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Examination of the fundus in arterial hypertension is recommended. visual impairment in hypertension. Acute obstruction of the central retinal artery

In fact, the fundus is what the back of the eyeball looks like when viewed on examination. Here you can see the retina, choroid and optic nerve papilla.

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

The optic nerve disc looks like a pinkish circle or an oval up to 1.5 mm in cross section. Almost in its center you can see a small funnel - the exit point of the central blood vessels (the central artery and retinal vein).

Closer to the lateral part of the disk, one can rarely see another depression like a bowl, it represents a physiological excavation. It looks slightly paler than the medial part of the optic disc.

Normal fundus, on which the optic nerve papilla (1), retinal vessels (2), fovea (3) are visualized

The norm in children is a more intense color of the optic disc, which becomes paler with age. The same is observed in people with myopia.
Some people have a black circle around the optic disc, which is formed by an accumulation of melanin pigment.

The arterial vessels of the fundus look thinner and lighter, they are more straight. Venous are larger in size, in a ratio of approximately 3: 2, more convoluted. After leaving the optic nerve papilla, the vessels begin to divide according to the dichotomous principle almost to the capillaries. In the thinnest part, which can be determined by the study of the fundus, they reach a diameter of only 20 microns.

The smallest vessels gather around the macula and form a plexus here. Its greatest density in the retina is achieved around the macula - the area of ​​​​best vision and light perception.

The very same area of ​​the macula (fovea) is completely devoid of blood vessels, its nutrition is carried out from the choriocapillary layer.

Age features

The fundus of the eye in normal newborns has a light yellow color, and the optic disc is pale pink with a grayish tinge. This slight pigmentation usually disappears by the age of two. If a similar picture of depigmentation is observed in adults, then this indicates atrophy of the optic nerve.

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

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

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

Changes in the fundus in children and adolescents can be:

• with the possibility of reverse development (no organic changes);
• transient (they can only be assessed at the time of their appearance);
• non-specific (there is no direct dependence on the general pathological process);
• predominantly arterial (no changes in the retina characteristic of hypertension).

With age, the walls of blood vessels thicken, which makes small arteries less visible and, in general, the arterial network seems more pale.

The norm in adults should be assessed with an eye to concomitant clinical conditions.

Research methods

There are several methods for checking the fundus. An ophthalmological examination aimed at examining the fundus of the eye is called ophthalmoscopy.

Examination by an ophthalmologist is performed by magnifying the illuminated areas of the fundus with a goldmann lens. Ophthalmoscopy can be carried out in direct and reverse form (the image will be inverted), which is due to the optical design of the ophthalmoscope device. Reverse ophthalmoscopy is suitable for general examination, the devices for its implementation are quite simple - a concave mirror with a hole in the center and a magnifying glass. Direct use if necessary, a more accurate examination, which is performed by an electric ophthalmoscope. To identify structures invisible in ordinary lighting, the fundus is illuminated with red, yellow, blue, yellow-green rays.

Fluorescent angiography is used to obtain an accurate picture of the vascular pattern of the retina.

Why does the eyeball hurt?

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

Vascular diseases

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

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

First: small stenoses of arterioles, the beginning of sclerotic changes. There is no hypertension yet.

Second: the severity of stenosis increases, arterio-venous decussations appear (the thickened artery presses on the underlying vein). Hypertension is noted, but the state of the body as a whole is normal, the heart and kidneys do not suffer yet.

Third: permanent angiospasm. In the retina, there is an effusion in the form of "lumps of cotton wool", small hemorrhages, edema; pale arterioles look like a "silver wire". The indicators of hypertension are high, the functionality of the heart and kidneys is impaired.

The fourth stage is characterized by the fact that the optic nerve swells, and the vessels undergo a critical spasm.

