few days, but never merge with each other. During resorption, the focus gradually decreases in size, flattens and fragments.

A cotton-wool lesion is an infarction of a small area of nerve fibers caused by occlusion of microvessels. As a result of the blockade, axoplasmic transport is disrupted, nerve fibers swell, and then fragment and disintegrate.

It should be noted that such foci are not pathognomonic for hypertensive retinopathy and can be observed with

stagnant discs,
diabetic retinopathy,
occlusion of the central retinal vein,
some other lesions of the retina, in which necrotic processes develop in arterioles.

Unlike cotton wool lesions, solid exudates in hypertension have no prognostic value. They can be punctate or larger, rounded or irregularly shaped, located in the outer plexiform layer and consist of lipids, fibrin, cellular debris and macrophages.

It is believed that these deposits result from the release of plasma from small vessels and the subsequent degeneration of tissue elements. In the macular region, solid lesions are banded and radially arranged, forming a complete or incomplete star figure. They have the same structure as other solid foci. With the improvement of the patient's condition, the figure of the star may resolve, but this process takes a long time for several months or even several years.

Edema of the retina and optic disc

Edema of the retina and optic disc, combined with the appearance of soft foci, indicates severe course illness.

Edema is localized mainly in the peripapillary zone and along the large vessels. At great content proteins in the transudate, the retina loses its transparency, becomes grayish-white, and the vessels are sometimes covered with edematous tissue.

Edema of the optic disc can be expressed in varying degrees from a slight blurring of its contour to a picture of a developed congestive disc. A congestive disc is often associated with peripapillary retinal edema, retinal hemorrhages, and cotton wool lesions.

visual functions

Decreased dark adaptation is one of the earliest functional signs in hypertensive retinopathy.

At the same time, there is a moderate narrowing of the isopters and the boundaries of the field of view, as well as an expansion of the "blind spot". With severe retinopathy, scotomas can be detected, localized in the paracentral region of the visual field.

Visual acuity decreases much less frequently: with ischemic maculopathy, macular hemorrhages, with the occurrence of edematous maculopathy and with the formation of an epiretinal membrane in the late stage of neuroretinopathy.

Classification of hypertensive changes in the fundus

Currently, there is no generally accepted classification of hypertensive angioretinopathy. In Russia and neighboring countries (the former republics of the USSR), the most popular classification is M.L. Krasnov and its modifications.

M.L. Krasnov singled out three stages of fundus changes in HD:

hypertensive angiopathy, characterized only by functional changes in the retinal vessels;
hypertensive angiosclerosis;
hypertensive retinopathy and neuroretinopathy, in which not only the vessels are affected, but also the retinal tissue, and often the optic disc.

sclerotic,
renal and
malignant.

The most severe changes in the retina are observed in renal and especially malignant forms.

The stages of hypertension and the prognosis for the patient's life are determined by the height of blood pressure and the severity of vascular changes in the kidneys, heart and brain. These changes are not always parallel with retinal lesions, but there is still a certain relationship between them. Therefore, multiple retinal hemorrhages, the appearance of areas of ischemia, non-perfused zones, cotton-like exudates, as well as pronounced edema of the optic disc, peripapillary retina indicate a severe progressive nature of the disease and the need to change and intensify therapeutic measures.

Treatment of hypertensive neuroretinopathy

Therapy for hypertensive (neuro)retinopathy is treatment of the underlying disease.

To reduce ischemia the retinas use vasodilators that dilate mainly the vessels of the brain and eyes (trental, cavinton, ksavin, stugeron).

To reduce hypoxia oxygen inhalation is often used. However, oxygen can cause constriction of the retinal vessels. Therefore, they prefer to prescribe inhalations of carbogen, which, in addition to oxygen, contains carbon dioxide (58%). Carbonic acid has a strong vasodilatory effect on the vessels of the brain and eyes.

To improve the state of blood rheology and prevention of thrombosis using antiplatelet agents.

It should be borne in mind that the elimination of retinal ischemia can lead to the development of postischemic reperfusion syndrome, which consists in excessive activation of free radical processes and lipid peroxidation. Therefore, constant intake of antioxidants (alphatocopherol, ascorbic acid, veteron, diquertin) is essential.

It is useful to prescribe angioprotectors, especially doxium.

Preparations containing proteolytic enzymes (wobenzym, papain, recombinant prourokinase) are used to resolve intraocular hemorrhages.

For the treatment of retinopathy of various origins, transpupillary irradiation of the retina is prescribed using a low-energy infrared diode laser.

