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Federal State Budgetary Educational Institution of Higher
Education «I.P.Pavlov Ryazan State Medical University»
of the Ministry of Healthcare of the Russian Federation;
Department of eye and ENT diseases
A.V. Kolesnikov, L.V. Mironenko,
M.A. Kolesnikova, V. A. Sokolov
PRINCIPLLES OF
EXAMINATION OF PATIENTS WITH
DIFFERENT OPHTHALMIC
PATHOLOGIES
Methodical recommendations for foreign students of the
medical faculties (in English medium)
Ryazan 2018
Федеральное государственное бюджетное
образовательное учреждение
высшего образования
«Рязанский государственный медицинский
университет имени академика И.П. Павлова»
Министерства здравоохранения Российской Федерации
(ФГБОУ ВО РязГМУ Минздрава России)
Кафедра глазных и ЛОР болезней
А.В. Колесников, В.А. Соколов, М.А. Колесникова,
Л.В. Мироненко
ОСОБЕННОСТИ ОБСЛЕДОВАНИЯ
ПАЦИЕНТОВ С РАЗЛИЧНОЙ
ОФТАЛЬМОЛОГИЧЕСКОЙ
ПАТОЛОГИЕЙ
Методические рекомендации для
самостоятельной работы иностранных
студентов лечебного факультета
(на английском языке)
Рязань 2018 г.
2
UDС 617.7-07 (075.83)
BBС 56.7
P 92
Reviewers: L.A. Zhukova, Ph.D., assistant professor of therapeutical department
with family medicine caurse of the P.Gs. education faculty
V.A. Zhadnov, M.D., assistant professor of the department of nervous
system diseases and neurosurgery
Authors: A.V. Kolesnikov, Ph.D., assistant professor
M.A. Kolesnikova, Ph.D., assistant professor
L.V. Mironenko, Ph.D., assistant professor
V. A. Sokolov, M.D., professor
Translated by Kardicheva L.I.
P 92 Principlles of examination of patients with different ophthalmic pathologies:
methodical recommendation for foreign students of the medical faculties (in
English medium) / A.V. Kolesnkov [and others]; FSBEI HE RyazSMU MOH,
– Ryazan: TSD and OP, 2018. – 76p.
The student independent work is the development of the creative abilities. It
plays a key role in the system of the education process.
Students can see the ophthalmologic patients first at ophthalmology
department. The examination of patients has many new specific characteristics.
As a rule, students working independently, have difficulties to gain the
anamnesis and choose necessary methods of examination to determine the
symptoms of a disease. The aim of the manual is to arm students with skills of
successful work.
UDС 617.7-07 (075.83)
BBС 56.7
© Authors, 2018
© FSBEI HE RyazSMU MOH, 2018
3
УДК 617.7-07 (075.83)
ББК 56.7
O-754
Рецензенты: Л.А. Жукова, доцент кафедры терапии и семейной медицины
ФДПО с курсом медико-социальной экспертизы ФГБОУ ВО
РязГМУ Минздрава России
В.А.Жаднов, доктор мед. наук, доцент кафедры нервных
болезней и нейрохирургии
Авторы: А.В. Колесников, к.м.н., доц., зав. кафедрой глазных и ЛОР-болезней;
М.А. Колесникова, к.м.н., доц. кафедры глазных и ЛОР-болезней;
В.А. Соколов, д.м.н., профессор кафедры глазных и ЛОР-болезней;
Л.В. Мироненко, к.м.н., доц. кафедры глазных и ЛОР-болезней
O-754 Особенности обследования пациентов с различной офтальмологической
патологией: методические рекомендации для самостоятельной работы
иностранных студентов лечебного факультета (на английском языке) /
А.В. Колесников [и др.]; ФГБОУ ВО РязГМУ Минздрава России. –
Рязань: ОТС и ОП, 2018. – 76 с.
В настоящих рекомендациях излагаются все наиболее распространенные
методы обследования органа зрения. Приводится краткое описание
современных
приборов,
с
помощью
которых
производится
офтальмологическое обследование.
Данные
методические
рекомендации
предназначены
для
самостоятельной работы иностранных студентов лечебного факультета и
помогут им в подготовке к практическим занятиям по офтальмологии.
УДК 617.7-083.98 (075.83)
ББК 56.7
© ФГБОУ ВО РязГМУ Минздрава России, 2018
© Авторы, 2018
4
Contents
Preface………………………………………………………………….…..6
Examination of a patient with anomalies of refraction…………………....6
Examination of a patient with the eyelid diseases……………………... 11
Examination of a patient with lachrymals diseases……………………..…16
Examination of a patient with strabismus…………………………….…...20
Examination of a patient with diseases of the conjunctiva………………..24
Examination of a patient with keratitis……………………………………32
Examination of a patient with iridocyclitis………………………….…….38
Examination of a patient with pathology of the crystalline lens…………..45
Examination of a patient with glaucoma…………………………….……54
Examination of a patient with ocular injuries………………………….….58
Conclusion…………………………………………………………………75
Literature…………………………………………………………………..76
5
PREFACE
Students deal with eye pathology on the ophthalmology department.
That is why students must learn characteristics of ophthalmic
examination. Various eye pathology must be evaluated by special
methods of examination. Given methodical recommendations will help
foreign students to acquire skills of independent work with patients
having various ophthalmologic pathology.
I. EXAMINATION OF A PATIENT WITH ANOMALIES OF
REFRACTION
Anamnesis:
Characteristic complaints.
The start of the failing sight arise.
Possible reasons of failing sight (as a result of previous diseases).
Previous treatment (correction, medicamental therapy)
Physical examination:
1. Examination of central visual acuity without correction.
2. Examination of clinical refraction by the subjective method
(adjusting of correcting eyeglasses). In the case of nearsightedness, we
must take first eyeglass, with which the patient has total acuity of vision;
in the case of longsightedness we must take last eyeglass, in order not to
switch the accomodation in the case of nearsightedness and to relax
completely the accomodation in the case of longsightedness.
3. Examination of clinical refraction by objective methods (skiascopy,
refractometry, ophthalmometry), in the case of cycloplegia.
4. Examination of presbyopia and its correction.
5. External examination of eyes.
6. Examination of refractive medium by the method of lateral light:
examination of the cornea, the anterior chamber, the lens.
6
7. Examination of deep refractive medium by passing light:
examination of the lens, and vitreous body.
8. Ophthalmoscopy.
9. Writing out a prescription for eyeglasses.
Practical skills:
1. To write down the results of visual acuity examination with
correction of refraction anomalies.
2. To use an optic lenses kit.
3. To differentiate concave lenses from convex lenses and to determine
their optic power lenses by the neutralization method.
4. To determine clinical refraction by subjective method. Adjusting
glasses in myopia, hypermetropia and presbyopia.
5. To determine the pupillate distance.
6. To determine the optic centers in glasses.
7. To write out a prescription for eyeglasses and bifocals.
8. To prepare the working place for skiascopy and to arrange the
approximate examination (to see the shadow shift in dilated pupil).
9. To determine the near visual point.
10.To calculate the accommodation range.
Situation tasks:
Refraction.
1. A 30-year-old patient has the following refraction:
OD=E
OS=M 4.0 D
Prescribe correcting glasses.
2. A 20-year-old patient has the following refraction:
OD=M 2.0 D OS=M 5.0 D.
Prescribe correcting glasses.
3. A 10-year-old patient has refraction
OD=M 2.0 D OS=H 5.0 D. Prescribe correcting glasses.
7
4. A 50-year-old patient has refraction
OD=H 5.0 D OS= M 2.0 D. Prescribe correcting glasses.
5. A 15-year-old child has refraction
OD=H 5.0 D OS=M 2.0 D. Prescribe correcting glasses.
6. A 40 year-old patient’s refraction is
OD=H 2.0 D OS =M 1.0 D.
Prescribe glasses for a short distance work.
7. Prescribe bifocals for a 70-year-old hypermetropic patient with 3.0
D.
8. Prescribe correcting glasses for a 75-year-old patient with
emmetropic refraction.
9. Where is the far visual point located in a myopic patient whose
volume of accommodation is 12.0 D?
10. The far visual point is located at a distance of 50 cm in front of the
eye. Define the kind of clinical refraction and prescribe correcting
glasses.
11. A patient admitted to infection department on account of food
poisoning with sausage noticed visual impairment: decrease in near
vision whereas distance vision remained normal. On checking visual
acuity on the chart she could read from 5 to 10 lines with both eyes.
How can visual impairment be explained?
12. After preventing examination a 7-year-old boy was directed to
an oculist on account of decrease in vision. The boy had noticed
8
decrease in distance vision about a year before. His near vision was
normal.
Examination showed: Vis OD=0.2-2.0 D=1.0
OS=0.3-1.75 D=1.0
Make a diagnosis and give recommendations.
13.A 40 year-old teacher has been using glasses +1.5 D on reading and
writing for five years, prescribed to him by an oculist to whom he came
with complaints of fast fatigability of the eyes and headaches on reading.
Wearing these glasses he began to see long distances better, though he
had thought that his distance vision was excellent. But lately he can’t see
small print well.
How can you explain visual impairment in the patient?
What examinations and prescriptions will be required?
14. Is accommodation volume equal in two students of the same age
having respectively myopia with 0.3 D and hypermetropia with 2.0 D?
Calculate this volume if it is known that the near visual point lies at 11.5
cm in the hypermetropic student and at 7.2 cm in the myopic student.
15. A 15-year-old patient complains of decreased visual acuity in both
eyes since childhood, rapid fatigability, pain in the eyes and headache on
intensive work. She repeatedly consulted a doctor who prescribed
glasses for her. But the glasses didn’t cause significant improvement.
Examination showed: Vis OD=0.06-6.0D=0.9
OS=0.1 correction not accepted
During skiascopic investigation it was revealed: myopia of 6.0D in the
right eye and hypermetropia of 0.3D in the left eye. Explain the
character of visual impairment and means of treatment.
16. At the end of the school year a pupil began to complain of
decrease in distance vision, rapid fatigability of the eyes on reading,
headache. At the beginning of the school year visual acuity in both eyes
9
equaled 1.0. During examination it was revealed: visual acuity in both
eyes was 0.1; correction –2,5D increased it to 1.0.
What disease can be supposed?
What would you undertake to make a more exact diagnosis?
17. A 30-year-old patient has broken glasses without which she can’t
see well. She has been suffering from myopia since childhood and worn
glasses since the 1st class. The patient repeatedly changed her glasses for
stronger ones as myopia has been progressing. During last 5-6 years
doctors can’t select glasses with which she could see long distance as
well as before.
Vis OD=0.02-18.0 D=0.2
OS= 0.01-15.0 D=0.3
The eye fundus: large staphylomae around the disks of optic nerves,
spots of pigmentation in the mascular zones, numerous big white
focuses of chorioretinal distrophy in the paramacular zone.
Make a diagnosis, prescribe correction and treatment.
18. A 50-year-old engineer has come to an oculist for consultation. He
has been using glasses for a short distance since he was 35. Last time an
oculist prescribed glasses with +1.5 D five years ago. Now wearing
these glasses the patient can see short distances worse. He feels pressure
in the eyes and headaches after work. He also complains of decrease in
distant vision though earlier he could see long distances well. No
pathological changes in the eyes have been revealed.
Vis OD=0.4-2.0 D=1.0
OS=0.3-2.0 D=1.0
Formulate a diagnosis and prescribe treatment.
10
II. EXAMINATION OF A PATIENT WITH THE EYELID
DISEASES
The most typical complaints are sharply full-grown reddening of
eyelid with painful swell; frequent sties, frequent or permanent
reddening of the eyelid margins, itch, frequent winking, foamy
accumulation in the external canthus, shedding of eyelashes; painless
pea-like infiltration (hailstone); incremental birthmarks, warts,
ulcerations; entropion, ectropion, twitching and closing of eyes tight,
unclosing eye-slit (sleep with an open eye), lowering upper eyelid;
overhand pleats of skin, oedema of eyelids in the morning, one-sided
oedema of eyelids (livid spot, bruise), cosmetic defects.
Anamnesis:
1. The beginning of the disease.
2. What are the reasons of the diseases to the patient’s mind?
3. The presence of systemic diseases.
4. Previous diseases of eyes.
5. Profession of the patient, the presence of professional insalubrities.
Physical examination:
1. Examination of central visual acuity without correction and with
correction.
2. External examination of eyes with the help of binocular magnifier.
Pay attention to the appearance, size and form of eye-slit and eyelids
(eye-slit is pared-down, dilated, short-cut, anomalous; eyelid is enlarged,
incrassate, skin’s pleats are smoothed, there are deformations, defects,
scarring) should be drawn.
The skin colour (pale, scarlet, cyanotic, icteric, violet), its surface
(smooth, shining, uneven with birthmark, wart, ulceration, obtrusive
new growth, eminent callous prominence, mobility subject to tissues)
should be determined. If there is a local swell, it should be determined,
manually (hard, solid, resilient, elastic, pasty, fluctuating, pulsatile,
11
crepitant, ect.). If there is an oedema, it should be determined, what it is:
“cold” (pale, watery, soft) or “hot” (red, strained, painful infiltration).
The ciliary margin of the lids (incrassate, hyperemic, smooth, even,
uneven, ulcerous), density of the eyelashes, growth regularity, wisp
agglutination, presence of alopecia, scales, ulcerations, scabs by root of
eyelashes should be determined. The position of eyelid to the surface of
eyeball should be determined (normal, solid adjacency, inadhesive,
entropion, ectropion). The tone of orbicularis muscle can be determined
by ability of lower eyelid to come back to the initial position after
drawing it off.