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

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

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

With ophthalmoscopy, the picture of the fundus has characteristic features:

• microaneurysms of retinal vessels in the area of ​​stenosis;
• an increase in the diameter of the veins and the development of phlebopathy;
• expansion of the avascular zone around the macula, due to the overlap of capillaries;
• the appearance of a hard lipid effusion and soft cotton-like exudate;
• microangiopathy develops with the appearance of clutches on the vessels, telangiectasias;
• multiple small hemorrhages at the hemorrhagic stage;
• the appearance of an area of ​​neovascularization with further gliosis - the growth of fibrous tissue. The spread of this process gradually can lead to tractional retinal detachment.

ONH

Pathology of the optic nerve head can be expressed as follows:

• megalopapilla - the measurement shows an increase and blanching of the optic disc (with myopia);
• hypoplasia - a decrease in the relative size of the optic disc in comparison with the vessels of the retina (with hypermetropia);
• oblique ascent - the optic disc has an unusual shape (myopic astigmatism), the accumulation of retinal vessels is displaced towards the nasal region;
• coloboma - an optic disc defect in the form of a notch, causing visual impairment;
• symptom of "morning glow" - mushroom-shaped protrusion of the optic disc into the vitreous body. Ophthalmoscopy descriptions also indicate chorioretinal pigmented rings around an elevated optic disc;
• congestive nipple and edema - an increase in the nipple of the optic nerve, its blanching and atrophy with an increase in intraocular pressure.

The pathologies of the fundus include a complex of disorders that occur in multiple sclerosis. This disease has a multiple etiology, often hereditary. When this occurs, the destruction of the myelin sheath of the nerve against the background of immunopathological reactions develops a disease called optic neuritis. There is an acute decrease in vision, central scotomas appear, color perception changes.

On the fundus, one can detect a sharp hyperemia and swelling of the optic disc, its borders are erased. There is a sign of atrophy of the optic nerve - blanching of its temporal region, the edge of the ONH is dotted with slit-like defects, indicating the onset of atrophy of the nerve fibers of the retina. Also noticeable is the narrowing of the arteries, the formation of muffs around the vessels, macular degeneration.

Treatment for multiple sclerosis is carried out with glucocorticoid preparations, since they inhibit the immune cause of the disease, and also have an anti-inflammatory and stabilizing effect on the vascular walls. For this purpose, injections of methylprednisolone, prednisolone, dexamethasone are used. In mild cases, corticosteroid eye drops such as Lotoprednol can be used.

Inflammation of the retina

Chorioretinitis is caused by infectious-allergic diseases, allergic non-infectious, post-traumatic conditions. In the fundus, they are manifested by many rounded formations of light yellow color, which are located below the level of the retinal vessels. The retina at the same time has a cloudy appearance and a grayish color due to the accumulation of exudate. With the progression of the disease, the color of the inflammatory foci in the fundus may approach whitish, as fibrous deposits form there, and the retina itself becomes thinner. Retinal vessels practically do not change. The outcome of inflammation of the retina is cataract, endophthalmitis, exudative, in extreme cases - atrophy of the eyeball.

Diseases affecting the vessels of the retina are called angiitis. Their causes can be very diverse (tuberculosis, brucellosis, viral infections, fungal infections, protozoa). In the picture of ophthalmoscopy, vessels surrounded by white exudative muffs and stripes are visible, areas of occlusion, cystic edema of the macula zone are noted.

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

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

In many cases, these diseases signal us about complex systemic diseases of our body as a whole. So, the narrowing of the fundus vessels will be the first alarm signal for all types of retinopathy, among which there will be secondary manifestations of diabetes mellitus, heart and vascular diseases, and many others.

Other pathologies of the fundus will also tell about serious health problems, as well as their danger in the loss of visual acuity, which, most likely, cannot be restored. These diseases require urgent and urgent treatment.

By the term "fundus", doctors mean the inside of the eyeball, which can be seen with ophthalmoscopy (this is a non-invasive examination, it is performed by eye doctors using an ophthalmoscope in a dark room). During ophthalmoscopy, they can see eye diseases, as well as the first symptoms of many systemic diseases, without interfering with our body.

