Inspection of eyelids, connective membrane, cornea, iris

1. Begin a study of the patient with a scan of the eyelids, in which the condition of the skin and the edges of the eyelids, their position( curvature, eversion), eyelash growth, the width of the eye gap, the presence of photophobia, lacrimation, spasm.

2. Inspection of the connective sheath is possible only with the eyelids turned out. The lower eyelid is turned out in the following stages:

• the patient should look up;

• pull the lower eyelid downwards;

• lightly press it against the bone edge of the orbit.

In this case, the mucous membrane of the lower eyelid and the transitional fold become visible.

3. For inspection of the mucous membrane of the upper eyelid, the patient should look downwards. The study should be carried out in the following stages:

• put the palm of the left hand on the forehead of the patient and pull the upper eyelid upward with the thumb;

• With the thumb and forefinger of the right hand, grasp the edge of the eyelid and pull it downwards, while under the skin the cartilage is delineated;

• press the eyelid with the thumb of the left hand or a glass rod, and, as at the fulcrum, unscrew the eyelid;

• after the eversion of the eyelid, it is necessary to remove the hand or wand, and turn the turned eyelid to the upper edge of the orbit.

For examination of the upper transitional fold, press the right hand on the eyeball through the lower eyelid and move it upward under the upper eyelid. In cases where this way it is not possible to twist the upper transitional fold well, you can use the eyelid. It is placed on the skin of the eyelid above the cartilage with a convex tip and, using it as a lever, twists the eyelid, pulling it off at the end of the instrument and holding the edge of the eyelid with a finger near the upper edge of the orbit.

All manipulations require careful treatment, especially with corneal ulcers and eye traumas, as sharp or rough handling can result in corneal perforation. It should be explained to the patient that during the examination he should behave calmly, do not move his head and look in the direction in which it is necessary for research.

4. Before examining the conjunctiva, one should note the presence or absence of a conjunctival detachable. When copious, it is necessary to remove it, wiping the edges of the eyelids with a moist tampon, then rinse the conjunctival sac with a disinfectant solution. Only after carrying out this procedure is it possible to turn the eyelids. This treatment is necessary to prevent pus from entering the patient's eyes. It is advisable to wear protective goggles. During the examination of the conjunctiva, attention should be paid to its color, thickness, which is determined by the clarity of the vascular pattern and the translucence of the vertical meibolic glands and cartilage through conjunctiva, the presence of follicles, scars, films. The detachable conjunctival sac is taken for a bacterioscopic examination. The procedure should be carried out with sterile instruments( slide glass or platinum loop).When bacteriological research is carried out with the observance of all the required rules, the culture is separated into a nutrient medium and stained with Gram stain.

5. When examining lacrimal passages, it is necessary to note the skin condition of this area, the location of lacrimal points, establish the presence or absence of stasis and tearing lachrymation. Next, you need to lightly press on the area of ​​the lacrimal sac and pay attention to whether pus or mucus from the lacrimal points is not prominent.

6. Violation of the patency of the lacrimal passages is detected when carrying out a collateral test, washing lacrimal passages, probing, radiography.

The collar-gage sample should be carried out according to the following scheme:

• inoculate into the conjunctival bag 2% solution of collargoll;

• after 3 minutes, note the absorption of the drug in the tear duct and disappearance from the conjunctival sac;

• easy to press on the area;

• determine the response to the sample:

a) if, upon pressing the lacrimal sac from the lower lacrimal point, a drop of collargolum protrudes, the positive tubular sample and the normal function of the lacrimal point and tubule are detected;B) if the collargol remains in the conjunctival sac longer than 3-5 minutes, overflows with a tear across the edge of the eyelid, does not secrete from the lacrimal point when pressing on the area of ​​the lacrimal sac, a negative tubular test and a violation of the lacrimal point and tubule function are determined.

Nasal collargot probe is performed to determine the patency of the bag and the tear duct. It can be carried out in two ways.

The first way. In the nose of the patient under the lower nasal conch insert a cotton swab and a conjunctival bag is instilled in the collargoll. In the patency of lacrimal passages after 5 minutes, a positive test is noted - cotton wool is stained with collargol. The absence of tampon staining and a negative reaction to the sample are established if the lacrimal passages are impassable.

The second way. In the eye of the patient instilled a collargol, and after 5 minutes he was offered to clean every nostril. When passing through lacrimal canals, the discharge from the nose is colored.

Sensing and rinsing. These methods are used to determine the site of narrowing or obstruction of lacrimal passages. First, preliminary conjunctival anesthesia is carried out by triple digestion of a solution of dicaine( lidocaine).Then the conical probe dilates the lower lacrimal point and injects into the tear duct with 5-10 ml of physiological saline through a special cannula or ordinary needle with blunt end. If the patency of the lacrimal tract is normal, the fluid can spill out of the nose. In cases of constriction or obstruction of lacrimal pathways, fluid flows out by drops, flows through the upper or lower lacrimal point. Washing of lacrimal points with disinfectant solutions is used for medical purposes.

Radiography is the most accurate and safe method for determining the condition of lacrimal passages. X-rays are taken after the injection of a contrast agent into the lacrimal sac.

7. To examine the anterior segment of the eye in children, especially with spasm of the eyelids, the eye gap is opened by the eyelids. In this case, the nurse or the mother of the child should put the patient on his knees, with one hand to hold his body and hands, and the other - to firmly hold his head to him. The legs of the child need to be fixed between the knees. Under the upper eyelid, carefully inject the eyelid.

8. Examination of the eye is usually carried out in a dark room with side or focal light. To do this, left in front of the patient, at the level of the head set an electric lamp and with a biconvex magnifier at 20.0 D collect the rays coming from the lamp in focus on the cornea. Such illumination makes it possible to see small changes in the cornea, iris, anterior part of the lens. It is even easier to see them if, when looking at the side light, consider the eye through the second loupe at 13.0 D, placed in front of the eye at its focal length, or with the help of a binocular magnifying glass fixed to the head with a special hoop. The best opportunity for examining the anterior part of the eye is provided by a slit lamp with a corneal microscope.

9. During examination of the cornea it is important to note its size, shape, transparency, gloss and specularity. The violation of these properties indicates the inflammatory process of the cornea. Also, surface and deep vessels can grow into it. Sometimes on the back surface of the cornea are whitish or brown points - precipitates - deposits of pigment and exudate in inflammatory diseases of the vascular tract. The sensitivity of the cornea is determined by touching it with a fiber of cotton wool, which is normally accompanied by the closing of the eyelids( corneal reflex) and sensation of touch.

10. The highest efficiency of inspection of the front camera and its contents - chamber moisture - is achieved by using focal light. The main signs of normal and pathological conditions are given in Table.

Table

Main signs of normal and pathological condition of the anterior chamber and its contents