Inspection age , connective membranes , cornea, iris
1. Begin study of patients with a tour of the age at which the set condition of the skin and the edges of the eyelids, their position (inversion, eversion), growth of eyelashes, ocular slit width, the presence of photophobia, lacrimation, spasm.
2. Inspection connecting shell is only possible when inverted eyelids.The lower eyelid is turned out in the following stages:
• patient should look upward;
• pull down the lower eyelid;
• lightly press it to the bony edge of the orbit.
This becomes visible mucous membrane of the lower eyelid and the transitional fold.
3. patient should look down the city's upper eyelid mucosa.The study should be conducted in the following stages:
• put on the patient's forehead with the palm of his left hand and thumb its upper eyelid to pull up;
• thumb and index finger of the right hand to seize the edge of the eyelid and pull it down, and the cartilage under the skin outlines;
• pressure on the eyelid with the thumb of the left hand or a glass rod, and, as a point o
• after eversion century have to take your hand or a stick, but inside-eyelid clamped to the upper edge of the orbit.
city's top transition folds should press his right hand on the eyeball through the lower lid and push it up under the upper eyelid.In cases where this is not possible by a well-turn upper labial fold, you can use vekopodemnikom.He put the convex end of the skin and the cartilage above the century, using it as a lever to evert the eyelid, pulling it to the end of the tool and holding the edge of the eyelid with your finger from the top edge of the orbit.
All procedures require a cautious attitude, especially in corneal ulcers and eye injuries as a sharp or rough handling can occur corneal perforation.It should be explained to the patient that during the inspection it must be calm, do not move your head and look in the direction in which it is necessary for the study.
4. Before examining the conjunctiva is necessary to note the presence or absence of conjunctival discharge.With abundant discharge of you want to remove it, wiping the edge of the eyelid wet swab, and then rinse the conjunctival sac with a disinfectant solution.Only after this procedure may be reversing a century.This processing is necessary to prevent pus in the eyes of the patient.It is advisable to wear safety glasses.During the inspection of the conjunctiva should pay attention to its color, thickness, which is determined by the definition of vascular pattern and radiography of vertical meybolievyh glands and cartilage through the conjunctiva, the presence of follicles, scarring, films.Discharge conjunctival sac to take microscopy studies.The procedure should be performed with sterile instruments (substantive piece of glass or platinum loop).Bacteriological examination of compliance with all the rules of conduct required to discharge crop nutrient medium and Gram stain.
5. In the study of lacrimal system is necessary to note the condition of the skin in the area, the position of the lacrimal points, to establish the presence or absence of stagnant tears and tearing.Next, you need a little extra pressure on the area of the lacrimal sac and pay attention, do not stand there pus or mucus from the lacrimal points.
6. Violation of lacrimal patency observed during kollargolovoy sample washing lacrimal system, sensing, medical imaging.
Kollargolovuyu trial should be conducted as follows:
• drip into the conjunctival sac of a 2% solution of colloid silver;
• 3 minutes to note the absorption of the drug in the tear ducts and the disappearance of the conjunctival sac;
• easy to put pressure on the region;
• determine the reaction to the trial:
a) if the pressure on the area of the lacrimal sac from the bottom of the tear drop Collargol point appears, the tubular sample is determined by the positive and normal function of the lacrimal points and canaliculi;
b) if the colloid silver remains in the conjunctival sac 3-5 minutes longer, with a tear spills over the edge of the century, did not stand out from the lacrimal point with pressure on the area of the lacrimal sac, the defined negative sample and tubular dysfunction of the lacrimal points and canaliculi.
bow kollargolovaya test is conducted to detect cross-sac and nasolacrimal duct.It can be done in two ways.
first method.The patient's nose under the inferior turbinate and insert a cotton swab into the conjunctival sac bury collargol.When lacrimal patency after 5 minutes there is a positive test - wool dyed Collargol.The lack of staining swab and a negative reaction to a sample set with obstruction of lacrimal system.
second method.In the eyes of the patient collargol buried, and after 5 minutes he offered to clear each nostril.When cross-lacrimal secretions from the nose is painted.
probing and washing.These methods are used to determine the constriction or obstruction lacrimal system.First, conduct a preliminary anesthesia of the conjunctiva by triple instillation of tetracaine solution (lidocaine).Then the cone penetration extend lower lacrimal point and a syringe through a special cannula or needle with the usual blunt end is introduced into the lacrimal canaliculus 5-10 ml of saline.If the permeability of the lacrimal ducts in the normal stream of liquid can be poured from his nose.In cases of lacrimal system obstruction or narrowing of the fluid flows drops poured through the top or bottom of the tear point.Washing of lacrimal points disinfectants are used for therapeutic purposes.
Radiography is considered the most accurate and secure method of determining the state of lacrimal system.X-rays do after the administration of contrast medium into the lacrimal sac.
7. To inspect the anterior segment of the eye in children, especially in the spasm of the eyelids, eye slit open vekopodemnikami.At the same time the nurse or mother must be put on the patient's knees, with one hand to hold his body and hands, and the other - firmly pressed his head to her.Feet need to fix the child between his knees.Under the upper eyelid gently introduced vekopodemnik.
8. Inspection of the eye is usually carried out in a dark room by a side or focal lighting.To do this, on the left in front of the patient, at the head set and an electric lamp with biconvex magnifier in 20.0 L collected coming from the lamp rays in focus on the cornea.This lighting gives an opportunity to see small changes in the cornea, the iris, the anterior part of the lens.Even easier for them to notice if a side light viewed through the second eye loupe to 13.0 A, set before the eye on its focal length, or with the help of binocular magnifying glass that special hoop is attached to the head.The best opportunities for viewing the anterior eye section gives a corneal slit lamp microscope.
9. During the inspection of the cornea is important to note its size, shape, transparency, gloss and reflectivity.Violation of these properties indicates the inflammatory process of the cornea.Also, it can grow into superficial and deep vessels.Sometimes, on the back surface of the cornea visible whitish or brown dots - precipitates - and exudate deposition of pigment in inflammatory diseases of the vascular tract.Corneal sensitivity is determined by touching her wool fibrils that normally accompanied by closing the eyelids (corneal reflex) and the sense of touch.
10. The greatest impact of the inspection of the anterior chamber and its contents - moisture chamber - is achieved by using a focal light.Main features of the normal and the pathological condition shown in Table.
main features of the normal and pathological state of the anterior chamber and its contents