So, with the help of an ophthalmoscope, the doctor sees:

• The structure of the vessels of the eye, veins and arteries, their filling, possible narrowing or, conversely, expansion, the presence of hemorrhages.
• Optic nerve and macula, their defects.
• Retina, its thinning (dystrophies), detachments, ruptures.

We ourselves will not be able to see the fundus, but the doctor will tell a lot about the state of our health simply by looking at the fundus through the ophthalmoscope.

The pathology of the fundus is always secondary. Therefore, it is imperative to look for the underlying disease.

Diseases of the vessels of the eye

Retinopathy (angiopathies) occupy the largest segment among fundus diseases. This can be narrowing, inflammation of blood vessels, their thrombosis, too much filling with blood or thinning, dystrophy. So, with narrowing and thrombosis of blood vessels, the tissues of the eye will lack nutrients, and with excessive filling, they become permeable and blood enters the retina, which causes its detachment and ruptures.

There can be several reasons for retinopathy: diabetes mellitus, high blood pressure, rheumatoid arthritis or vascular atherosclerosis, age-related changes, congenital pathologies. The vessels of the eye are the first to react to pathogenic processes in the body, their changes are already visible when there are no other clinical manifestations yet.

Treatment of the vascular membrane of the eye

Treatment will depend on the type of vascular changes. So, with thrombosis of the central vein or one of the branches, the veins expand and wriggle, retinal edema occurs, hemorrhages are small and larger. Among the symptoms will be pain in the eye, a sharp deterioration in vision (most often in one eye), flashing lightning.

Thrombosis occurs as a result of heart disease, vascular atherosclerosis, varicose veins. Their treatment should take place in a hospital and involves thrombolisis in the acute period, which includes the introduction of heparin behind the eyeball, treatment with fibrolytic drugs and anticoagulants, today laser coagulation is often performed. After the acute symptoms are relieved, treatment is carried out with anti-inflammatory eye drops and corticosteroids. It is not possible to significantly restore vision in such cases.

With occlusion of the central retinal artery, its acute obstruction occurs. The reason for this may be blood clots, emboli, closure of the lumen, on examination there is swelling of the retina, narrowing of the artery or its expansion. The causes of this condition will be the same diseases as with vein thrombosis, narrowing of the lumen may occur due to hypertension, atrial fibrillation, and chronic infections. It is usually impossible to determine the cause of occlusion. Among the symptoms there will be a sharp decrease in vision, pain, pain in the eye, the appearance of a veil.

Treatment should be started as early as possible. As part of it, thrombolisis is performed, plasminogen or streptokinase is injected intravenously, the thrombus dissolves and blood circulation is restored. The prognosis for recovery is good. In the future, the patient is prescribed vasodilators and diuretics, corticosteroids (to prevent occlusion in the future).

With vasculitis (angiopathies, periphlebitis, Eales' disease), inflammation of the retinal vessels occurs, and as a result of damage to the vascular walls, they swell, edema appears, the blood supply to the tissues of the eye is disturbed, vasculitis can affect small areas or be extensive. The occurrence of vasculitis will be indicated by inflammation, swelling and thickening of the vascular walls.

Symptoms of the disease will be poor eyesight, twilight blindness, dry eye syndrome. These diseases most often affect people aged 20-55 years, age-related vasculitis (retinopathy) affects the elderly. Treatment of vasculitis involves, first of all, the treatment of the underlying disease, as well as non-steroidal anti-inflammatory drops, sometimes glucocorticosteroids, complex eye preparations are good. This usually gives good results.

If this disease occurs, the main symptom will be a decrease (with subsequent loss) of visual acuity, which cannot be corrected. At the same time, there is also a narrowing of the visual fields (the most difficult manifestation will be “tunnel” vision) and the appearance of cattle (blurring, loss of areas, spots).

