Ophthalmology program for studentsall faculties
GENERAL OPHTHALMOLOGY
Introduction
The eye and its role in the life of the body. The eye as a link in the photoenergetic (FES) or optical-vegetative system (OVS) of the body (eye-hypothalamus-pituitary gland).
The purpose of studying ophthalmology in an age aspect for the future daily activities of a doctor.
List of the main common diseases in children and adults that contribute to the occurrence of a pathological process or manifest themselves in the eye (tuberculosis, collagenosis, vascular diseases, leukemia, diabetes, infections, diseases of the central nervous system and DR)
The contribution of teams of scientists from research institutes and departments of eye diseases, and the development of ophthalmology.
Characteristics of achievements and unsolved problems in various areas of ophthalmology. The main directions and results of scientific research, participation in solving these problems of the department
Combating blindness and reducing eye morbidity among the population. Ethics and deontology in ophthalmology.
Basic documents regulating work in the field of vision protection.
Brief introduction to students of the principles, objectives and methods of teaching ophthalmology and their features in the conditions of this higher educational institution
Formation of the organ of vision
Conditions ensuring the development and functioning of the eye. Paths and directions of development of the light-perceiving apparatus. Differentiation of the visual apparatus due to the living conditions of living beings.
Stages of development of the visual analyzer, their duration and the state of visual functions in each of them. The role of heredity and other factors in the formation and development of the eye.
Age-related anatomy, physiology and function of the constituent parts of the eye and itsauxiliary (adjunct) apparatus
Three links of the visual analyzer: Specific peripheral receptor, pathways, visual centers. The role of the visual analyzer, illumination in the general development of a person and his adaptation to the external environment. Structure and level, dynamics of eye morbidity in the population in comparison with other countries.
Eyelids. Anatomy and functions of the eyelids. Developmental anomalies
Lacrimal organs. Tear-producing apparatus. Lacrimal ducts, Beginning of active functioning of the lacrimal gland, Anomalies in the structure of the nasolacrimal canal in newborns, their possible consequences
Conjunctiva. Anatomy, functions of the conjunctiva of the eyelids, transitional fold and eyeball. Three sections, structural features of the conjunctiva in children. Properties of normal conjunctiva The significance of the structural features of the conjunctiva in pathology,
Oculomotor apparatus. Topographic anatomy Innervation, functions of the extraocular muscles. Types of pathology.
Eyeball. Age dynamics of the size, weight and shape of the eyeball.
Outer shell (capsule) of the eye:
a) cornea, its structure, chemical composition, functions. Features of metabolic processes. The role of anatomical and physiological features of the cornea and its pathology. Developmental anomalies;
b) sclera, its structure, topographic anatomy, functions. The nature of the pathological processes,
c) limbus, its topographic anatomy, features of the width and color of the limbus in people of different ages (embryotoxon, gerotoxon, Kayser-Fleischer ring, etc.).
Choroid(iris, ciliary body, choroid). Two blood supply systems of the choroid, anastomoses between them. The importance of separate blood supply in the occurrence and spread of inflammatory diseases.
Main types and frequency of pathology:
a) iris, age-related features of the structure of the iris. The role of the iris in the penetration of light flux to the retina, in ultrafiltration and outflow of intraocular fluid; types of pathology:
b) the ciliary body, its topographic anatomy and structural features, its role in the formation and outflow of intraocular fluid, in the act of accommodation, in thermoregulation, etc.; the significance of the ciliary body in the physiology and pathology of the eye; types of pathology:
c) choroid, its structure. The role of the choroid in the visual process; types of pathology.
Retina. Structure and functions of the retina. Features of the retina in newborns. Two retinal power systems. Types of pathology Interaction of the retina and choroid in the visual act. The theory of Vavilov and Lazarev.
Visual path. Topographic anatomy of 4 sections of the optic nerve (intraocular, orbital, intracanalicular, and cranial) features of the optic nerve head in children. Chiasma, topography, the role of border formations (internal carotid arteries, pituitary gland) in the development of pathology. Optic tract, subcortical visual centers. Timing of formation of visual centers of the cerebral cortex. Topography of these formations and functions Associative connections of poly 17-18-19 with other fields (according to Brodmann). The role of the cerebral cortex in the visual act
Vessels and nerves of the eye and its adnexa. Features of the formation and function of cranial nerves and sympathetic innervation in children. Terms of functional formation,
Orbit. Structure, contents, topographic anatomy, functions. Types of pathology, the role of anatomical relationship with the ENT organs, oral cavity, cranial cavity in the occurrence of pathological processes,
Visual functions and age dynamics of their development
Physiology of visual perception. The importance of the structure of the light-receiving apparatus, the nutritional conditions of the retina, the presence of vitamin A, rhodopsin, iodopsin, selenium, hydrogen, etc., retinomotor, photochemical and bioelectric reactions. The role of the state of the conduction pathways and visual centers in the act of vision and division.
Hypermetropia (farsightedness) Age dynamics. frequency. Features of optical correction of hypermetropia.
Myopia (myopia) Characteristics, age dynamics and frequency. Congenital and progressive myopia. Changes in the membranes of the eye with progressive myopia. Pathogenesis, classification (magnitude, progression, optical, axial, stages, degree of vision loss). Prevalence and role of unfavorable factors Treatment is medicinal and surgical. Prevention. Optimal spectacle correction of myopia, contact correction.