VASCULAR CHANGES OF THE EYE FOUNDATION IN GENERAL DISEASES

The vessels of the fundus change similarly to the vessels of the whole organism.

The ophthalmologist sees arteries, arterioles, capillaries, veins.

In 1978, Ernest proved that arteries have autoregulation, but only retinal vessels have it.

Normal fundus: what we see are columns of blood. Arteries are already veins. A:V=2:3.

TsSP - the central light strip - in the center of the vessel, it is associated with the sphericity of the vessel.

On the veins of the CSP - 1/12d - in the place of the first bifurcation at the entrance to v. opticus.

HYPERTONIC DISEASE

Stage I - hypertensive angiopathy - transient, accompanied by spasm of the arteries, plethora of veins, the ratio a:v=1:3.

The central light strip has become narrower and brighter on the arteries.

Due to phlebopathy - CSP appears on the veins of the second and third order.

The narrowing of the arteries leads to the closure of part of the capillaries - the arterial tree is pale.

The veins are dilated, plethoric, + CSP (phlebopathy).

Irregularity of the caliber of the arteries along the length - angiospasm due to incomplete autoregulation.

Guist symptom- corkscrew-shaped tortuosity of venules due to a multiple increase in blood pressure.

Due to the repeated increase in blood pressure, phlebopathy develops, i.e., venous pressure rises and compression and expansion of blood vessels occur, vascular hypoxia appears, hyalinosis of the vessel walls (sclerosis) develops - the CSP becomes yellowish (normally pink) and wider.

When the vessel begins to sclerosis, then spasm occurs sausage symptom(pericytes die - muscle-type cells, shrink) - sclerotic changes begin.

white line symptom- the accompanying strip is associated with sclerotic changes in the vessel wall (turbidity next to the blood column).

Symptom "tulip" or "bull horns"- normal bifurcation of the artery at an acute angle. With an increase in blood pressure, an impact is exerted on the site of impact, a bifurcation reversal occurs - an obtuse angle is formed.

Symptom of Bunnasalus(Relman-Salus, Salus-Gunn) - in the presence of closely spaced (adjacent) veins and arteries. The artery should be over the vein and close + cross. It is based on a “concrete” artery and a soft, supple vein.

Depending on the severity of sclerosis of the artery wall, there may be 3 variants of the symptom:

Ø narrowing of the vein at the intersection with the artery

Ø the adducting segment of the vein is wider than the efferent and narrowing at the site of compression

Ø The afferent segment is wide, the outlet is barely visible, there is almost no blood flow after the intersection with the artery.

The wall of the artery in a different way begins to refract light due to hyalinosis of the vessel, highlighting of the blood (copper color) - dangerously hemophthalmos due to rupture of the vein.

Symptom of "copper" and "silver" wire:

Ø copper - sclerosis increases and the contents are visible in a different color

Ø silver - hyalinosis through the entire wall, there may be no blood flow

Various formations can be deposited inside the vascular wall, which leads to an uneven internal caliber of the vessels.

Stage I - hypertensiveangiopathy

Ø hypertensive angiospasm(m. b. in pregnant women): spasm --- ischemia --- sclerosis

constriction of arteries, dilation of veins

ü poor arterial tree

ü dilated venous tree

ü CSP is narrow, bright on the arteries

ü DSP on veins of the second and third order

ü uneven caliber of arteries along the length

Gwist's symptom

Ø hypertensive angiospasm with symptoms of initial arteriosclerosis

ü CSP yellowish color on the arteries

ü accompanying strips

ü symptom of sausages, tulip

Ø hypertensive angiospasm with symptoms of severe sclerosis

ü symptom of "copper" and "silver" wire

ü uneven internal caliber of blood vessels

Reynon-Sylus sign

"Concrete" arteries and increased blood pressure leads to the development of vascular parosity, the release of erythrocytes, fibrin, and hemorrhages appear in the fundus (the retina is affected), which leads to the formation of stage II - angioretinopathy.

IIstage - angioretinopathy

hemorrhages - resolve in 2-3 weeks or more, localization of hemorrhage is important.

Ø according to the type of flame in the center

Ø rounded on the periphery

Ø irregular shape with a deep lesion

Ø under the choroid, severe complications develop: retinal atrophy, decreased vision

Plasma output (fibrin):

Ø stearin foci (in case of DM)

Ø the figure of a star in old age is a very formidable symptom

Ø cotton-like foci - after them atrophy, pigment deposits - are formed due to capillary sclerosis (heart attack) and are a sign of a malignant course

IIIstage - neuroretinopathy

Changes in blood vessels, retina, which leads to the suffering of the optic nerve - comes last.