There is atrophy of the optic nerve as a result of a violation of its nutrition. There can be many reasons for this:

• genetic predisposition and hereditary diseases;
• disease of the structures of the eye, inflammation of the retina, compression of the optic nerve, its inflammation;
• tumors of the central nervous system, brain, abscesses;
• encephalitis and meningitis;
• poisoning, intoxication (including ethyl alcohol);
• severe hypertension;
• atherosclerosis;
• glaucoma.

With atrophy of the optic nerve, there is a partial death of the fibers and their replacement by connective tissue cells. It is impossible to restore the lost nerve fibers, so the treatment will be aimed at preserving those that are in the process of destruction, stopping the process of atrophy. Restoration of lost functions is impossible, optic nerve atrophy is difficult to treat.

To treat this disease, first of all, it is necessary to treat the underlying disease, in addition, eye drops (anti-inflammatory, corticosteroids), intravenous injections and into the structures of the eye, electrophoresis is indicated. All treatment will be aimed at improving metabolic processes in the nerve fibers of the optic nerve, tissues of the eye and the body as a whole, activating regenerative processes, as well as improving blood circulation in the optic nerve and its fibers, and resolving pathological formations.

Tumors of the retina

The most commonly diagnosed retinoblastoma is a tumor of the retina, which is most often hereditary. The disease occurs in the prenatal period of fetal development, manifests itself at the age of 1-2 years. A characteristic feature will be the glow of the eyes (white eye syndrome), a fixed pupil and strabismus (appears a little later). But in many cases, only a regular examination of the fundus allows you to start treatment in a timely manner.

Choroid melanoma will be next in frequency of detection. The tumor is located behind the retina in the choroid. It develops slowly and is asymptomatic for a long time. Deterioration of the general condition, decreased mobility of the eye, inability to completely close it, swelling of the eyelid and, in the later stages, bulging eyes, occur quite late.

Treatment of tumors of the fundus involves surgery. Today, a laser is used to remove retinoblastoma. Good results in the early stages are given by cryotherapy and photocoagulation. In later cases, enucleation or exenteration, radiation therapy, chemotherapy are used.

Treatment of melanoma also involves the removal of the eyeball (exenteration), but very often the tumor is detected too late for it (the presence of metastases to other organs and tissues).

Detachment, ruptures and dystrophy of the retina

These diseases of the fundus are always secondary. Retinal detachments and ruptures occur as a consequence of vascular retinopathy or vein thrombosis. The hemorrhage enters the retina and contributes to its edema, swelling and detachment from the choroid, with swelling, both single and multiple ruptures are possible.

The appearance of retinal breaks can contribute to its thinning, due to genetic (congenital) factors or general diseases.

In most cases, the causes of retinal dystrophy in childhood and young age are hereditary factors. Signs will be scotomas, loss of fields, violation (to the complete absence) of color perception.

In a more mature (after 50 years) and elderly, retinal dystrophy is caused by systemic diseases (high blood pressure, diabetes mellitus, etc.), as well as age-related changes in the body. In these cases, it is secondary.

Treatment of dystrophy is symptomatic, aimed at localizing the lesion. Medical treatment is indicated (strengthening, absorbable and corticosteroid injections, complex eye drops).

With detachment and ruptures of the retina, hospitalization is urgent. Symptoms appear quickly - this is a deterioration in visual acuity, lightning before the eyes, a veil, loss of fields. These pathologies can cause complete blindness. Vitreoretinal surgery (laser), cryotherapy, followed by conservative treatment are widely used here.

Forecasts for vision recovery are disappointing.

Prevention of eye diseases

Diseases of the fundus in the vast majority are secondary. They arise as a consequence of other systemic diseases of the body, which means that in order to prevent them, it is important to treat the underlying disease in a timely and adequate manner.

For prevention, it is also important to have a proper lifestyle, moderate alcohol consumption, and smoking cessation. The eye is very sensitive to the intoxication of the body.

One of the important components of prevention will be a systematic examination of the fundus.