Practical skills:
1. To evert the lid.
2. To prepare a solid tampon turned over the end of a probe or a glass
rod for greasing of the lid margins.
3. To grease and cauterize the lid margins in blepharitises and sties.
4. To do the epilation of eyelaches.
5. To place some ointment behind the eyelids.
6. To learn UHF-therapy, therapy of dry warm in eyelids diseases
(blues light, paraffin, dry compress).
7. To massage of the eyelids by a glass rod.
8. To put a plaster to avoid spastic entropion of the eyelids.
Термины по теме – The terms on the theme
ВЕКО(И)
EVELID(S)
upper lid
lower ltd
abscess of the eyelid
adenocarcinoma of the lid
inflammation of the lid margins,
blepharitis
lid retraction
lid evertion, ectropion
верхнее веко
нижнее веко
абсцесс века
аденокарцинома века
воспаление краев век,
блефарит
втяжение века выворот века,
эктропион
12
гемангиома века
дефект края века, колобома века
заворот века
контагиозный моллюск век
ксантелазма век,
опущение/птоз [верхнего] века,
отек века (век)
отрыв века
разрыв века
рак кожи века
базальноклеточный рак кожи века
ранение века
ресничный край век
сальные железы век, мейбомиевы
железы
свисание истонченной кожи
верхнего века, блефарохалазис
сращение век между собой и
глазным яблоком,
анкилоблефарон
lid hemangioma
lid coloboma, coloboma palpebrale
blepharelosis, entropion
molluscum contagiosum of the
eyelids
xanthelasma palpebrarum[upper]
lid ptosis
edematous lid(s)
lid abruption
lid rupture
skin carcinoma of the lid
skin basal cell carcinoma of the lid
lid injury
ciliary margin of the lids
meibomian glands
blepharochalasis
ankyloblepharon
флегмона века
lid phlegmon
фурункул века
lid furuncle
экзема кожи века
lid skin eczema
глазная щель, щель век
eye-slit, ocular fissure
кожный рог
спазм вековой части круговой
мышцы глаза, блефароспазм
халазнон, градина
эпикантус
ресницы
ячмень
внутренний ячмень
наружный ячмень
cutaneous horn
blepharospasm
chalazion
epicanthus
eyelashes
sty, hordeolum
inner/ internal sty
outer/external sty
13
вывернуть веко
вывернуть веко с помощью
векоподъемника (стеклянной
палочки)
слипаться (о веках)
смыкать веки, закрывать глаз(а)
to evert a lid
to evert a lid with the aid of an
eyelid lifter (glass rod)
to stick together (of lids)
to close lids, to close eye(s)
БЛЕФАРИТ
ангулярный блефарит
мейбомиевый блефарит
простой/чешуйчатый блефарит,
себорея век
язвенный блефарит
розацеа-блефарит
БЛЕФАРОСПАЗМ
истерический блефароспазм
клоннческий блефароспазм
рефлекторный блефароспазм
симптоматический блефароспазм
старческий блефароспазм
тонический блефароспазм
эссенцнальный блефароспазм
BLEPHARITIS
angular blepharitis
meibomian blepharitis
simple/squamous blepharitis
ulcerative blepharitis
rosacea blepharitis
BLEPHAROSPASM
hysterical blepharospasm
clonic blepharospasm
reflex blepharospasm
symptomatic blepharospasm
senile blepharospasm
tonic blepharospasm
essential blepharospasm
TURNING OUT OF AN
EYELID. EVERS1ON OF AN
EYELID. ECTROPION,
ECTROPIUM
atonic eversion of an eyelid
paralytic eversion of an eyelid,
paralytic ectropion
cicatricial eversion of an eyelid
spastic eversion of an eyelid
ВЫВОРОТ ВЕКА,
ЭКТРОПИОН
атонический выворот века
паралитический выворот века
рубцовый выворот века
спастический выворот века
старческий выворот века
senile ectropion
ГЛАЗНАЯ ЩЕЛЬ, ЩЕЛЬ ВЕК
EYE-SLIT, OCULAR FISSURE
узкая глазная щель
narrow eye-slit
широкая глазная щель
wide eye-slit
14
смыкание глазной щели
неполное смыкание глазной
щели, лагофтальм
сужение глазной щели
угол глазной щели
укорочение и сужение глазной
щели, блефарофимоз
ширина глазной щели
ОТЕК ВЕКА (ВЕК)
аллергический отек век
ангионевротический отек век
травматический отек век
ПТОЗ
ВЕКА
(ВЕК),
БЛЕФАРОПТОЗ
врожденный птоз века
двусторонний птоз век
миогенный птоз века
односторонний птоз века
паралитический птоз век
полный (неполный) птоз века
приобретенный птоз века
старческий птоз век
поза звездочета
РЕСНИЦА (Ы)
густые (редкие) ресницы
неправильный рост ресниц,
трихиаз века
полное выпадение ресниц,
мадароз прекращение роста
ресниц
closing of eye-slit
incomplete closing of eye-slit,
lagophthalmos
narrowing of the eye-slit
canthus
blepharophimosis
eye-slit width
LID EDEMA
allergic lid edema
angioneurotic lid edema
traumatic lid edema
EYELID
PTOSIS,
BLEPHAROPTOSIS
congenital eyelid ptosis
bilateral eyelid ptosis
myogenic/myogenetic/myogenous ptosis
unilateral eyelid ptosis
paralytic eyelid ptosis
complete (incomplete) eyelid ptosis
acquired eyelid ptosis
senile eyelid ptosis
posture of an astrologer
EYELASH(ES)
dense (thin) eyelashes
trichiasis of the lid
total falling out of eyelashes
non-growth of eyelashes
15
III. EXAMINATION OF A PATIENT WITH LACHRYMALS
DISEASES
The most typical complaints are persistent eyewatering especially
caused by wind. Besides of it, some patients complain of discharge of
pus, protrusion in projection of lacrimal sac and recurrent abscesses. In
the case of dacryocystitis in infants, parents are notice eyewatering and
pus discharge from one eye or both ones during first days or weeks of
living.
Anamnesis:
1. The beginning of the disease.
2. The reasons of the disease.
3. Previous diseases of eyes.
4. Profession of the patient, the presence of professional insalubrities.
Physical examination:
the most frequent reasons of eyewatering are:
1.Unsubmerged lacrimal points into the lacrimal lake touching softly
the eyelid margins (ectropion).
2. Inflammation of the ducts, lacrimal sac, nasolacrimal duct.
3. Narrowing or obstruction at any part of the lacrimal ducts.
The physical examination begins with external examination. Pay
attention to eyelids position, size and location of lacrimal point. They
must adjoin the eyeball and submerge into the lacrimal lake in the region
of semilunar pleat. The aperture of lacrimal opening is about 0.5 mm in
average. Plentiful accumulation of tear along the back margin of lower
eyelid (dilation “rivrus lacrimalis”) is a definite sign of disturbance of
lacrimal abstraction. The region of lacrimal sac should be carefully
examined. A protrusion under medial palpebral commissure which is
sometimes so large that it take a form of big kidney bean appearing
through the fairy skin (dropsy of lacrimal sac) may be observed.
16
The cardinal sign of dacryocystitis is the pus discharge from lacrimal
points by thumb pressure at region of lacrimal sac. The pressure should
be done under medial palpebral ligament bottom-up.
The examination of functional permeability of lacrimal ducts should be
performed in every case. To do it the tear should be dyed (put with an
dropper the 3 % solution of collargol or 1 % solution of fluorescein in
eye) and determine a ductus and nasal colour tests. If nasal test is
negative or slowed, wash out of lacrimal ducts with physiological
solution from syringe with dull thick needle or special cannula.
Diagnostic probing of the lacrimal ducts is not recommended because
of possible injure of mucous tunic with subsequent formation of scarry
strictures. Sometimes, a rontgenogram with infill their contrast
substance (30 % solution of iodolipol) should be performed to get the
more clear picture of the lacrimal ducts outlines.
Practical skills:
1. To examine the lacrimal ducts permeability by the ductus and nasal
tests.
2. To prepare the tool kit for washing out lacrimal ducts.
3. To wash out the lacrimal ducts.
4. To dilate the lacrimal point by a conical probe.
5. To squeeze out pus from lacrimal sac in the case of chronic
dacryocystitis.
6. To observe probing lacrimal ducts in the case of dacryocystitis in
infants.
Situation tasks:
Diseases of lacrimal organs.
1. A 55-year-old patient has had an incremental film in the left eye for
several years. Lately he can see worse with this eye.
Examination shows: Vis OD=1.0 / VisOS=0.4, correction not accepted
17
The right eye is normal. The left eye: from the internal corner a pink
film is crawling over the cornea. The film has a form of a triangle which
apex reaches the central corneal section and the wide base is facing the
semilunar fold.
Make a diagnosis and administer treatment.
2. A 48-year-old patient complains of redness and edema of the eyelids
with sharp painfulness at the internal corner of the right eyelid. Pain and
slight swelling at this place appeared three days ago. Last night she
couldn’t sleep because of severe pain, fever and temperature to 38.5˚.
Watering and purulent discharge have troubled her for several months.
On examination: Vis OD=1.0.
There is an evident edema and hyperemia of the eyelids, spreading over
the cheek. There is a dense crimson infiltrate with sharp painfulness on
palpation at the internal corner of the eye. Fluctuation is present in the
central section.
Formulate a diagnosis and means of treatment.
3. A 74-year-old patient complains of blindness, watering and purulent
discharge from the left eye. The symptoms have troubled her for three
days.
Examination shows: Vis OD=0.3+2.0 D=1.0 Vis OS=1/ ∞ pr 1.c.
OD: the supplementary apparatus is unaltered, optic mediums are
transparent, the eye fundus is normal.
OS: there is excessive watering at the margins of the lower eyelid.
When depressing with a finger under the medial ligament of the eyelids
the tear points extract profuse purulent discharge. The conjunctiva is
hyperemic. The cornea is transparent, the anterior chamber is of medium
depth. The pattern of the iris is distinct; it has the same color as the right
one. The pupil is grey with normal reactions. A reflex from the eye
fundus is absent.
Make a diagnosis and a plan of treatment.
18
4. Watering and purulent discharge appeared in a child of 3 weeks
old. When depressing on the region of the lacrimal sac the tear points
extract mucous-purulent discharge.
Form a diagnosis and administer treatment.
5. A 34-year-old patient has: OD: passive congestion in the veins of
the forehead, ptosis, immobility of the eyeball: slight exophthalmos,
impairment of sensitivity of the anterior section of the eye, midriasis and
accommodation paralysis.
OS is normal.
Make a diagnosis.
Термины по теме – The terms on the theme
СЛЕЗНЫЕ ОРГАНЫ
LACRIMAL ORGANS
носослезный канал/проток
nasolacrimal canal/duct
атрезия носослезного канала
отверстие носослезного канала
слезная железа
воспаление слезной железы,
дакриоаденит
слезная точка
выворот слезной точки
сужение слезной точки
слезное озеро
слезный каналец
слезный мешок
слезный сосочек
слезовыделение
избыточное слезовыделение
отсутствие слезовыделения
слезоотводящие пути
слезотечение
atresia of nasolacrimal duct
orifice/opening of nasolacrimal duct
lacrimal gland
lacrimal gland inflammation/infection, dacryoadenitis
lacrimal point/opening
lacrimal opening eversion
lacrimal opening stricture
lacrimal lake
lacrimal duct
lacrimal sac
lacrimal papilla
lacrimation, tearing
excessive tearing
lack/absence of tears
lacrimal ducts/tracts
running eyes, epiphora, watery eyes,
eyewatering
to probe lacrimal ducts
зондировать слезопроводящие
19
пути промывать слезные пути
расширять слезную точку
СЛЕЗНЫЙ КАНАЛЕЦ
воспаление слезного канальца
непроходимость слезного канальца сужение слезного
канальца
СЛЕЗНЫЙ МЕШОК
воспаление слезного мешка,
дакриоцистит
водянка слезного мешка
свищ слезного мешка
флегмона слезного мешка,
ДАКРИОЦИСТИТ
острый дакриоцистит, флегмона
слезного мешка
хронический дакриоцистит
дакриоцистит новорожденных
to wash out/bathe lacrimal ducts
to widen the lacrimal opening
LACRIMAL DUCT
lacrimal duct inflammation
lacrimal duct obstruction
lacrimal duct stricture/narrowing
LACRIMAL SAC
lacrimal sac inflammation,
dacryocystitis
lacrimal sac dropsy
lacrimal sac fistula
lacrimal sac phlegmon,
DACRYOCYSTITIS
acute dacryocystitis, lacrimal sac
phlegmon
chronic dacryocystitis
dacryocystitis of the newborn
IV. EXAMINATION OF A PATIENT WITH STRABISMUS
Anamnesis:
1. The beginning of the disease.
2. The reasons of the disease.
3. Previous diseases of eyes.
Physical examination:
1. External examination of eyes.
2. Examination of visual acuity:
a) without correction;
b) with correction (in eyeglasses or with necessary correction).
3. Examination of clinical refraction by objective method (by
skiascopy, by refractometry, by ophthalmometry).
4. Examination of the vision type:
20
a) by colour devices or polaroid.
b) with aide of prism.
c) by adjusting movement of eyes.
5. Examination of eye movements.
6. Examination of squint angle:
a) following the method of Hyrchberg;
b) using synoptophore;
c) using perimeter;
7. Examination of refracting medium of the eyes and the eye fundus.
8. Diagnose.
Plan of therapy.