Ø edema of the optic disc, due to which it will promenade (stand) into the vitreous body

Ø the optic disc is enlarged

Ø disc edema extends to the retina

Ø m. b. hemorrhages

Ø visual acuity usually does not change, because there are no organic disorders (it can decrease with hemorrhages in the macular zone or paramacular zone)

KIDNEY PATHOLOGY

Sclerotic changes, plasmorrhagia, star figures.

With spasm of the arteries or dilatation of the veins, the arterial tree is poor.

Glomerulonephritis, amyloidosis, nephrosclerosis, CRF develop.

Istage - renal angiopathy- similar to the analogous stage with GB, m. b. more pronounced tortuosity of the veins due to toxic effects on the vascular wall, causing cell death.

IIstage - renal angioretinopathy- changes in the general background of the retina - pale dull with a yellowish component. Often these changes are tied to large retinal vessels. Toxic changes are based on toxic vascular damage, plasmatic and hemorrhagic components lead to the formation of edema as a result of increased permeability of the vascular wall, fibrin deposits, stearin deposits.

Ø A star shape is formed in the area of the spot ( bad sign). It can also form with acute renal failure in children, with adequate therapy it resolves.

Edema (toxicosis) of the retina, optic disc, m. retinal disinsertion.

IIIstage - renal neuroretinopathy

NEPHROPATHY OF PREGNANT WOMEN

Ø myopia of pregnant women- the eye is stretched, the choroid is torn, the retina is stretched, which, with attempts, can break (traumatic detachment), which will lead to blindness. Myopia of 6 diopters or more is a relative contraindication to childbirth.

Very often there are hemorrhages, secondary retinal detachment:

Ø due to increased blood pressure, vascular porosity develops:

ü hemorrhages, white watery foci

ü hemorrhages through the gap - in the form of a tongue of flame - this is very bad for hemorrhages in the central zone - abortion

Ø secondary retinal detachment- transudative - due to the release of fluid from the vessels (diapedesis) - termination of pregnancy

Indications for childbirth:

preeclampsia, eclampsia

hemorrhage in the macula

- plasmorrhagic foci

ATHEROSCLEROSIS

Changes can proceed according to the type of ischemic, necrotic and fibrinous lesions.

Ø poor arterial tree

Ø Guist symptom -

Ø a symptom of uneven caliber along the length -

Ø symptom of sausages -

Ø tulip symptom m. b. due to atherosclerosis

small hemorrhages. Atrophic changes in the macular zone.

Symptom "copper" and "silver", symptom of Salus II, III stage.

DIABETES

In diabetes, all types of metabolism are affected. Essence:

Ø newly formed vessels- compensatory process - defective, fragile, therefore, plasmorrhagia, aneurysms, hemorrhages develop

Ø proliferation phenomena- tissues grow inside the eye, along which the vessels go. Due to the movement of the vitreous body, the newly formed films are torn, hemorrhages appear, which lead to blindness. Grows from the optic nerve into the retina connective tissue which leads to blindness.

Changes in the lens.

Changes from the side of the fundus.

Istage - angiopathy- phlebopathy, dilated, newly formed, tortuous veins, microaneurysms in the central zone.

IIstage - angioretinopathy:

Ø initial

a large number of pinpoint hemorrhages

ü exudative foci around the macula

waxy (stearic) exudates

ü visual acuity decreases to 0.7-0.9

Ø expressed

o multiple hemorrhages

thrombosis of small veins

visual acuity less than 0.7

IIIstage - proliferative retinopathy– see above phenomena of proliferation

Laser coagulation is effective only in stage I.

DISORDERS OF THE VENOUS CIRCULATION OF THE RETINA

It can occur with or without prodromes.

At the core - a feature of the structure of the veins - there are no circular muscle fibers, only longitudinal ones, therefore, with spasm, the veins expand, the wall thins, and permeability increases. If these changes capture the paramacular zone, then vision is distorted, spots appear before the eyes.

If only the retina is interested, then the reflex will be normal.

Crushed tomato symptom- in the fundus of the eye, the veins are dilated, pathological tortuosity, plasmorrhagia, hemorrhages.

Ø there may be resorption of areas of hemorrhagic, plasma impregnation

Ø unstable, self-absorbable and re-emerged. disorders - prodrome

Ø if the macular zone is practically not involved, then the central vision will be mature, if the damage to the macula is a minor effect

Ø secondary glaucoma may develop - newly formed vessels grow in (pathological, malignant process), which leads to an increase in IOP - post-thrombotic glaucoma

After hemorrhage, IOP control is mandatory.