For adults, ophthalmoscopy is indicated once a year in the absence of eye diseases and at least once every six months if they are present. For children and adolescents, it is advisable to undergo such an examination every six months.

This will allow timely detection of pathology (both secondary and caused by hereditary factors) and begin adequate treatment.

Heal and be healthy!

In fact, the fundus is what the back of the eyeball looks like when viewed on examination. Here you can see the retina, choroid and optic nerve papilla.

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

The optic nerve disc looks like a pinkish circle or an oval up to 1.5 mm in cross section. Almost in its center you can see a small funnel - the exit point of the central blood vessels (the central artery and retinal vein).

Closer to the lateral part of the disk, one can rarely see another depression like a bowl, it represents a physiological excavation. It looks slightly paler than the medial part of the optic disc.

Normal fundus, on which the optic nerve papilla (1), retinal vessels (2), fovea (3) are visualized

The norm in children is a more intense color of the optic disc, which becomes paler with age. The same is observed in people with myopia.
Some people have a black circle around the optic disc, which is formed by an accumulation of melanin pigment.

The arterial vessels of the fundus look thinner and lighter, they are more straight. Venous are larger in size, in a ratio of approximately 3: 2, more convoluted. After leaving the optic nerve papilla, the vessels begin to divide according to the dichotomous principle almost to the capillaries. In the thinnest part, which can be determined by the study of the fundus, they reach a diameter of only 20 microns.

The smallest vessels gather around the macula and form a plexus here. Its greatest density in the retina is achieved around the macula - the area of ​​​​best vision and light perception.

The very same area of ​​the macula (fovea) is completely devoid of blood vessels, its nutrition is carried out from the choriocapillary layer.

Age features

The fundus of the eye in normal newborns has a light yellow color, and the optic disc is pale pink with a grayish tinge. This slight pigmentation usually disappears by the age of two. If a similar picture of depigmentation is observed in adults, then this indicates atrophy of the optic nerve.

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

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

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

Changes in the fundus in children and adolescents can be:

• with the possibility of reverse development (no organic changes);
• transient (they can only be assessed at the time of their appearance);
• non-specific (there is no direct dependence on the general pathological process);
• predominantly arterial (no changes in the retina characteristic of hypertension).

With age, the walls of blood vessels thicken, which makes small arteries less visible and, in general, the arterial network seems more pale.

The norm in adults should be assessed with an eye to concomitant clinical conditions.

Research methods

There are several methods for checking the fundus. An ophthalmological examination aimed at examining the fundus of the eye is called ophthalmoscopy.

Examination by an ophthalmologist is performed by magnifying the illuminated areas of the fundus with a goldmann lens. Ophthalmoscopy can be carried out in direct and reverse form (the image will be inverted), which is due to the optical design of the ophthalmoscope device. Reverse ophthalmoscopy is suitable for general examination, the devices for its implementation are quite simple - a concave mirror with a hole in the center and a magnifying glass. Direct use if necessary, a more accurate examination, which is performed by an electric ophthalmoscope. To identify structures invisible in ordinary lighting, the fundus is illuminated with red, yellow, blue, yellow-green rays.

Fluorescent angiography is used to obtain an accurate picture of the vascular pattern of the retina.

Why does the eyeball hurt?

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

Vascular diseases

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

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

First: small stenoses of arterioles, the beginning of sclerotic changes. There is no hypertension yet.

Second: the severity of stenosis increases, arterio-venous decussations appear (the thickened artery presses on the underlying vein). Hypertension is noted, but the state of the body as a whole is normal, the heart and kidneys do not suffer yet.

Third: permanent angiospasm. In the retina, there is an effusion in the form of "lumps of cotton wool", small hemorrhages, edema; pale arterioles look like a "silver wire". The indicators of hypertension are high, the functionality of the heart and kidneys is impaired.

The fourth stage is characterized by the fact that the optic nerve swells, and the vessels undergo a critical spasm.