1. Optic correction of ametropia (after examination of refraction eyes
using the cycloplegia).
2. Therapy of amblyopia;
a) method of direct occlusion;
b) method of negative successive images (at BO);
c) method of local blinding irritation by light of optic pit ( at BO).
3. Preoperative orthoptic exercises for rehabilitation of binocular
vision:
a) using the synoptophore;
b) using the stereoscope;
c) reading with the grate;
d) stereoscopic exercises;
e) exercises with prisms;
f) exercises for development of eye movement.
4. Operation on oculomotor muscles.
5. Postoperative orthoptic exercises (a, b, c, d, e, f).
Practical skills:
1. To determine visual acuity without correction and with correction.
2. To examine refraction by objective methods, skiascopy, and, if
possible, by refractometry, and ophthalmometry.
21
3. To adjust glasses to child with squint.
4. To determine the pupillate distance.
5. To examine the vision type:
a) using colour devices.
b) using the polaroid.
c) using the prism.
d) by the adjusting movement of eyes.
6. To examine eyeballs mobility.
7. To examine of primary and secondary deviation angles.
8. To differentiate concomitant squint from paralytic.
9. To examine of squint angle using by Hyrchberg’s method, using
synoptophore and perimeter.
10. To differentiate accommodative squint from unaccommodative
one.
11. To learn the direct occlusion of amblyopia with correct fixation
during therapy.
12. To learn therapeutic principles of amblyopia with anomalous
fixation.
13. To learn the therapy scheme in general types of squint.
14. To learn the optimal dates of squint therapy.
Термины по теме – The terms on the theme
КОСОГЛАЗИЕ,
СТРАБИЗМ
ГЕТЕРОТРОПИЯ, SQUINT, HETEROTROPIA,
STRABISMUS
аккомодационное косоглазие
альтернирующее косоглазие
вертикальное косоглазие
горизонтальное косоглазие
двустороннее косоглазие
мнимое/кажущееся косоглазие,
псевдострабизм
одностороннее/монолатеральное
/монокулярное косоглазие
22
accomodation squint/strabismus
alternating squint/strabismus
vertical squint/strabismus
horizontal squint/strabismus
bilateral strabismus
sham/apparent strabismus,
pseudostrabismus
unilateral/monolateral strabismus
паралитическое косоглазие
периодическое косоглазие
расходящееся/дивергирующее/
наружное косоглазие,
экзотропия
скрытое косоглазие,
гетерофория
содружественное косоглазие
сходящееся/внутреннее/конвергирующее косоглазие
фиксированное/постоянное
косоглазие
явное косоглазие
косоглазие кверху,
гипертропия, суправергенция
косоглазие книзу, гипотропия,
инфравергенция
угол косоглазия, величина,
отклонения глаза
НИСТАГМ
бинокулярный нистагм
вертикальный нистагм
вестибулярный нистагм
вращательный нистагм
горизонтальный нистагм
диагональный нистагм
диссоциированный нистагм
интенционный/установочный
нистагм
крупноразмашистый нистагм
лабиринтный нистагм
маятникообразный/качательный
нистагм
мелкоразмашистый нистагм
монокулярный нистагм
оптический нистагм
оптокинетический/зрительный
23
paralytic squint
periodical squint/strabismus
divergent/external squint,
exotropia
latent squint, heterophoria
concomitant squint
convergent/internal squint
fixed/constant squint/strabismus
apparent/manifest squint
upward squint, hypertropia,
supravergence
downward squint, hypotropia,
infravergence
angle of squint,
eye deviation, value
NYSTAGMUS
binocular nystagmus
vertical nystagmus
vestibular nystagmus
rotatory nystagmus
horizontal nystagmus
diagonal nystagmus
dissociated nystagmus
intention/adaptive nystagmus
large-swinging nystagmus
labyrinthine nystagmus
pendular/rocking nystagmus
small-swinging nystagmus
monocular nystagmus
optic nystagmus
optokinetk/optkokinetk/ visual
нистагм
послевращательный нистагм,
постнистагм
прессорный нистагм
пульсирующий/ретракторный
нистагм
ротаторный нистагм
содружественный/ассоциирован
ный нистагм
смешанный нистагм
спонтанный нистагм
среднеразмашистый нистагм
толчкообразный/клонический
нистагм
тонический нистагм
нистагм положения
nystagmus
postrotatory nystagmus,
post-nystagmus
pressure nystagmus
pulsating, throbbing/retractor
nystagmus
rotatory nystagmus
conjugated/associated nystagmus
mixed nystagmus
spontaneous nystagmus
middle-swinging nystagmus
jerk/clonk nystagmus
tonic nystagmus
posture nystagmus
V. EXAMINATION OF A PATIENT WITH DISEASES OF THE
CONJUNCTIVA
The most common type of the illness of conjunctiva is inflammations
the most common type of inflammation is infectious conjunctivitises.
Basic signs of acute conjunctivitis are redening of eyes, discharge of
mucus and pus from conjuctival sac. Besides of it, patients complane of
sharp, burning pain, gritty feeling in the eyes, pronounced sensitivy to
light, eyewatering, agglutination of eyelashes in the morning by dry
ejesta.
Anamnesis:
The probable cause of the illness should be ascertained: clogging of
eyes, adverse conditions of production, contact with patient,
contamination in baths, swimming baths, and ect.
Physical examination: External changes of eyesin the case of
conjuctivitis (redening of eyes, discharge from them, photofobia, and
24
ect.) are noticeable at distance and it is easy to diagnose conjuctivitis. To
avoid diagnostic mistakes, it is necessary to determine the sort of
hyperemia which should be differentiated in this case from other,
peculiar to different more serious illnesses, types of reddening
(pericorneal, mixed, episcleral, stagnant injection).
The examination of the conjunctiva can be started with examination of
its bulbar part. To do it, the patient should be asked to look from side to
side with wide-open eyes. Constricted eye-slit, oedema and reddening of
eyelids, inflammation, discharges of eyes, maceration of skin can be
noticed during an external examination. Some external signs allow to
assume the aetiology of illness. For example, reddening and maceration
of skin at the corners of the eyes are characteristic signs of the subacute
angular conjunctivitis of Morax-Axanfald. Plentiful pus discharge is
most frequent in vulgar infection; thick plentiful creamy pus is typical
for gonorrheal conjunctivitis. Eruptions on the eyelids or lips follow
herpetic conjunctivitis.
The great diagnostic importance has examination of eyelids
conjunctiva, upper and lower transitional folds. Soft or whitish
fibrinogenous pellicles, which are easily strippable by a humid cotton
wool, are usually observed by pneumococcal conjunctivitis. Tight united
necrotic pellicles make us think of diphtheritic conjunctivitis.
Plentiful eruption of follicles on the conjunctiva may be a symptom of
allergic conjunctivitis, in particular, medicinal conjunctivitis, as well as,
virus conjunctivitis. By adenovirus conjunctivitis, follicles are big,
limpid, mainly located at mucous tunic, or lower transitional pleat. The
adenovirus conjunctivitis always proceed on the background of
respiratory virus infection followed by nasopharyngitis. Discharge is
mucus or mucopurulent.
It is most important to diagnose acute epidemic conjunctivitis. The
highly contagious character of the acute epidemic conjunctivitis should
be taken into account. Therefore, prophilactic measures should be
undertaken by the examination of the patients. The disease is
characterized by several specific signs. A headache, indisposition, and
25
sometimes a fever can precede the illness. Plentiful eruption of follicles
is accompanied by submaxillary and aural lymphadenopathy. Discharge
is mucus and not abundant. A week after the onset of the conjunctivitis,
plural punctulated subepithelial infiltrations appear at cornea and that
becomes apparent by a reinforcement of photophobia, eyewatering and a
gritty feeling in the eyes (“corneal syndrome”). As a rule, the illness has
an epidemic character.
Paratrachoma and trachoma cause an appearance of plenty follicles,
mainly at upper transitional pleat, but, in Russia, trachoma has been
completely liquidated as epidemic disease and its acute stage does not
occur.
Epithelial papillary can be seen on the gristly part of the upper eyelid
conjunctiva. It is a typical sign of spring catarrh. Aged patients often
come with complaints of accretion growing at eye. This is vascularized
pellicle, that crawls over cornea from internal side. This is pterygium.
Practical skills:
1. To drop a drug solution in an eye.
2. To place some ointment.
3. To evert the upper lid.
4. To wash out the conjunctival sac.
5. To dye the margins of the lids.
6. To massage the eyelids by a glass rod.
Situation tasks:
Diseases of conjunctiva.
1.
A 25-year-old patient complains of purulent discharge from the
eyes. The disease began three days ago with redness, burning and a
gritty sensation.
On examination: the eye slits are constricted, profuse mucous-purulent
discharge is present. The palpebral conjunctiva is hyperemic, thick and
loose. There is purulent secree in the conjunctival capacity.
26
Make up a plan of further examination and treatment.
2.
A patient complains of redness of the eyes, a burning sensation
and mucous discharge. The disease appeared against a background of
ARD with high temperature, evident nasopharyngitis, enlargement of the
submaxillary and admaxillary glands.
On examination: the palpebral conjunctiva and the sclera are sharply
hyperemic, edematic. There are a lot of semitransparent follicles, mainly
on the lower transition fold.
Form a presumptive diagnosis and make up a plan of treatment.
3.
A mother came to a doctor with her 3 year-old child. The child’s
left eye turned red and began to suppurate two days before and the same
symptoms appeared in the right eye that day.
On examination: insignificant edema of the eyelids and the eyeball, the
eyelashes are sticked together with purulent discharge. There is sharp
hyperemia of the eyelids and the eyeball. Thin whitish films, which are
easily removed with a moist cotton ball, are present on the conjunctiva
of the lower eyelid.
Make a presumptive diagnosis and a plan of further examination and
treatment.
4.
Full-blown redness and edema of the eyelids appeared in a child
on the 3d day after his birth. It is impossible to open the swollen purple
eyelids for examination. The eye slit is discharging inchor.
Form a diagnosis and plan of further actions.
5.
A 3-year-old child fell ill with high temperature, headache and
sore throat.
On external examination: there is severe edema, hyperemia and
induration of the eyelids, which margins are covered with unremovable
grey films.
Make a presumptive diagnosis and a plan of further actions.
27
6.
A patient complains of photophobia, watering and a sensation of
sand in the eyes. A week ago he had general weakness, headache, slight
fever, painful swallowing, burning pain in the eyes.
On examination: hyperemia of the pharynx, enlargement of the
submaxillary glands, sharp redness of all sections of the conjunctiva,
numerous small follicles in the transition folds.
Make a presumptive diagnosis and administer treatment.
7.
A 18-year-old boy periodically has photophobia, watering,
itchiness and a sensation of a foreign body behind the eyelids, mainly in
spring and summer.
Examination shows: the conjunctiva of the cartilage of the upper
eyelids is of milky color and is covered with numerous big flat pale pink
papillary formations, giving the conjunctiva a granular appearance of a
“cobblestone pavement”.
Make a diagnosis and a plan of actions.
8.
A 30-year-old patient came to a doctor complaining of
photophobia, watering and a sensation of a foreign body in the right eye.
On examination: Vis OD=0.9, conjunctival injection, mucous discharge
from the conjunctival cavity, small transparent follicles on the lower and
upper transition folds, vitreous edema of the bulbar conjunctiva. The
cornea is intact. The patient was administered treatment but in a week he
came to the doctor again on account of decrease in vision.
Repeated examination showed: oval, coin-like, subepithalial infiltrates
appeared on the cornea whereas the conjunctival pattern remained the
same. The corneal sensitivity is decreased.
Make an etiological diagnosis and administer treatment.
9.
A granular sensation, redness and mucous-purulent discharge
from both eyes have troubled a patient for several months. The external
examination shows: a slight edema of the upper eyelids, the palpebral
conjunctiva is thick, loose, hyperemic. There are a lot of big grey yellow
28
jelly-like follicles on the conjunctiva of the upper eyelid, especially in
the upper transition fold. The upper section of the cornea is clouding,
infiltrated and vascularized.
Form a diagnosis and a plan of further actions.
10. Cicatrical changes in the palpebral conjunctiva without any signs of
inflammation were revealed during clinical examination of a patient.
What diseases might the patient have suffered from? What would you
undertake in such cases?
11. During out-patient reception hours a student complains of a
sensation of a foreign body in both eyes, slight photophobia, itchiness
and rapid blinking. The disease appears every spring during three years.
Examination shows: the eyelids are slightly constricted, the eyeballs are
hyperemic and excessively moistened. The conjunctiva of the cartilage
of the upper eyelid is of milky whitish color, covered with large flat
papillomatous formations. Other sections are unaltered.
Make a diagnosis and administer treatment.
12. A pupil, having returned from a camp, complains of decrease in
vision and photophobia. Ten days ago many children in his group had
pain in the eyes, redness, a gritty sensation and watering with mucouspurulent discharge. Some of them had indisposition, swelling and
painfulness of the submaxillary and admaxillary glands. According to
administrations of a doctor all ill children were given drugs, local
treatment and sent home.
Examination of the pupil shows: Vis OD=0.6 correction not accepted
OS=0.4 correction not accepted
The eye slits are constricted because of photophobia. There is moderate
watering, numerous transparent follicles on the palpebral conjunctiva,
hyperemia of the eyeballs. The cornea is filled with punctated opacities;
its sensitivity is decreased.
