Syndrome of reduced vision

AIM It is necessary for doctors of all specialties to know the pathologies of organ of vision which proceed with loss of transparency of optical mediums of an eye, such as diseases of a vascular layer, keratitis and a cataract. Very often it is local display of many general diseases of an organism: rheumatism, diabetes, tuberculosis, chronic and sharp infectious diseases, a thyroid gland pathology etc. Doctors should be able to diagnose and treat patients with the given pathology. It is necessary to be able to carry out preventive maintenance of the possible complications probable at these diseases. Necessity of studying of the theme follows from this, that patients with the given pathologies of organ of vision can address to any expert.

GOALS GP should know: - Classification of diseases of a vascular layer, keratitis and cataracts; - Aetiopathogenesis and diagnostics of diseases of a vascular layer, keratitis and cataracts; - Clinic and principles of treatment of diseases of a vascular layer, keratitis and cataracts; - Complication and preventive maintenance of diseases of a vascular layer, keratitis and cataracts. 2010г.Каф.ПК.ВОП.ТашИУВ

GOALS GP should be able: –Finding-out the complaints and the short anamnesis of disease; –Rough check of visual acuity of each eye; –Survey of forward department of an eye with obligatory eversion of an upper eyelid; –Survey of all anterior parts of an eye by a method of lateral illumination and biomicroscopy; –Instillate of eye drops; –Put in the ointments –Wash conjunctival cavities; –Impose aseptic bandages; –Define the passableness of lacrimal ways, investigate tear production; Have acquaintance to technics of irrigating of lacrimal ways.

Anamnesis Reducing of vision: One sight or both sights Suddenly or slowly Conditions of reducing How long Dynamic Degree of vision increase Drugs influence Congenital causes

Patients examination Determination of visual acuity Study of the reaction of pupils to light The study of the visual fields Study of color vision Funduscopy

Vision with eye redness Conjunctivitis - vision does not suffer Iritis - a slight decrease of vision Defeat of the cornea - varying degrees of visual acuity When glaucoma attack – from attack to attack progressive decrease of vision

Acute attack glaucoma Typically, in elders Usually one-sided pain in the eye Decreased vision redness of the eye Nausea and vomiting Bright circles around lights Fixed wide pupil Sensation of tension in the eye

Blurred vision Acute diseases Chronic diseases

Внезапная безболезненная потеря зрения Относительно распространенные:  Окклюзия центральной артерии сетчатки  Окклюзия центральной вены сетчатки  Отслойка сетчатки  Кровоизлияние в стекловидное тело

Sudden painless loss of vision (continued) Uncirculated Transient ischemic attack Idiopathic ischemic optic neuropathy Toxic - alcohol Ischemia of the occipital lobe Functional-hysterical-simulating

Blurred vision - "blurred vision" Blurred in the eyes – scarring of the cornea – cataract – back vitreous detachment – problems with the optical focus – pigmentary degeneration

Cataracts. Definition. Reduction of lens transparency that leads to impaired vision.

Clinical manifestations Cataracts - the most common cause of visual loss in adults. 95% of adults over age 65 have some degree of visual impairment. Gradual, painless decrease of vision over a period of time Many patients are not aware of the problem of view.

Pathogenesis Coagulation of protein leads to the formation of opaque areas in the lens (unknown cause) Aging process Other causes: metabolic, congenital, eye injury caused by drugs, eye disease (chronic anterior uveitis)

Симптомы «пятна», «туман», «расплывчатость» пред глазами «Вспышки», «блески»- одно из симптоматических проявлений рассеивания света и появляется когда пациент смотрит на источник света. Блески характерны при ночном вождении автомобиля

Clinic Cataracts can occur in one eye (monocular) ripens quickly or in one eye than in the other Children with congenital, traumatic or metabolic cataracts may not indicate a problem on their vision. (parents and teachers may first suspect the problem of view)

Factors that influence to the formation of cataracts Too large ultraviolet irradiation diabetes mellitus corticosteroids Smoking and alcohol intake Avitaninosis

Taking of anamnesis Ask about duration of symptoms Struck only one eye or both? As a "lip", "flash" effect on vision and how long they were Children with cataracts: ask parents about change of behavior (games at school, homework)

Сбор анамнеза Спросите о факторах риска – ожирение, неправильное питание Травма глаза в анамнезе Прием ЛС и прошлый анамнез

Examination Visual acuity on long and short distance (broken most) The reaction of the pupil to light (not broken in cataract)

Examination Look for leykokoriya (gray pupil) with mature cataract Field of view (without pathology) Check the red reflex at a distance of 20 cm

Additional studies Conducts an ophthalmologist Investigation with slit lamp

Non-surgical treatment Decides ophthalmologist Changing lenses and glasses Right light Wear a hat and sunglasses Stop smoking Antioxidants, vitamins E, C and A Observation: ophthalmologist

Cataract surgery

Application of IOL