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

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

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

With ophthalmoscopy, the picture of the fundus has characteristic features:

• microaneurysms of retinal vessels in the area of ​​stenosis;
• an increase in the diameter of the veins and the development of phlebopathy;
• expansion of the avascular zone around the macula, due to the overlap of capillaries;
• the appearance of a hard lipid effusion and soft cotton-like exudate;
• microangiopathy develops with the appearance of clutches on the vessels, telangiectasias;
• multiple small hemorrhages at the hemorrhagic stage;
• the appearance of an area of ​​neovascularization with further gliosis - the growth of fibrous tissue. The spread of this process gradually can lead to tractional retinal detachment.

ONH

Pathology of the optic nerve head can be expressed as follows:

• megalopapilla - the measurement shows an increase and blanching of the optic disc (with myopia);
• hypoplasia - a decrease in the relative size of the optic disc in comparison with the vessels of the retina (with hypermetropia);
• oblique ascent - the optic disc has an unusual shape (myopic astigmatism), the accumulation of retinal vessels is displaced towards the nasal region;
• coloboma - an optic disc defect in the form of a notch, causing visual impairment;
• symptom of "morning glow" - mushroom-shaped protrusion of the optic disc into the vitreous body. Ophthalmoscopy descriptions also indicate chorioretinal pigmented rings around an elevated optic disc;
• congestive nipple and edema - an increase in the nipple of the optic nerve, its blanching and atrophy with an increase in intraocular pressure.

The pathologies of the fundus include a complex of disorders that occur in multiple sclerosis. This disease has a multiple etiology, often hereditary. When this occurs, the destruction of the myelin sheath of the nerve against the background of immunopathological reactions develops a disease called optic neuritis. There is an acute decrease in vision, central scotomas appear, color perception changes.

On the fundus, one can detect a sharp hyperemia and swelling of the optic disc, its borders are erased. There is a sign of atrophy of the optic nerve - blanching of its temporal region, the edge of the ONH is dotted with slit-like defects, indicating the onset of atrophy of the nerve fibers of the retina. Also noticeable is the narrowing of the arteries, the formation of muffs around the vessels, macular degeneration.

Treatment for multiple sclerosis is carried out with glucocorticoid preparations, since they inhibit the immune cause of the disease, and also have an anti-inflammatory and stabilizing effect on the vascular walls. For this purpose, injections of methylprednisolone, prednisolone, dexamethasone are used. In mild cases, corticosteroid eye drops such as Lotoprednol can be used.

Inflammation of the retina

Chorioretinitis is caused by infectious-allergic diseases, allergic non-infectious, post-traumatic conditions. In the fundus, they are manifested by many rounded formations of light yellow color, which are located below the level of the retinal vessels. The retina at the same time has a cloudy appearance and a grayish color due to the accumulation of exudate. With the progression of the disease, the color of the inflammatory foci in the fundus may approach whitish, as fibrous deposits form there, and the retina itself becomes thinner. Retinal vessels practically do not change. The outcome of inflammation of the retina is cataract, endophthalmitis, exudative, in extreme cases - atrophy of the eyeball.

Diseases affecting the vessels of the retina are called angiitis. Their causes can be very diverse (tuberculosis, brucellosis, viral infections, fungal infections, protozoa). In the picture of ophthalmoscopy, vessels surrounded by white exudative muffs and stripes are visible, areas of occlusion, cystic edema of the macula zone are noted.

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

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

The fundus of the eye is often examined for various diseases. This, in fact, is the only "window" that allows you to look inside the body without surgical intervention and identify many pathologies in the initial stages. Therefore, this topic will be of interest to many people.

The concept of the fundus and how it is explored

The fundus is internal, which is visible with ophthalmoscopy. This technique makes it possible to examine in detail with magnification the inner surface, with the optic nerve disk located on it, and blood vessels. The fundus of the eye during such a study has a red color, against this background the optic nerve (circle or pink oval), vessels and yellow spot stand out. The most informative are the following indicators:

• color of the optic disc;
• the clarity of its boundaries;
• the number of veins and arteries (the norm is from 16 to 22);
• presence of pulsation.