Formulate a diagnosis and make up a plan of further actions.
29
13. A 40-year-old patient came to an oculist with complaints of redness
of the right eye, watering, photophobia and a sensation of a foreign
body.
Examination showed: Vis OD=0.9 / Vis OS =1.0
There was conjunctival injection, mucous discharge from the
conjunctival cavity, small follicles on the lower and upper transition
folds and the palpebral conjunctiva, vitreous edema of the bulbar
conjunctiva. The cornea was intact. Treatment was administered. In a
week vision of this eye decreased.
Vis OD=0.2 correction not accepted
Vis OS=1.0 E
Numerous small oval subepithelial infiltrates appeared on the cornea
whereas the conjunctival pattern was unaltered. The corneal sensitivity
was decreased.
Make an etiological diagnosis. Administer treatment.
14. A 19-year-old patient complains of burning pain and purulent
discharge from both eyes. Her right eye began to hurt a day ago and her
left eye – three days ago.
On examination: edema, redness of the eyelids and profuse purulent
discharge are obvious even at a distance. The eyelashes are sticked
together with pus. There is creamy pus on the skin of the lower eyelids
and cheeks. The conjunctiva is sharply hyperemic and thick with pus in
the lower arch.
Make a presumptive diagnosis and a plan of further actions.
15. A 50- year-old patient complains of redness of the eyes and a gritty
sensation. Her eyes have been hurt for several years.
On examination: entropion of the lower eyelids, incorrect growth of the
eye lashes, cicatrical changes of the palpebral conjunctiva. The
transition folds are thick, loose and hyperemic. The lower one third of
the cornea is clouding, profusely vascularized.
Formulate a diagnosis and administer treatment.
30
Термины по теме – The terms on the theme
КОНЪЮНКТИВИТ
CONJUNCTIVITIS
аденовирусный конъюнктивит
аллергический
конъюнктивит adenovirus conjunctivitis
allergic conjunctivitis
ангулярный
конъюнктивит
angular conjunctivitis
блефароконъюнктивит
blepharoconjunctivitis
spring conjunctivitis/catarrh
весенний конъюнктивит/ катар
virus conjunctivitis
вирусный конъюнктивит
herpetic conjunctivitis
герпетический конъюнктивит
purulent conjunctivitis
гнойный конъюнктивит
gonorrheal conjunctivitis
гонорейный конъюнктивит
diphtheritic conjunctivitis,
дифтерийный конъюнктивит,
ocular diphtheria, diphtheria of the
дифтерия глаза
eye
катаральный конъюнктивит
catarrhal conjunctivitis
коревой конъюнктивит
measles conjunctivitis
острый конъюнктивит
acute conjunctivitis
острый эпидемический конъюнк- acute epidemic conjunctivitis
тивит
membranous conjunctivitis
пленчатый конъюнктивит
pneumococcal conjunctivitis
пневмококковый конъюнктивит
allergic conjunctivitis
сенной конъюнктивит
staphylococcal conjunctivitis
стафилококковый конъюнктивит streptococcal conjunctivitis
стрептококковый конъюнктивит
trachoma-like conjunctivitis
трахомоподобный конъюнктивит phlyctenular conjunctivitis
фликтенулезный конъюнктивит
follicular conjunctivitis
фолликулярный конъюнктивит
chronic conjunctivitis
хронический конъюнктивит
infantile conjunctivitis
конъюнктивит новорожденных
inclusion conjunctivitis, granular
конъюнктивит с включениями,
conjunctivitis, paratrachoma,
паратрахома, банный/ бассейный bath/pool conjunctivitis
конъюнктивит
ocular pemphigus
пемфигус/пузырчатка глаза
snow blindness
снежная слепота
electrophthalmia
электрофтальмия
31
VI. EXAMINATION OF A PATIENT WITH KERATITIS
Typical complaints are photophobia, eyewatering, a sensation of a
foreign body present, eye-slit is pared-down, falling vision.
Anamnesis:
1. Onset of disease.
2. Supposed causes (supercooling, superheating, hit of a foreign body
in eye, work in dust-laden premise, as a result of suffering diseases).
3. Similar illnesses in the past.
4. Previous pathologic processes in the organism.
5. Heredity.
6. Previous examination and treatment
Physical examination:
1. Examination of acuity of central vision with and without correction.
2. External examination of eyes. Draw attention to presence and
intensity of photophobia, eyewatering and blepharospasm.
4. Method of lateral light: a character of injection of the eyeball, state
of the cornea (its surface, presence of infiltration, size and depth of its
bedding, form and nature of border). Presence and nature of
vascularization. State of anterior chamber, iris, pupil. Taking in account
that illness of cornea can be complicated by iritis and iridocyclitis, it is
necessary to pay attention to the signs of this illness.
5. Determination of corneal perceptibility.
6. Determination of defect of corneal tissue by dye-stuff solutions.
7. Biomicroscopy of cornea.
8. Method of passing light: quickly determine the clarity of deep
refracting mediums of eyes (crystalline lens, and vitreous body) in the
passing light.
When a diagnosis is determined, you should think over a plan of
therapy.
32
Practical skills:
1. To drop a drug solution in an eye, placing some salve behind eyelids.
2. To paint the cornea.
3. To put on a monocular and binocular bandage.
4. To determine of defects of cornea by method of dyeing by solution
of fluorescein or methylene-blue.
5. To determine of perceptibility of cornea by a fine wisp of cotton,
hair method, algesimeter.
6. To take a swab from a corneal ulcer.
7. To learn injection technique of a drug under conjunctiva and
physiotherapy methods of treatment.
Situation tasks:
Corneal diseases.
1.
A 20-year-old patient is admitted to the hospital with complaints
of sharp photophobia and decrease in vision, which appeared after the
eye was contused by a branch of a tree.
Vis OD=0.01 correction not accepted. Paracentraly in the cornea there
is a greyish yellowish infiltrate with a defect in the center. One margin
of the defect is elevated, the other one is flat. Hypopion. The iris is
hyperemic, its pattern is vague. The pupil has an irregular form.
Formulate a diagnosis, make up a plan of investigation and treatment.
2.
After a foreign body had been removed from the cornea the right
eye began to trouble a patient. His vision decreased.
During investigation: Vis OD=0.02, correction not accepted. Evident
mixed injection. In the cornea there is a large purulent sore with purulent
infiltrated bottom and margins. In the center of the sore there is a
transparent formation in a form of a bleb. Hypopion. The pattern of the
iris is vague. The pupil has an irregular form.
Make a presumptive diagnosis and a plan of treatment.
33
3.
A patient has had troubles with the right eye for two weeks. She
complains of visual impairment, photophobia, blepharospasm, watering.
Vis OD=0.06, correction not accepted. There is an evident mixed
injection. In the corner of the right eye, against a background of diffused
infiltration there are two big infiltrates with dendraformed branchy
vessels coming to them in the medium layers of the cornea.
Make a presumptive diagnosis and a plan of investigation and
treatment.
4.
A 27-year-old patient got a trauma of the left eye with dry grass
during haymaking. Photophobia, watering, a sensation of a foreign body
appeared in the eye. The next day pain increased, vision significantly
reduced. The patient had severe redness of the eye and clouding of the
cornea.
During examination: Vis OS=0.01, correction not accepted. The
eyelids are slightly edematic, blepharospasm, watering, photophobia,
mixed injection of the eyeball. The cornea is edematic, its lower-external
section is filled with a dirty yellow infiltrate 5x5 in its size with loose
margins and disintegration in the center. There is pus in the anterior
chamber.
Make an etiological diagnosis and administer conservative treatment.
5. A 21-year-old patient came to an oculist with complaints of a
sensation of a foreign body, redness of the right eye, rapid decrease in
vision of this eye. A week before after bathing in cold water the patient
had had a cold with rash on the skin of the upper lip.
Examination showed:
Vis OD=0.1, watering, photophobia,
constriction of the eye slit, perecorneal injection of the eyeball. A
superficial infiltrate in a form of a branch was present in the central
section of the cornea.
What additional investigations should be carried out to make up a more
exact diagnosis? Formulate a presumptive diagnosis and administer
treatment.
34
6.
A 30-year-old patient came to an oculist with complains of
redness of the right eye, watering, photophobia, a sensation of a foreign
body.
During examination: Vis OD=0.9, conjunctival injection, mucous
discharge from the conjunctival cavity, small follicles on the lower and
upper transition folds and the palpebral conjunctiva, vitreous edema of
the bulbar conjunctiva. The cornea was intact.
The oculist administered treatment. In a week vision of this eye
decreased. Examination showed: numerous coin-like subepithelial
infiltrates appeared on the cornea whereas the conjuctival pattern
remained unaltered. The corneal sensitivity was decreased.
Make an etiological diagnosis and administer treatment.
7. A 9-year-old child came to on oculist with complaints of decrease in
vision and slight redness of the eye, which had appeared 1.5 months
before. He had been given a local treatment at the policlinic.
During examination: Vis OD-0.1, correction not accepted. Feebly
marked perecorneal injection. Clouding in the medium and deep corneal
layers with vascular ingrowth. The corneal sensitivity is not changed.
The child’s hearing is decreased.
What disease can be supposed? What diseases it should be
differentiated from?
Administer treatment.
8. A 35-year-old patient came to an oculist with complaints of decrease
in vision of the right eye. He had got a third-degree burn with sulfuric
acid five years before.
Examination showed: Vis=1/ ∞ p. l. c.
The eye was calm, contraction of the lower arch (adhesion of the
palpebral conjunctiva and the bulbar conjunctiva), the cornea was totally
clouding, shining, smooth, vasculirized.
Make a diagnosis and administer treatment.
35
9. A 21-year-old patient came to an oculist with complaints of pain in
the right eye, decrease in vision, photophobia, watering, redness of the
eye. Four days before emery got into the eye when he was sharpening a
tool. The foreign body was removed immediately and local treatment
was administered. But the eye didn’t make recovery. It began to hurt,
vision sharply decreased. Earlier the patient had had constant watering
and purulent discharge from this eye for one year.
Vis OS=0.02, correction not accepted.
During examination: watering, photophobia, evident mixed injection of
the eyeball. A dirty infiltrate 5 mm in its size with disintegration in the
center is present on the cornea. The pupil is constricted. There is pus in
the anterior chamber. The iris is green, its pattern is vague.
Make a diagnosis. What investigations should be carried out to detect
ethiology of the disease? Administer treatment.
10. A 18-year-old patient complains of pain, a sensation of a foreign
body, watering, redness of the left eye, decrease in vision. The
symptoms appeared three days ago. The patient had AVD with rash on
the lip a week ago.
Examination shows: watering, photophobia, blepharospasm,
perecorneal injection of the eyeball. In the central cornea section there is
a shallow infiltrate of incorrect branchy form, it becomes painted when
fluorescein is put into the eye. The cornea sensitivity is decreased.
What additional investigations should be carried out? Make a diagnosis
and administer treatment.
11. A 17-year-old patient complains of photophobia, gradual decrease
in vision of the left eye.
Examination shows: slight photophobia, constriction of the eye slit,
perecorneal injection. The eyeballs are excessively moistened with tears.
The corneal surface is rough (resembles shagreen leather). There is
diffusive clouding of the deep corneal folds with new vessels in a form
of brushes.
36
What disease can you suppose? Make up a plan of general examination
of the patient. What additional investigations should be carried out?
12. Sharp photophobia, watering, edema of the right eye and decrease
in vision has troubled a 3-year-old child for a week.
Examination shows: Vis OD=0.1 the correction not accepted.
OD: sharp photophobia, constriction of the eye slit, difficulty in
opening the eyelids because of blepharospasm. The eyeball is with
evident mixed injection, mainly in the internal section. On the iris, at the
limb, at 2, 4, 5, 6 o’clock there are several obtrusive round infiltrates 1-2
mm in their size with vessels coming to them. Other changes haven’t
been revealed.
Make a diagnosis and a plan of investigation and treatment.
Термины по теме – The terms on the theme
Кератит
авитаминозный кератит
аллергический кератит
бактериальный кератит
бессосудистый кератит
герпетический кератит
глубокий кератит
грибковый кератит, кератомикоз
дисковидный кератит
диффузный кератит
древовидный кератит
интерстициальный/паренхиматоз
ный кератит
Keratitis
aritaminotic keratitis
allergic keratitis
bacterial keratitis
nonvascular keratitis
htrpetic keratitis
deep keratitis
mycotic keratitis, keratomycosis
diskform keratitis
diffuse keratitis
dendriform keratitis
interstitial/parenchymatous keratitis
лучевой кератит
поверхностный кератит
поверхностный краевой кератит
полосчатый кератит
пучковидный кератит, блуждаю-
radiation/stellate keratitis
shallow/superficial keratitis
superficial marginal keratitis
strip keratitis
fascicular keratitis, wandering/travelling phlyctena
37
щая/странствующая фликтена
сифилитический кератит
сухой/нитчатый/филаментозный
кератит, сухой кератоконъюнктивит
точечный кератит
травматический кератит
туберкулезный кератит
фликтенулезный/скрофулезный/
туберкулезно-аллергический
кератит
центральный кератит
язвенный кератит, язва роговицы
розацеа-кератит
syphilitic keratitis
dry/filamentous keratitis, dry
keratoconjunctivitis
punctate keratitis
traumatic keratitis
tuberculous keratitis
phlyctenular/scrofular/tuberculoaller
glc
keratitis
central keratitis
ulcerative keratitis, corneal ulcer
rosacea keratitis
VII. EXAMINATION OF A PATIENT WITH
IRIDOCYCLITIS
The most typical complaints are severe pain in the eye, photophobia,
watering, reddening of an eyeball.