Lutger's syndrome- This is a bilateral violation of venous circulation, a bilateral decrease in visual acuity, which is based on a sharp compression of the chest, causing overflow of the veins, including the retinal veins.

Tactics:

Ø angioprotectors

Ø blood rheology

Ø lasix in / m

Ø Urgent hospitalization in the eye department

PRODROM - the phenomenon of Ernst

“I got nervous and lost my sight, then I rested - it came back”

Prodrome - this is a short-term loss of vision, due to the formation of a parietal thrombus and spasm, which leads to a temporary cessation of blood flow, because of this, autoregulation of the retina is turned on and pressure is compensated in the central retinal artery and ischemic phenomena are eliminated. Border time 3-4 minutes.

At the time of spasm, not only the retina is ischemically damaged, but also the vessel itself, which leads to desquamation (loss) of endothelial cells, therefore, the zeta potential changes, a sludge syndrome occurs, leading to thrombosis and blockage of the vessel, then thromboembolism may develop.

With pathology (sclerosis, angioretinopathy, etc.), angiospasm can be delayed, which leads to irreversible changes and blindness. The front section is absolutely calm.

Ø complaint:

ü Decreased vision

ü Veil in front of the eyes, first from the side, then passes to the entire eye from the periphery

ü a spot immediately appeared from the center

There may be a funnel-shaped detachment in the terminal stages: painless, redness of the eye may not be (if it is not traumatic, then no).

Ø fact of injury - even if the injury was 6 months ago or more

Ø surgical eye injuries

Ø check visual acuity and field of view:

ü when viewed in transmitted light, the location of the detachment can be detected

ü gray tint of the reflex, m. b. a clear demarcation line or a smooth transition of the pink reflex to gray - it is better to look with a wide pupil (after instillation)

Ø if the detachment is old and not associated with a tumor, then hypotension of the eye is determined - T "-"

Tactics: sent to the hospital.

PIGMENTARY RETINA DEGENERATION

Pigmentary retinal degeneration begins in childhood and progresses.

Ø heredity

Ø begins with a decrease in visual acuity in the dark - hemeralopia - night blindness

Ø field of view change

Ø bilateral, symmetrical disease

Ø reflex grey, black, alternating with pink (unchanged areas)

Ø blindness by 40-50 years

Ø may be secondary strabismus

Ø m. b. pigmentless degeneration - same symptoms

First, an annular scotoma develops, which is not subjectively felt, but then there is a narrowing of the visual fields, it becomes difficult for the patient to navigate in space.

The optic disc is pale, bone bodies = pigment cells appear in the fundus. They move from the periphery to the center and there are more and more of them, up to the confluence.

Tactics: if retinitis pigmentosa is suspected, refer to an ophthalmologist at a polyclinic.

Lifelong maintenance therapy is provided.

optic neuritis

Ø intrabulbar neuritis

Ø retrobulbar neuritis - outside the eyeball

Causes:

ü general inflammatory diseases

inflammation of the brain and its membranes

ü from neighboring organs - ENT organs, oral cavity

ü toxic-allergic manifestations

ü toxic - tropism to the optic nerve

Complaints:

Ø intrabulbar neuritis

ü Decreased visual acuity

constriction of visual fields

ü Decreased color perception

ü photopsies - flashes - periphery

Ø retrobulbar neuritis +

o headaches

pain behind the eye due to toxic effects on the oculomotor muscles - pain on movement

ü m. b. exophthalmos on the affected side

ü strabismus

Objectively:

Ø reduced eye movement

Ø exophthalmos - determined using exophthalmometry - normally 17-18 mm protrusion of the eyeball from the orbit

A simplified way to determine exophthalmos:

ü eyelids move apart, the width of the palpebral fissure increases - the measurement is carried out with an ordinary ruler in the vertical direction in the widest part at the same distance from the eye on the right and left. If the difference is more than 2 mm, then this is a pathology, if less than 2 mm - a variant of the norm.

The patient takes an object in his hand and looks at it. The doctor tilts the patient's head back, raises the eyelids and asks to set the object so that the anterior poles of the cornea are directed forward - we look at whether they are at the same level. Normally, the eyeball will stand for 1-2 mm, if more - pathology.

Differential diagnosis of optic neuritis with congestive optic disc:

Ø the nature of complaints is taken into account:

Complaints arise later - already as a sign of the outcome

headache occurs early

Ø additional examination - CT, Rg, ophthalmoscopy

Causes of unilateral exophthalmos:

Ø phlegmon of the orbit

Ø tumor

Ø retrobulbar hematoma in blunt trauma.