Any deviations from the norm and the slightest changes can tell a lot to an experienced ophthalmologist. And very often, after the diagnosis, he gives referrals to other specialists. As for the ophthalmoscopy procedure itself, it is completely harmless to humans, and there is no deterioration in vision after such a diagnosis, contrary to various opinions.

It is a standard procedure when visiting an ophthalmologist and, perhaps, the most informative method for detecting eye diseases.

How is ophthalmoscopy performed?

Before the procedure, a special drug is instilled in, which. This is done in order to better examine the bottom of the eye. This procedure has practically no contraindications. And the most common indications for conduction are visual impairments, or simply when the eye hurts.

What can tell changes in the fundus of the eye? By the type of vessels in it, one can to some extent judge the state of the blood vessels of the brain. And the optic disc will also tell about diseases of the central nervous system. Sometimes such a diagnosis can reveal a disease whose symptoms are expressed only in changes in the retina. These are very serious illnesses, such as, for example, brain tumors.

That is why doctors regularly refer patients for such an examination who have violations in the work of the following organs and systems:

• cardiovascular;
• endocrine;
• nervous system;
• metabolic disorders.

This manipulation is carried out using an ophthalmoscope - a round concave mirror, in the center of which there is a small hole. However, now such a procedure is performed using electronic devices, which, if necessary, can even photograph the fundus.

What ailments are pathological changes talking about?

Ophthalmoscopy provides doctors with a lot of information. What ailments can this type of diagnosis reveal? They are the following:

1. diabetes . One of the very first signs of this disease, when nothing else hurts, and the person feels fine, may be a slight bleeding in the retina. With early detection of such a phenomenon, the chances are significantly increased that the disease will not go into a stage when changes in the body become irreversible.
2. arterial hypertension. With hypertension, the doctor can detect a number of symptoms in the fundus, for example, narrowing of the fundus vessels. This phenomenon, otherwise called angiopathy, indicates a malfunction in the human cardiovascular system. And very often these transformations are the first sign that manifests itself in hypertension.
3. cancer . An experienced eye doctor can detect not only signs of oncological diseases of the brain, but also other organs. Moreover, at an early stage, when the patient still has no pain. Therefore, we can safely say that timely ophthalmoscopy can save a person's life.
4. multiple sclerosis. Inflammation of the optic nerve may be a harbinger of this serious disease. According to some studies, this symptom appears very first in 75% of cases.
5. rheumatoid arthritis. This insidious disease may not manifest itself for a long time, but will manifest itself when the changes affect the cardiovascular system and become irreversible. It is during the study of the fundus that this disease can be detected at a very early stage. This diagnosis will reveal inflammation of the choroid, which will be a characteristic symptom of arthritis.

Summarizing

A person who does not have any pain should still visit an ophthalmologist once a year and conduct an examination.

People with vision problems, with hypertension or other chronic diseases, this procedure should be done even more often - at least once every six months.

The fundus of the eye is a mirror of many ailments. It gives the very first information about them. Early diagnosis of such diseases is very important, because it will contribute to their rapid cure or symptom relief.

Article author: Anna Golubeva

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

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

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

Features of the disease

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

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

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

Classification

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

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

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

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

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

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

Background angiopathy of the eyes appears against the background of other diseases. With this type of pathology, dangerous dystrophy processes occur in the retina. Traumatic lesions, hypertension, diabetes mellitus, high blood pressure, work with constant eye strain can provoke it.

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

Traumatic angiopathy begins to develop as a result of compression of the chest, trauma to the brain, neck, and edema after contusion.

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

Main reasons

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

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

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

Characteristic features

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

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

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

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

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

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

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

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

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

Features of treatment

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

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

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

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

Medical therapy

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

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

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

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

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

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

Possible Complications

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

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

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

Forecast

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

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

Carrying out prevention

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

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

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

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

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