Anamnesis:
1. Beginning of the disease.
2. Supposed causes of the disease to the patient’s mind (supercooling,
suffering diseases or acute phase of chronic disease).
3. Niduses of a chronic infection.
4. Similar suffed eye illness of the patient or his relatives.
5. Previous examination and treatment.
6. Profession of the patient, conditions of his work.
Physical examination:
1. Examination of central visual acuity with and without correction.
Irising examination if pupil is dilated by a mydriatic preparation.
38
2. External examination of the eyes. Pay attention to reddening of the
eye, presence and intensity of photophobia, eyewatering, heterochromia.
3. Method of lateral light: variety of injection into the eyeball, presence
or absence of precipitates on the back surface of the cornea, opacity of
liquid of anterior chamber or presence of hypopyon, the iris (colour and
pattern), presence of posterior synechiae, status of the pupil (size, form
and colour).
4. Method of passing light: you should evaluate the clarity of deep
refracting medium of the eyes (opacity of the posterior capsule of the
crystalline lens, dimness of other parts of crystalline lens, opacity of
vitreous body). It is necessary to differentiate opacity of crystalline lens
from that of vitreous body.
5. Palpating the eyeball in the region of projection of ciliary body, you
should determine presence of ciliary morbidity and intraocular pressure.
6. To diagnose iridocyclitis, it is necessary to take into account general
status of the patient (he must be examined by a phthisiatrician,
rheumatologist,
rontgenologist,
otolaryngologist,
dentist,
neuropathologist, therapeutist, venereologist) and results of laboratory
tests (blood count, Wassermann test, brucellosis tests, toxoplasmosis,
rheumatism).
7. When the diagnosis of iridocyclitis is proved you should think over a
plan of therapy. The shedule of treatment for iridocyclitis should
include:
a)
a complex of urgent local and general measures by iridocyclitis.
Remember, that myotic preparation are contra-indicated by
iridocyclitis!
b) Etiotropic treatment.
c) Nonspecific treatment (antiinflammatory, desensibilizating,
absorbing, revulsive and osmotic preparations, elimination of pain, and
dilation of the pupil).
Illness of the posterior part of the vascular tract (choroiditis) have
different clinical presentations. They have painless clinical course. The
39
most typical troubles of patients are disturbance of vision: failing sight,
photopsy, metamorphopsia, scotoma, disturbance of twilight vision. The
diagnosis of choroiditis are based on methods of ophthalmoscopy,
diaphanoscopy, ultrasonic biometrics. In the similar troubles, you should
not forget about the possibility of the choroid tumors.
Practical skills:
1. To put by an eye dropper, placing a salve behind eyelids.
2. To put on a monocular and binocular bandage.
3. To measure intraocular pressure by palpation.
4. To determine of ciliary morbidity of the eyeball.
5. To know physiotherapatic methods of treatment of illness of
vascular tract.
6. To know injection technique of medical product subconjunctivaly
and near bulbarly.
7. To know methods of diaphanoscopy, echo-ophthalmography.
Situation tasks:
Diseases of the uveal tract.
1.
A 18-year-old patient has been suffering from rheumatism for
several years. Her right eye began to trouble her a week ago. Redness
and dull pain appeared.
Vis OD=0.8, correction not accepted.
There is evident mixed injection. On the posterior corneal surface there
are a lot of small whitish precipitates. Descemet’s membrane is folded.
The iris is hyperemic and has a vague pattern. The pupil has an irregular
form. Pigmentary precipitates are present.
Form a diagnosis and a plan of investigation and treatment.
2.
A 20-year-old patient is admitted to the hospital with complaints
of sharp pain and decrease in vision of the right eye.
Vis OD=0.6, correction not accepted.
40
The eye is irritated. Evident mixed injection is present. There are
precipitates on the posteria cornea surface, some of them are big and
tallowy. The iris is green with a vague pattern. There are a lot of
posterior synechiae.
Make a presumptive diagnosis, a plan of investigation and administer
treatment.
3.
A 42-year-old patient came to an oculist with complaints of
progressive decrease in vision and pain in the right eye. The patient has
periodical redness of the eye.
Vis OD=0.1, correction not accepted.
Vis OS=1.0
OD: moderate photophobia, pericorneal injection of the eyeball. The
cornea is slightly edematic with tallowy precipitates on its posterior
surface. The depth of the anterior chamber is not uniform. The pupil is
constricted with a circular posterior synechia along its borders. The iris
is swollen out toward the anterior chamber (bulging). A reflex from the
eye fundus is decreased. Intraocular pressure – T=2 (on palpation).
Formulate a diagnosis, administer treatment.
4.
A 28-year-old patient has been suffering from rheumatism for
several years. Decrease in vision, dull pain in the right eye, redness and
photophobia appeared after supercooling a week ago.
During examination: Vis OD=0.6, correction not accepted
Vis OS=1.0
The right eye: photophobia, evident mixed injection of the eyeball,
edema of the posterior corneal sections (folds of Descemet’s
membrane). Numerous small precipitates are present on the posterior
surface of the cornea. The humor of the anterior chamber is slightly
opalescent. The iris is green, its pattern is vague. The pupil is constricted
with a gelatinoid exudate. On palpation the eyeball hurts in the area of
the cilliary body.
41
Make a diagnosis and a plan of clinical-laboratory investigation.
Administer treatment.
5.
A 20-year-old patient came to the policlinic with complaints of
sharp decrease in vision, moving flakes in front of the right eye, redness
of the eyeball and pain in it. The patient had fallen ill two days before
after he had suffered from ARD.
Examination showed: VisOD=0.1, correction not accepted/Vis OS=1.0
The right eye: there is photophobia, moderate edema of the eyelids,
evident redness of the eyeball near the cornea. The cornea is slightly
edematic with numerous precipitates on its internal surface. The iris is
green with a vague pattern. The pupil is constricted and has an indefinite
form. The eyeball sharply hurts on palpation.
Make a diagnosis. How can you explain the complaints of moving
flakes in front of the eye? What methods should be used to diagnose the
case? Make up a plan of etiological investigation and administer
treatment.
6.
A 27-year-old patient came to an oculist with complaints of
severe pain, redness and decrease in vision of the left eye. The
symptoms appeared three days before after supercooling.
Examination showed: Vis OD=1.0
Vis Os=0.5, correction not accepted.
Intraocular pressure for OD=22 mm Hg, for OS=16 mm Hg. The ocular
slit of the left eye is moderately constricted, evident perecorneal
injection of the eyeball, sharp painfulness on palpation. With lateral
illumination precipitates are seen on the cornea. The humor of the
anterior chamber is cloudy. The iris has a vague pattern, its color is
darker than in the right eye. The right eye is normal.
Make a diagnosis. Administer urgent measures and make up a plan of
treatment.
42
7.
A 60-year-old patient complains of sudden sharp pain, redness
and decrease in vision of the left eye. He fell ill 2 days ago after
supercooling. He has been suffering from rheumatism for five years.
Vis OD=1.0 Vis OS=0.2, correction not accepted.
During examination: the left eye – the eye slit is constricted, the eye is
irritated, the cornea is transparent. The anterior chamber is of medium
depth, the humor is cloudy. The iris has a vague pattern, its color is
changed. The eye fundus is without pathology. Intraocular pressure is 18
mm Hg. The right eye is normal.
Formulate a diagnosis. What diseases this case should be differentiated
from? Administer treatment.
Термины по теме – The terms on the theme
ИРИДОЦИКЛИТ
герпетический иридоциклит
гнойный иридоциклит
гонорейный иридоциклит
лучевой иридоциклит
серозный иридоциклит
симпатический иридоциклит,
симпатическое воспаление,
симпатическая офтальмия
фибринозный иридоциклит
травматический иридоциклит
Радужка
воспаление радужки, ирит
воспаление радужки и ресничного
тела, иридоциклит
выпадение радужки
гетерохромия радужки
меланома радужки
отсутствие радужки, аниридия
патологическое расслоение
радужки, иридошизис,
43
IRIDOCYCLITIS
herpetic iridocyclitis p
urulent iridocyclitis
gonorrheal iridocyclitis
radial iridocyclitis
serous iridocyclitis
sympathetic/sympathic iridocyclitis, sympathetic inflammation,
sympathetic ophthalmia
fibrinous iridocyclitis
traumatic iridocyclitis
Iris
inflammation of the iris, iritis
inflammation of the iris and ciliary
body, inflamed iris and ciliary body
iridocyclitis
prolapse of iris
heterochromia of iris
melanoma of iris
absence of iris, aniridia
pathologic stratification of iris
иридошизис
зрачок
кольцо Кайзера-Флейшера
пятна Брушфильда
Зрачок(чки)
активный зрачок
вяло реагирующий зрачок
искусственный зрачок
круглый зрачок
неподвижный зрачок
неправильный зрачок
расширенный зрачок
симметричные зрачки
суженный зрачок
за ращение зрачка
расширение зрачка, мидриаз
реакция зрачка на свет
сращение зрачка средство,
расширяющее (суживающее)
зрачок сужение зрачка, миоз
pupil, pupilla
Kayser-Fleischer's ring
Brushfield's spots
Хориоидея
воспаление хориоидеи, хориоидит
воспаление радужки и хориоидеи,
иридохориоидит
Cnoroid, vascular coat of the eye
inflammation of choroid, choroiditis
inflammation of iris and choroid,
iridochoroiditis
Хориоидит
диссеминированный/рассе-янный
хориоидит
диффузный хориоидит
ограниченный хориоидит
очаговый хориоидит
периферический хориоидит
симпатический хориоидит
туберкулезный хориоидит
центральный хориоидит
экваториальный хориоидит
Choroiditis
disseminated choroiditis
Pupil(s), pupilla (papillae)
active pupil
sluggish pupil
artificial pupil
round pupil
fixed pupil
irregular pupil
dilated/mydriatic pupil
symmetrical pupils
constricted/miotic pupil
pupillary constriction
pupillary dilation, mydriasis
pupillary response to light
pupillary adhesion/symphysis
mydriatic (miotic)
pupillary constriction, miosis
44
diffuse choroiditis
limited choroiditis
focal choroiditis
peripheral choroiditis
sympathetic choroiditis
tuberculous choroiditis
central choroiditis
equatorial choroiditis
VIII. EXAMINATION OF A PATIENT WITH PATHOLOGY
OF THE CRYSTALLINE LENS
The most typical complaint is gradual painless decrease of vision.
Anamnesis:
1. The initial stage of the disease, its age.
2. Nature of failing vision.
3. Supposed causes of the disease to the patient’s mind.
4. An injury (especially head one) in the past.
5. Concomitant disease of the eyes (glaucoma, shortsightedness,
uveitis).
6. Profession of the patient, professional insalubrities.
7. Systemic diseases.
8. Family anamnesis, analogue illness in his relatives.
Physical examination:
1. Examination of central visual acuity with and without correction.
In the absence of subject vision, you should determine the
photoperception. You should note the type of lightprojection. It is
necessary to examine the photoperception thoroughly. The visual
acuity equaled photoperception with incorrect projection of light or
equaled zero is an evidence of lesion of the retina or the optic nerve.
This is a contra-indication for cataract extraction. In this case,
additional methods of investigation are necessary (echoophthalmometry, diaphanoscopy and others) to avoid retinal
detachment, an intraocular tumor, absolute glaucoma etc.
2. External examination of the eyes. You should determine the state of
surrounding tissues and supplementary apparatus (including lacrimal
sac: presence or absence of discharge from lacrimal points pressing
the region of lacrimal sac).
45
3. Method of lateral light: you should determine the state of
conjunctiva, sclera, and cornea and the depth of the anterior chamber
in comparison with the other eye. You should look at the colour and
pattern of the iris, presence of its trembling (iridodonesis), size, form,
reaction of the pupil to light; you should draw an especial attention to
the pupil colour (black, grey, nacreous, milk-white) and presence the
iris shadow and its width.
4. Method of passing light: you should determine the lenticular
transparency of the crystalline lens. You should pay attention to the
presence of spoke like, punctated, and polymorphous opacity on the
fundus in the case of total cataract. For more accurate localization of
opacity (the cornea, the different parts of the lens, or vitreous body),
you should evaluate the opacity and its motility.
5. Biomicroscopy. You should evaluate lentucular opacity, its depth,
presence of vacuole, water slits, and plaques.
6. You should measure intraocular pressure by palpation and
tonometer. You should make a preliminary diagnosis basing upon the
patient’s complaints, anamnesis, and physical examination. You
should differentiate a cataract from an open-angle glaucoma. You
should prove your recommendations for the treatment. You should
determine a possibility of a surgical treatment and prove the
indications for an operation. If the surgical treatment is recommended,
it is necessary to performe additional tests (see list of necessary tests
for the preparation of the patient for an operation).
List of necessary tests preparing a patient for a cataract extraction.
Ophthalmoscopy:
1. Acuity of vision, refraction.
2. Tonometry.
3. Method of lateral light.
4. Method of passing light.
5. Biomicroscopy.
46
6. Ultrasonometry.
7. Examination of state of lacrimal ducts.
8. Investigation of microflora of conjunctival sac.
General tests:
1. Blood count, blood sugar, Wassermann test.
2. Urine analysis.
3. Feces analysis on helminth eggs.
4. X-ray examination of the chest.
5. Electrocardiogram
6. Certificate of therapeutist about possibility of a surgical operation
(absence of contraindications for base on general condition of the
patient).
7. Certificate of a dentist about the state of oral cavity, and dental
sanation.
8. Certificate of an otolaryngologist.
9. Certificate of a neuropathologist if it is necessary.
10. Certificate of an endocrinologist if it is necessary.
Practical skills:
1. To examine visual acuity in failed vision and lack of subject vision
(determination of photoperception with correct or incorrect
lightprojection).
2. To evaluate opacity of the iris by means of lateral light in the
immature cataract, tears of ligaments, aphakia.
3. To evaluate opacity of the lens by means of passing light. There are
punctated, polymorphous, and spoke like opacities on pink
background.
4. To evaluate the lacrimal ducts pressing the region of lacrimal sac
and putting the collargol solution in conjunctival sac by a dropper,
and washing out lacrimal ducts.
Situation tasks:
47
Cataract
1. Visual acuity of both eyes had been gradually and painlessly
decreasing for 2 years in a 62-year-old patient. At first flying midges,
polyopia (numerous images of a light source) and then dimness
appeared in front of the eyes.
What pathology may take place in this case? What investigations
should be carried out to make a more exact diagnosis? What treatment
would you recommend?
2. A woman with a 3-year-old child came to an oculist. She
occasionally noticed small white dots in the papillary centers in the
child’s both eyes. The child was developing in accordance with his
age. Anemnestic pathologies were absent.
During investigation by passing light against a background of pink
reflex of the pupil dark dots are seen shifting when the eyeballs were
moving.
Formulate a diagnosis and give recommendations.
3. A 68-year-old woman who had been wearing reading glasses +3.0
D for many years noticed that she began to read without the glasses
well, but her distance vision decreased.
Vis OD=0.4-2.5D=1.0
Vis OS=0.4-2.5D=1.0.
The eyes were calm. With the focal light and in the passing light no
significant changes were revealed.
What initial pathological process can be supposed? What additional
methods of investigation could help to make a correct diagnosis?
4. A 45-year-old patient came to the policlinic with complaints of
significant decrease in vision of both eyes.
Vis OD=0.03, correction not accepted
Vis OS=0.04, correction not accepted.
48
The visual fields of both eyes are normal. Intraocular pressure in both
eyes is 20 mm Hg. Biomacroscopy examination showed the presence of
clouding in the posterior capsule, more compact in the center. The reflex
from the eye fundus is marked at the periphery.
Make a diagnosis and administer treatment.
5. A patient is admitted to the hospital with complaints of absent
subject vision of the right eye.
Examination shows: the eye is calm, the cornea is transparent, the
anterior chamber is shallow. The dilated oval pupil has an irregular
form. Local atrophy of the iris is present at 3 o’clock. There is marginal
cupping of the optic disk on the eye fundus.
Vis OS=1/∞ PLC, intraocular pressure is 36 mm Hg.
Gonioscopy shows: the angle is closed by the root of the iris.
Make a diagnosis and administer treatment.
6. A 38-year-old employee of a radioisotope therapy laboratory
noticed rapid decrease in vision of both eyes. Examination showed:
Vis OD=0.02 correction not accepted
Vis OS=0.04 correction not accepted.
With focal illumination the pupils looked grey. During investigation
by passing light clouding of the lens in the posterior coretal layers was
present. There was a red reflex at the periphery of the pupillary region.
Formulate a diagnosis. Make up a plan of treatment taking into
account low visual acuity. Means of further correction.
7. A 23-year-old patient came to an oculist with complaints of
progressive painless decrease in vision of the right eye after a blunt
cranium trauma. During examination by lateral illumination it was
revealed that the pupil of the right eye had a quick reaction to light
and the pupillary region was grey. A decreased pink reflex was seen in
the passing light.
49
Formulate a diagnosis, give recommendations and administer
treatment.
8. A 30-year-old patient complains of gradual painless decrease in
vision of both eyes. During investigation by biomicroscopia it is
revealed that clouding in the cortical layers of the lens in a form of
small grey spots and vacuoles are present. The patient has been
suffering from diabetes for 12 years. The sugar level in blood is
unsteady. The patient breaks insulin dosage regimen.
Make a diagnosis and give recommendations.
9. A 17-year-old patient complains of low visual acuity of the left eye.
Examination shows:
Vis OD=1.0
Vis OS=0.02+10.0 D=1.0.
During investigation by lateral illumination: OS – the anterior
chamber is deep, the iris is trembling, the pupillary region is of black
color. In the passing light a pink reflex is seen. A half of a year ago the
patient received a blunt trauma of the left eye after which vision sharply
decreased. The patient didn’t come to an oculist then.
Formulate a diagnosis and give recommendations.
10. A 60-year-old patient being at a therapeutics department with
severe diabetes lost vision of the right eye. Visual acuity of both eyes
had been sharply decreasing during last year. Glasses didn’t help
anymore.
Vis OD=1/∞ pr.l.c.
Vis OS=0.06, correction not accepted.
No pathology was revealed in the anterior sections of both eyes. A
reflex from the fundus of the right eye was absent. The fundus of the left
eye was clearly seen. Dilation and twisting of the veins, numerous
microaneurysms, small hemorrhages and cotton-like focuses were
observed.
50
Make a diagnosis and a plan of treatment.
11. A 68-year-old patient came to an oculist with complaints of slow
painless decrease in distance vision forseveral years.
Examination showed:
Vis OD=0.2, correction not accepted, refraction – E.
Vis OS=0.3, correction not accepted, refraction – E.
The eyes were calm, the anterior section was unaltered.
What disease can you suppose?
Make up a plan of further investigations to diagnose the case.
12. A 75-year-old patient came to an oculist with complaints of
progressive painless decrease in vision of both eyes for two years. There
was no pain and redness in the eyes.
During examination: Vis OD=0.04, correction not accepted
Vis OS= 1/∞ pr.l.c.
OD – the eyeball was calm, the cornea was transparent. The anterior
chamber was normal. The pupil was of grey-white color with falciform
shadow falling from the iris. A reflex from the eye fundus was absent.
OS – the eyeball was calm. The cornea was transparent, the anterior
chamber was normal. The pupil was of uniform grey color. A reflex
from the eye fundus was absent.
IOP OD=18 mm Hg,
IOP OS=19 mm Hg.
Formulate a presumptive diagnosis and make up a plan of
investigations and treatment.
13. A 68-year-old patient complains of progressive painless decrease
in vision of the right eye for two years. There were no signs of
inflammation. Examination shows:
Vis OD=0.02, correction not accepted
Vis OS=1.0 E.
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On investigation of the right eye by the method of the lateral
illumination it is revealed: the pupil is grey. There is a slight shadow
from the iris. In the passing light a red reflex from the eye fundus is
absent. The left eye is normal.
Make a diagnosis and give recommendations.
14. A bus driver underwent an operation for traumatic cataract a half
of a year ago. After that glasses were prescribed to the patient, which
increased vision of the left eye to 1.0. At present moment the patient
complains of the fact that he can’t use the glasses since vertigo, nausea
and diplopia appear when he wear them. During examination:
Vis OD=1.0 E
Vis OS=0.02+10.0 D=1.0.
The right eye is normal. The left eye is calm, the cornea is transparent,
the anterior chamber is deep, refractive mediums are clear, iridodonesis
is present. The fundus of the eye is normal.
Make a diagnosis and indicate the means of professional
rehabilitation.
52
Термины по теме – The terms on the theme
КАТАРАКТА
бурая/черная катаракта
веретенообразная катаракта
врожденная катаракта
вторичная/последовательная
катаракта голубая катаракта
диабетическая катаракта
дисковидная катаракта
дырчатая катаракта
задняя полярная катаракта
звездчатая катаракта,
катаракта хрусталикового шва
зрелая (незрелая) катаракта
корковая/кортикальная катаракта
коронарная/венечная катаракта
лентикулярнаяя катаракта
лучевая катаракта
люксированная катаракта
медная катаракта, халькоз
хрусталика
морганиева/молочная катаракта
начинающаяся катаракта
передняя полярная катаракта
перезрелая катаракта
перепончатая катаракта
пленчатая катаракта
порошкообразная ядерная катаракта, катаракта Коппок
приобретенная катаракта
прогрессирующая катаракта
розетчатая катаракта
слоистая катаракта
старческая катаракта
тотальная катаракта
травматическая катаракта
ядерная катаракта
53
CATARACT
brown/black cataract
spindle-shaped cataract
congenital cataract
secondary/successive cataract
blue cataract
diabetic cataract
diskform cataract
stenopeic cataract
posterior polar cataract
stellate cataract,
cataract of lenticular raphe
mature (immature) cataract
cortical cataract
coronary/coronal cataract
lenticular cataract
stllate cataract
luxated cataract
copper cataract, lenticular chalcosis
Morgagni's/lacteal/lacteous cataract
arising cataract
anterior polar cataract
overripe/hypermature cataract
membranous cataract
membranous cataract
powdered nuclear cataract,
Coppock's cataract
acquired cataract
progressive cataract
rosella/rosula cataract
stratified cataract
senile cataract
total cataract
traumatic cataract
nuclear cataract
IX. EXAMINATION OF A PATIENT WITH GLAUCOMA
Typical complaints of the patient with the closed-angle glaucoma are:
1) periodical opacities (usually in the morning);
2) appearance of rainbow circles in a glance at a source of light;
3) pain in an eye and the same part of the head.
4) nausea, vomiting and the listed signs present in the acute attack of
glaucoma.
Complaints of a patient by in an acute attack:
1. Severe pain in eye irradiating in the same part of the head, heart
region, and abdomen region.
2. Different stages of vision failing. Sometimes blindness.
3. Nausea, sometimes vomiting.
Complaints in the case of open-angle glaucoma: slow painless failing
of vision.
Anamnesis:
1. When the complaints appeared. Supposed causes of the disease
(work with lopsided head, excess of consumption of liquid,
superheating, stress and so on)
2. Has the patient a medical record because of glaucoma?
3. Treatment applied in the past and actual therapy (regimen of myotic
preparations), its effectiveness (subjective feeling of the patient, the state
of function of vision, intraocular pressure).
Anamnesis of live:
1. Age of the patient (as a rule, after 40).
2. The presence of endocrine and vascular disorders (diabetes,
climacteric, diencephalic pathology).
3. The presence of glaucoma in relatives.
4. The presence of professional insalubrities.
5. Long application of corticosteroids.
54
Physical examination:
1. Examination of central visual acuity with correction.
2. Examination of borders of visual fild approximately and with the
help of perimeter.
3. By the use of lateral light, you should pay an attention to the
possibility of dilation anterior ciliary vessels (“cobra symptom”), the
clarity and sensitivity of the cornea, depth of the anterior chamber, the
size of the pupil, and the state of the iris.
4. In biomicroscopy, the changes of the front part of eye should be
evaluated in details thoroughly (the anterior ciliary vessels,
postoperative sutures; coloboma, atrophy of stroma of the iris, size of
the pupil and its dystrophy, especially in the people who were treated by
miotics and so on).
5. Ophthalmoscopy (usually, it is performed with a teacher):
1) the presence of glaucoma’s exavation coming up to the margin of the
optic nerve and accompanied by a curve of vessels.
2) grey colour of the optic disk.
6. Examination of the angle of the anterior chamber:
1) the approximate test following the Vurgaft method.
2) with the help of gonioscope (it should be demonstrated by a teacher).
7. Tonometry:
1) by palpation;
2) with the help of Maklakov tonometer (10g. weight).
Additional diagnostic examination are day's tonometry, frequentative
tonometry during the day (every 3 hours), elastotonometry, tonography,
stress, and unloading tests. The diagnosis of glaucoma should be
comprehensive. The type, the stage, the level of ocular tension,
dynamics should be evaluated in the both eyes separately.
Therapeutic approach
You should determine the treatment (writing out a prescription for
drops, eye ointment, medicines orally, intramuscularly, intravenously).
If an operation is nesessary. You should determine the type of operation.
55
It should be emphasized that mydriatic preparation are contraindicated in iridocyclitis.
Practical skills:
1. To determine intraocular pressure by palpation, data recording.
2. To determine intraocular pressure by Maklakov tonometer, data
recording.
3. To determine the field of vision by confrontation field testing.
4. To determine the field of vision by perimeter.
5. To carry out biomicroscopy of front part of eye. You should learn
examination of the cornea, the depth of the anterior chamber, the iris,
and its pigment border.
6. To learn elastotonometry, tonography, gonioscopy, campimetry,
7. To determine of the width of the angle of the anterior chamber by
side illumination.
Situation tasks:
Glaucoma.
1. A patient complains of periodical dimness in front of the right eye
and rainbow effects around a source of light in the morning. Vis
OD=1.0. The visual field on the nasal side is constricted to 30˚ from the
fixation point. The anterior cilliary arteries are dilated. The anterior
chamber has small depth and a narrow angle. Initial excavation of the
disk is present on the eye fundus. Intraocular pressure is 30 mm Hg.
Make a diagnosis.
2. A 48-year-old patient complains of decrease in vision of the left
eye, which he occasionally noticed a week ago.
Vis OS=0.2, correction not accepted. The anterior chamber is of
medium depth, its angle is opened. The pupil with the diameter of 2 mm
is sluggish. Evident excavation of the optic nerve is present on the eye
fundus. Intraocular pressure is 36 mm Hg. The visual field is constricted
to 15˚ around the fixation point.
56
Make a diagnosis.
3. After doing the laundry a 60-year-old woman felt pain in the left
half of the head and in the left eye, nausea, vomiting. Her left eye turned
red, its vision decreased.
Examination showed: Vis OS=0.2, correction not accepted. The eye
was red with a blue shade, the cornea was grey-white, opalescent, the
epithelium was edematic. The pupil was dilated and grey-green in its
color. A reflex from the eye fundus was decreased. T+3.
Formulate a diagnosis and administer treatment.
4. A patient came to a doctor with chronic bronchitis and bronchial
asthma. On his outpatient card there is a note “Glaucoma”. What drugs
used for asthmatic diseases are contradicted to the patient?
5. A 65-year-old woman was admitted to the intensive therapy
department for antrioventricular block and rare rhythm of ventricle
contraction. The disease was accompanied by diabetes of the fist type
and closed-angle glaucoma. What medicaments shouldn’t be used for
antrioventricular block in this particular situation? What drugs may
substitute them?
6. A 63-year-old blind in both eyes man was directed to an oculist to
remove a cataract. The patient said that his right eye hadn’t seen for a
half of a year and the left eye became blind three months ago. Vision
had been falling slowly and painfully. A doctor diagnosed a cataract that
could be removed when the eye would stop seeing. After examination
the oculist denied the presence of a cataract and determined that the
cause of blindness was glaucoma and operation wouldn’t help.
What methods of investigation allowed the oculist to deny cataract
and diagnose glaucoma? What form and phase of glaucoma took place
in the patient? Why couldn’t the patient be made an operation? What
was the doctor’s mistake?
57
Термины по теме – The terms on the theme
ГЛАУКОМА
врожденная глаукома
вторичная глаукома
закрытоугольная глаукома
застойная глаукома
открытоугольная глаукома
первичная глаукома
приобретенная глаукома
простая глаукома
травматическая глаукома
приступ глаукомы
острый приступ глаукомы
подострый приступ глаукомы
внутриглазное давление,
офтальмотонус
повышение внутриглазного
давления
GLAUCOMA
congenital glaucoma
secondary glaucoma
closed-angle glaucoma
congestive glaucoma
open-angle glaucoma
primary glaucoma
acquired glaucoma
simple glaucoma
traumatic glaucoma
attack of glaucoma
acute attack of glaucoma
subacute attack of glaucoma
tension of the eye, ocular
tension, intraocular pressure,
ophthalmotonus elevation in the
ocular tension
видение радужных кругов
rainbow vision, seeing
rainbow effects
краевая экскавация диска
marginal excavation of the optic
зрительного нерва
disk
сужение поля зрения
narrowing of visual field margin
понизить внутриглазное давление to relieve intraocular pressure
X. EXAMINATION OF A PATIENT WITH OCULAR
INJURIES
Examining patients with a injury of an organ of vision, the type of the
injury should be determined first of all. The patient can have a
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contusion, a wound, or a burn. To do that it is important to know
significant and probable signs of perforative injury.
A. Characteristics of medical examination of a patient with a
penetrating wound of eyes
Anamnesis:
1. You should ask what the patient was doing when he got injured.
2. What the material did the patient working with in the time of injury?
3. Were the objects dirty, which were worked with?
4. You should ask the patient could a foreign body get in his eye. Could
it be magnetic?
5. The time of the injury and the time of medical aid.
6. What the measures were performed as a first aid? Where was the
first aid administered?
Physical examination:
1. Examination of visual acuity with and without correction.
2. External examination of eye.
3. Method of lateral light. You should determine the type of injection of
the eyeball, the presence of a wound of the cornea, sclera or limb, the
presence of adaptation or gaping of the margins of the wound,
infiltration of the margins of the wound, incarceration in the wound
internal membranes. The state of the anterior chamber (depth, nature of
contents), iris (incarceration in the wound, dislocation of the wound,
colour of the iris, presence of apertures, defects in the iris), the pupil
(size, form, colour) should be examined. The presence of a foreign body
can be suspected if there are aperture in the iris, tears of the pupil
margins, or limited opacity of the lens.
It should be remembered that these signs of a foreign body are
relative. To make the detection of intraocular foreign body completely
certain, it is necessary to perform rontgenologic examination with the
subsequent localization of foreign body in all the patients.
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In all patients with the penetrating wound, pay attention to signs of
incipient infection (infiltration of margins of the wound, precipitates on
the back surface of the cornea, muddy moisture of the anterior chamber,
pus from the anterior chamber, change of colour of iris).
4. Method of passing light: pay attention to presence of opacities of the
lens, floating opacities in vitreous body resulting hemorrhage at its.
Floating foreign body in vitreous body a with metallic tint is possible.
5. Ophthalmoscopy: pay attention to a foreign body on the fundus. The
foreign body can be visible in ophthalmoscopy.
B. Characteristics of examination of a patient with a burn of eyes
Anamnesis:
1. You should ask the patient was it a thermal burn or a chemical one.
2. If some chemical substance got into an eye, it is necessary to find out
properties of the substance (acid or alkali, other characteristics), its
concentration, and quantity of the substance.
3. The time of the burn and the time of the first aid.
4. What the measures were performed as the first aid? Where was the
first aid applied?
5. When was the patient sent to the clinic?
Physical examination of the eye:
1. Examination of central visual acuity with and without correction.
2. External examination of the eyes. The the eyelids (swell, hyperemia
of skin, blistering, presence of necrosis), the conjunctiva (hyperemia,
oedema, formation of white pellicles, defects of tissue, necrosis) should
be evaluated. The margin of the eyelids, the conjunctiva of the eyeball
should be evaluated. Pay attention to examination of the cornea (cornea
dimness of different degree, infiltration, necrosis, the presence of defect
of tissue). For detection of area and depth of defects of cornea and
conjunctiva, you should dye the eye tissue with the 1% solution of
fluorescein or 1% water solution of methylene-blue. Burns of eyes can
60
be complicated by iritis, iridocyclitis, secondary glaucoma, and cataract.
During the medical examination of the patients, it is necessary to draw
attention to the presence of signs these diseases.
Practical skills:
1. To determine intraocular pressure by palpation.
2. To put on a monocular and binocular aseptic bandage and plaster
bandage.
3. To wash out the conjunctival sac.
4. To remove superficial foreign bodies from conjunctiva and cornea.
5. To localize intraocular foreign bodies by X-ray photograph with the
help of Komberg – Baltin scheme.
6. To detect defects of conjunctiva and cornea by method of the dyeing
with the 1% solution of fluorescein or 1% water solution of methyleneblue.
C. Characteristics of examination of a patient with contusion of
organ of vision
Anamnesis:
1. Listen to the patient complaints, determine conditions of injury: what
object inflicted the injury and what strength was the injury inflicted
with? Was the injury inflicted during work or in private life? Note the
time of the injury and the time of seek medical advice.
If there is a haematoma of the eyelids, you should ask the patient
whether the haematoma has appeared immediately after the trauma or
after a while. Ask the patient did he lose consciousness. Did the patient
is given first aid? What the measures were performed as first aid? Where
was the first aid administered? It should be noted if the vaccination with
tetanus vaccine was done. If no vaccination was done after the injury,
the time of the last vaccination should be asked.
Method of passing light allows to determine the traumatic opacities of
the lens, floating opacities or partial absence of reflex on the fundus of
61
the eye by partial hemophthalmus, absolute absence of pink reflex on the
fundus of the eye by total hemophthalmus.
Ophthalmoscopy allows to determine the hemorrhage in the retina,
retinal detachment, oedema of the region of yellow spot (opacity of the
retina), the rupture of choroid at periphery, course of vascular fascicles
on the fundus of the eye.
Biomicroscopy allows to work out a detailed diagnosis of thin injuries.
You should measure intraocular pressure by palpation because the
contusions are often accompanied by hypertension that can transform to
the secondary glaucoma, or contrariwise to hypotonia of the eyeball.
Rontgenography of an eye-socket and paranasal sinus is performed to
determine the integrity of bones. When the diagnosis is proved you
should think over a plan of therapy.
Situation tasks:
Ocular trauma.
1. A 20-year-old patient was admitted to the hospital with complaints
of pain, severe irritation and decrease in vision of the right eye, which
appeared soon after a contusion of the eye with a branch of a tree.
Vis OD=0.01, correction not accepted. Evident mixed injection.
Paracentrally in the cornea there is a grey yellowish infiltrate with a
defect in the center. One margin of the defect is elevated, the other one
is flat. Hypopion. The iris is hyperemic with a vague pattern. The pupil
has an irregular form.
Make a diagnosis, a plan of investigation and treatment.
2. After a foreign body was removed from the cornea the right eye
began to trouble a patient. His vision decreased.
During investigation: Vis OD=0.02, correction not accepted. Evident
mixed injection. In the cornea there is a large purulent sore with purulent
infiltrated bottom and margins. In the center of the sore a transparent
62
formation in a form of a bleb is present. Hypopion. The pattern of the
iris is vague. The pupil has an irregular form.
Make a presumable diagnosis and a plan of treatment.
3. A 27-year-old patient received a trauma of the left eye with dry
grass that resulted in photophobia, watering, a sensation of a foreign
body. The next day pain increased, vision significantly decreased. The
patient had sharp redness of the eye and a white spot on the cornea.
Examination showed: Vis OD=0.01, correction not accepted. The
eyelids were slightly edematic. Blephorospasm, watering, photophobia,
mixed injection of the eyeball. The cornea was edematic, its lowexternal section was filled with a dirty yellow infiltrate 5x5 mm in its
size with disintegration in the center and loose margins. There is pus in
the anterior chamber.
Formulate a diagnosis and administer treatment.
4. A patient complains of watering, photophobia, blepharospasm,
appeared after a microtrauma of the cornea.
Examination shows: perecorneal injection of the eyeball, the cornea is
edematic. In the center of the cornea there is a pointed infiltrate which is
swollen out of the surface. Shining is absent. The corneal surface is
painted with fluorescein.
Make a diagnosis and administer treatment.
5. A 22-year-old patient came to an oculist with complaints of pain in
the right eye, decrease in vision, photophobia, watering and redness of
the eye. Four days before emery got into the eye when he was
sharpening a tool. The foreign body was removed immediately and local
treatment was administered. But the eye didn’t make recovery. It began
to hurt, vision sharply decreased. Earlier the patient had had constant
watering and purulent discharge from this eye for one year.
Vis OS=0.02, correction not accepted.
63
During examination: watering, photophobia, evident mixed injection of
the eyeball. A dirty infiltrate 5.5 mm in its size with disintegration in the
center was present on the cornea. The pupil was constricted. There was
pus in the anterior chamber. The iris was green with a vague pattern.
Make an etiological diagnosis. What additional investigations should
be carried out to reveal the local pathology? Administer treatment.
6. A 35-year-old patient came to an oculist with complaints of decrease
in vision of the right eye. He had got a third-degree burn with sulfuric
acid five years before.
Examination showed: Vis=1/∞ p. l. c.
The eye was calm, contraction of the lower arch (adhesion of the
palpebral conjunctiva and the bulbar conjunctiva), the cornea was totally
clouding, shining, smooth, vasculirized.
Make a diagnosis and administer treatment.
7. A 13-year-old patient is admitted to the hospital with complaints of
decrease in vision of the right eye. The eye was hit with a snowball two
hours before. During examination:
Vis OD=0.1. Hematoma of the eyelids, the eye is calm, the cornea is
transparent. There is a 1-mm blood level in the anterior chamber. The
pupil 5x4 mm in its size has an irregular form. Mydriasis. The lens is
transparent. There is a moving clouding in the anterior chamber of the
vitreous body.
Form a diagnosis and administer treatment.
8. A 36-year-old patient is admitted to the hospital with complaints of
sharp pain in the left eye and decrease in vision. 40 minutes ago splashes
of calcimine got into the left eye when the patient was plastering.
Examination shows:
Vis OD=1,0
OS=0.2, correction not accepted.
64
The skin of the eyelids is edematic. Chemosis. The cornea is cloudy
and de-epithalized. The anterior chamber is of medium depth. The iris is
edematic. The pupil is 5 mm in its size. A reflex from the eye fundus is
decreased, the details are not seen.
Formulate a diagnosis and define the volume of the first medical aid.
Administer treatment.
9. A 35-year-old patient is admitted to the hospital with complaints of
decrease in vision, redness of the right eye and pain in it. The symptoms
appeared a week ago without obvious reasons. Three years ago the
patient took treatment in the in-patient department on account of severe
penetrating corneoscleral trauma in the left eye. After a week’s
treatment enucleation of the left eye was offered to the patient, but he
refused.
Examination shows: Vis OD=0.2, correction not accepted, Vis OS=0.
The right eye: perecorneal injection, precipitates on the cornea, the iris is
green, the pupil is 2 mm. There is a deposition of fibrin in the lens. A
reflex from the fundus of the eye is decreased, the details are not seen.
The left eye: calm, diminished in its size, evident hypotonia, the cornea
is cloudy with a scar from 12 to 4 o’clock. The anterior chamber is flat,
the iris is atrophic.
Formulate a diagnosis and administer treatment.
10. A 27-year-old patient received a trauma of the right eye with dry
grass. After that redness of the eye, watering, photophobia and decrease
in vision appeared. The condition of the eye was getting worse. It
became blind and severe pain appeared in it.
Vis OD= 1/∞ p.l.in.c.
Vis OD=1.0
The right eye: the blue eyelids are dense and edematic. The eye slit is
constricted. Exophthalmos, the eyeball is motionless. The edematic
conjunctiva is swollen out in a form of a roller and trapped by the
eyelids. On the cornea there is a loose clouding with disintegration in the
65
center. The anterior chamber is of medium depth, the iris is of dirty grey
color with a green shade. The pupil is yellowish white. A reflex from the
eye fundus is absent. There is full-blown painfulness of the eyeball. The
patient has weakness, headache and temperature 38˚.
Make a diagnosis and administer treatment.
11. A 41-year-old patient is admitted to the ophthalmologic clinic with
complaints of sharp decrease in vision and pain in the left eye. Two days
ago something got into the left eye when he was working with metal.
Next day he noticed decrease in vision, redness of the eye and felt pain
in it.
During examination: Vis OD=1.0
Vis OS=1/∞ p.l.in.c.
Mixed injection, impairment of the conjunctiva in the external sections,
the cornea is opalescent, the anterior chamber is of medium depth, the
pupil is 3 mm. A reflex from the eye fundus is greenish, T+1. Cilliary
pain.
Formulate a diagnosis and make up a plan of investigation and
treatment. Prognosis.
66
Model of the case history
Design of the front page of the case history.
State educational institution
Higher Professional education
Ryazan State I.P.Pavlov Medical University
Ministry of Health of the Russian Federation
The chair of ophthalmology
(the head of the chair,
assistant, teacher).
History of the patient.
Name and Sirname
The diagnosis: The mature senile cataract of the right eye, aphakia,
secondary membranous cataract of the left eye.
Concomitant diseases: The general atherosclerosis, anchylosis of right
ankle-joint.
The curator: student of 5 year,
12 group, medical department
Lisicina G. N.
12 December 2018 year.
67
The passport data: the patient’s name, last name, patronymic, age,
the time of admission to hospital.
Complaints of the patient (concerned eyes and any other) on the day
of medical examination.
History of the disease: the development of the disease from its
beginning should be described. In the case of an acute condition of
chronic disease, the character of the last exacerbation should be
described first. The cause of the disease supposed by the patient
should be noticed. Mention any illness of eyes has taken place in the
past. Circumstances of the injury, mechanism, the time of the injury
and the time of the first aid should be noted by the trauma. The
treatment of the patient and its efficacy (from day of the first medical
examination) should be described.
Past history: you should briefly indicate important events of patient
life. Every fact which is essential for appearing and development of
the actual diseases should be described in details. Suffered diseases
and heredity should be noted
General examination (organ systems should be described briefly):
The state of organ of vision.
Vis OD = without correction and then with correction.
Vis OS = without correction and then with correction.
The right eye:
Eyelids: the size and the form of the eye-slit, the position of the
eyelids, the skin, margins of the eyelids, growth of the eyelashes.
68
Lacrimal organs: the lachrymal gland, lacrimal points, ducts, lacrimal
sac, the ductus and nasal tests, the rontgenography of lacrimal ducts.
The palpebral and bulbar conjunctiva: the colour, the state of surface,
the clarity, the discharge.
The eyeball: the size, the form, the position in the eye-socket, the
mobility, the presence or absence of injection and its type.
The sclera: the colour, the surface, local infiltration, painful palpation.
The cornea: the form, the size, the clarity, the smoothness, the
humidity, the luster, the perceptibility, the presence of vessels.
The anterior chamber: the depth, the clarity of moisture (liquid).
The iris: the colour, the pattern, the pupil (diameter, form, colour,
reaction for light, accommodation and convergence), symptom of
trembling.
The ciliary body: palpatory tenderness of eye at the region of ciliary
body.
The crystalline lens: the state, the clarity (localization, intensity, form
of dimness).
The vitreous body: the clarity (type of dimness).
The fundus of eye: the optic disk, the state of vessels, the region of
yellow spot, marginal parts of the fundus of eye.
The field of vision.
Intraocular pressure.
69
The left eye:
(it should be described in the same consecution)
A preliminary diagnosis:
Laboratory and other methods of examination:
A differential diagnosis: (if necessary, the problems of aetiology and
pathogenesis should be discussed).
Substantiation of diagnosis:
Final clinical diagnosis:
Treatment: should be prescribed individually to the patient (as a
prescription)
If the surgical treatment is necessary, the type of recommended
operation should be determined and substantiated.
The prognosis of the disease (with respect to vision) :
The signature of the curator:
Special attention writing the case history should be paid to the
differential diagnosis of similar diseases.
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Вы видите лучше вдали или
вблизи?
70
 TYPICAL EXPRESSION
 Do you have any trouble with
your eyes (eyesight)?
Do you have good (poor) vision?
Do you see better at a distance or
near to?
Каким глазом вы видите хуже?
Когда последний раз вы проверяли зрение?
Назовите букву, на которую я
показываю
У вас абсолютно нормальное
зрение (дальнозоркость, близорукость, высокая степень
близорукости, слабая степень
дальнозоркости)
У вас косоглазие с детства?
Вы видите ясно (нечетко, как в
тумане)?
Вы постоянно носите очки?
Какие?
Вы пользуетесь очками только
для работы на близком расстоянии (для дали)?
Вы должны носить очки постоянно (по необходимости)
Вам нужны очки для чтения (для
дали)
Which eye do you see worse with?
When did you last have your
eyes tested?
What letter am I pointing
to?
Your eyesight is quite normal (you
are longsighted, nearsighted, you
have a high degree of nearsightedness, a slight degree of
longsightedness)
Have you had a squint since
childhood?
Is your sight clear (blurred, dim)?
Do you wear glasses permanently?
What kind of glasses?
Do you use glasses only for shortdistance (long-distance) work?
You must wear your glasses
permanently (only when necessary)
You need glasses for reading (for
distant vision)
I'll prescribe glasses for shortЯ вам выпишу рецепт на очки для distance work (for long-distance
работы вблизи (для дали, для
work, for permanent wear)
постоянного пользования)
Do you see double?
У вас есть двоение в глазах?
Can you see better at dusk or in
Вы лучше видите в сумерки или
bright light?
при ярком свете?
Can you distinguish all colours?
Вы различаете все цвета?
Are your eyes often red and
У вас часто краснеют и восinflamed? (Do your eyes form pus
паляются глаза (нагнаиваются
sometimes? Do you often have
иногда глаза, часто бывают
sties?)
ячмени)?
Do your eyelids stick together in the
Края век утром слипаются?
morning?
Do you often have severe pains in
Вы часто ощущаете сильную боль the eyes?
71
в глазах?
Бывает ли у вас слизисто-гнойное
отделяемое в уголках глаз?
У вас есть ощущение засоренности глаз песком (ощущение
инородного тела за веками,
постоянный мучительный зуд в
веках, постоянное раздражение
век, выраженная чувствительность к пыли, искусственному свету)?
Вас беспокоит постоянное
слезотечение (спазм век)?
В вашей семье есть больные
Do you have a discharge of mucus
and pus at the corners of the eyes?
Do you have a gritty feeling in the
eyes (a sensation of a foreign body
present behind the eyelids,
persistent troublesome itching in the
eyelids, constant irritation of the
eyelids, pronounced sensitivity to
dust, artificial light)?
Are you troubled with persistent
eyewatering (eyelid spasm)?
Is there a history of glaucoma in
your family?
Do you have headache (eye pain
глаукомой?
after sleep)?
У вас бывает головная боль (боль Do you have periodical failing
в глазах утром после сна)?
vision (seeing rainbow effects
У вас бывает(ют) периодическое around a distant light, discomfort in
ухудшение зрения (видение
the eyes after excitement or in
радужных кругов вокруг
reduced illumination)?
источника света, находящегося на
расстоянии, неприятные
ощущения в глазах после
Have you [ever] noticed that one of
волнения или при плохом
your pupils is larger than the other?
освещении)?
Вы [когда-нибудь] замечали, что
у вас один зрачок шире, чем
другой?
 У больного(ой) стало быстро
ухудшаться зрение
У больного(ой) что-то с глазами
 A The patient has developed
rapidly failing vision
There is something wrong with the
patient's eyes
Установите офтальмоскоп на О Set the ophthalmoscope at О
diopters. Darken the room
диоптрий. Затемните комнату
Check visual acuity and fields
72
Проверьте остроту зрения и поля
зрения
Определите степень косоглазия!
Выверните веко! Приподнимите
слегка веко!
Поставьте канальцевую (носовую) пробу
Функция канальцев сохранена
Слеза свободно проходит в
слезный мешок
Канальцевая проба положительная, слезноносовая проба
отрицательная
Определите проходимость слезоотводящих путей
Какие зрачки у больного(ой)?
Зрачки круглые (правильной
формы, равномерно реагируют на
Measure the degree of strabismus
Evert the lid. Raise the upper eyelid
slightly
Do a ductus (nasal) test
Ductus function is retained
The tear passes into the lac-rimal
sac easily
Test of the duct is positive,
lacrimonasal test is negative
Determine if the lacrimal passage is
patent
What is the pupillary status?
The pupils are round (regular, react
equally to light and accomodation)
свет и аккомодацию)
Направляйте свет на каждый
зрачок по очереди
Исследуйте реакцию зрачков
Зрачки расширены (сужены,
неодинаковых размеров,
симметричны)
Левый зрачок шире, чем правый
Shine a light on each pupil in turn
Observe the pupillary response
The pupils are dilated (constricted,
unequal in size, symmetrical)
The left pupil is larger than the right
one
Pupil size and reaction to light are
Размер зрачков и реакция на свет
adequate
адекватны
Test the corneal reflex
Проверьте роговичный рефлекс!
Touch the cornea with a fine wisp of
Коснитесь
роговицы
тонким
cotton
жгутиком ваты
Не назначайте средств, расDon't order mydriatics without a
ширяющих зрачок, без кон- consultation with an
ophthalmologist
73
сультации с офтальмологом!
Больной(ая) жалуется на затуманивание зрения (видение
радужных кругов перед глазами,
одностороннюю головную боль)
Проведите тонометрию (компрессионно-тонометрическую
пробу, гониоскопию)
У больного(ой) язва роговицы
(бельмо роговицы, разрыв
радужки)
Тушируйте язву роговицы
Сделайте криоаппликацию
(фотокоагуляцию, лазерокоагуляцию, кератопластику)
Отмечается перикорнеальная
инъекция глаза (углубление
передней камеры глаза, помутнение ее влаги, изменение
цвета и рисунка радужной
оболочки)
Роговица блестящая (прозрачная,
тусклая, мутная)
Выделения из глаз гнойные
(обильные, сливкообразной
консистенции, желтого цвета)
Конъюнктива нормальной
окраски (отечная, гипертрофирована, разрыхлена, инфильтрирована, набухшая, яркокрасного цвета)
Отмечается болезненность
глазного яблока (светобоязнь,
покраснение век)
Диск зрительного нерва отечен
(гиперемирован, розовато-серый,
74
The patient complains of clouding
of vision (rainbow vision, one-sided
headache)
Perform tonometry (compressiontonometric test, gonioscopy)
The patient has a corneal ulcer (a
corneal spot, rupture of iris)
Paint the corneal ulcer
Perform cryoapplication
(photocoagulation, laser
coagulation, keratoplasty)
There is pericorneal injection of the
eye (recess of the anterior ocular
chamber, clouding of its humor,
change in colour and pattern of the
iris)
The cornea is bright (trans-parant,
dull, opaque)
Eye discharges are purulent
(profuse, of cream-like consistency,
of yellow colour)
Conjunctiva is of normal colour
(edematous, hypertro-phic, loose,
infiltrated, swollen, of bright-red
colour)
There is eyeball tenderness
(photofobia, reddening of the
eyelids)
The optic disk is edematous
(reddened, pinkish-gray, dis-
обесцвечен)
coloured)
Границы диска зрительного нерва
четкие (нечеткие)
Отмечается выраженное (незначительное) кровоизлияние в
сетчатку, частичное (краевое,
тотальное) отслоение сетчатки
Показана диатермокоагуляция
(криопексия)
Сосуды сетчатки резко расширены (сужены, извиты,
прерываются)
Закапайте в глаз пипеткой
дезинфицирующий раствор
(раствор пилокарпина, раствор
альбуцида)
Заложите в конъюнктивальный
мешок дезинфицирующую мазь
The optic disk borders are distinct
(blurred)
There is pronounced (slight)
bleeding into the retina, partial
(marginal, total) detachment of the
retina
There is indicated diathermocoagulation (cryopexy)
Промойте конъюнктивальный
мешок (слезные пути) дезинфицирующим раствором
Wash out the conjunctival sac
(lacrimal ducts) with a disinfectant
solution
Retinal vessels are greatly dilated
(narrowed, tortuous, interrupt)
Put with an eye dropper a disinfectant solution (a pilo-carpine
solution, an albucid solution) into
the eye
Place some disinfectant salve into
the conjunctival sac
Conclusion
Independent work of a student with a patient on the ophthalmology
department is very important. To examine a patient, students must know
special
methods
of
ophthalmologic
examination.
Various
ophthalmologic pathology demands different methods of examination to
be applied depending on the character of the disease. The basic goal of
given methodical recommendations is to help students in acquiring the
skills to work independently.
75
Literature
1. А.А. Бочкарева Глазные болезни, М.: Медицина, 1989 – 414 с.
2. Т.И. Ерошевский, А.А. Бочкарева Глазные болезни, М.:
Медицина, 1983 –448 с.
3. Lang G.K., Ophthalmology, Stuttgart, New York, 2000 – p. 1-16.
4. James B., Chew C., Bron A., Lecture Notes on Ophthalmology,
2000 – p.19-35.
5. Practical skills in Ophthalmology, Ryazan, 2004 – 95 p.
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