Astigmatism. Characteristics, prevalence, dynamics of astigmatism depending on age. Types of astigmatism, methods for its determination. Features of glasses used to correct astigmatism. Contact lenses.
Accommodation. Topographic changes in the eye during accommodation. Convergence and its role in accommodation. Length and volume accommodation. Changes in accommodation associated with age, Spasm and paralysis of accommodation, their causes Diagnosis of spasms of accommodation and their prevention Visual fatigue (asthenopia) and methods of its treatment Presbyopia (age-related senile vision) and its correction depending on the initial clinical refraction and age Hygiene of visual work in children and old age.
Methods for examining the organ of vision
In the process of examining the eye and its auxiliary apparatus, it is always necessary to remember the age-related characteristics of its condition, since only in this case it is possible to promptly identify and correctly assess the type and severity of pathology of the organ of vision
External inspection. Determination of the symmetry of the location of the eyes, the size and shape of the palpebral fissure. Examination of the shape, size, position, integrity of the eyelids, identification of congenital anomalies: eyelid coloboma, ankyloblepharon, blephorochalasis, ptosis, epicanthus, etc., examination of the skin of the eyelids - hyperemia, hemorrhage, swelling, as well as the edges of the eyelids - growth of eyelashes, scales, crusts, ulcerations, eversion, volvulus. Examination of the eyeball, its size, position in the orbit and mobility. Lacrimation, lacrimation, purulent or other discharge. Inspection of the conjunctiva - color, surface, moisture, nature of the discharge in the conjunctival sac. Studies of the lacrimal gland and lacrimal ducts - lacrimal openings, their position, size, determination of the presence of contents in the lacrimal sac, canalicular and nasal tests. Features of external examination in newborns and young children.
Side lighting. Technique of simple and combined side lighting. Clarification of the condition of the conjunctiva. Study of the sclera, its color, and the condition of the blood vessels. Inspection of the limb, its boundaries and dimensions. Study of the cornea: transparency, smoothness, shine, specularity, shape, size, sphericity. Inspection of the anterior chamber; depth, uniformity, transparency of the content. Characteristics of the iris" color, pattern, presence of congenital and acquired defects (coloboma, etc.), fusion with the lens or cornea (synechia), iridodialysis (separation), iridodenesis (trembling). The shape and size of the pupils, pupillary reactions to light.
Transmitted light examination . Technique of the method, its capabilities, assessment of the transparency of the lens and vitreous body. Localization and differentiation of opacities in various parts of the transparent media of the eye. Intensity, uniformity, shape, size, color of opacities, nature of the reflex from the fundus of the eye. Differential diagnosis of opacities in the lens with opacities in the vitreous body.
Ophthalmoscopy. Study of the retina, choroid, optic nerve head Direct ophthalmoscopy using electric ophthalmoscopes View of the optic nerve head, retinal vessels of the macula area, central fovea in people of different ages.
Biomicroscopy. Examination of the eye using stationary and manual slit lamps, Study of the condition of the membranes of the eye and localization of changes in the eyelids, conjunctiva, sclera, cornea, anterior chamber, iris, lens, vitreous body and fundus. The importance of biomicroscopy for the diagnosis and monitoring of the course of eye diseases.
Ophthalmotonometry. Subjective (palpation) method for studying eye tone. An objective method for measuring intraocular pressure with tonometers Maklakov, Shiotz, etc. Age-related values of intraocular pressure and their significance in the diagnosis of glaucoma. The concept of topography - the main topographic indicators in normal and pathological conditions. Features of tonometry in children of the first years of life (general anesthesia).
Echoophthalmography. Determining the size of the eye using an ultrasound machine and identifying tumors, foreign bodies, retinal detachment, etc. in the eye.
Ophthalmometry Method for determining corneal curvature, its relationship with tonometry indicators according to Maklakov.
The concept of refractometry, ophthalmoplethysmography, rheoophthalmography, electroretinography, ophthalmodynamometry, diaphanoscopy, fluorescentangiography.
PRIVATE OPHTHALMOLOGY
Goal: to master early diagnosis of the most common eye diseases, learn to provide first aid, study preventive measures for eye pathology, become familiar with professional selection and labor examination.
Pathology of the eyelids The frequency of diseases of the eyelids, the main types of pathological processes in the eyelids and their relationship with the general condition of the body.
Inflammatory diseases of the eyelids
Blepharitis , The role of endogenous and exogenous factors in development. Clinic and course of blepharitis, complications, outcomes. Principles and duration of treatment.
Barley. Etiology, clinical picture, treatment, complications, outcomes.
Abscess of the eyelids. Etiology, clinical picture, treatment, outcomes
Chalazion . Causes of occurrence, clinical picture, differential diagnosis with adenocarcinoma of the meibomian glands. Principles of treatment (corticosteroids, surgery).
Molluscum contagiosum . Clinic, causes, tendency to dissemination, surgical treatment.
Herpes simplex and herpes zoster, vaccine pustules. Clinic, reasons. Baking.
Allergic diseases of the eyelids.
Quincke's edema. Toxicoderma. Drug-induced dermatitis of the eyelids. Causes and features of occurrence. Clinic, course, relapse rate, principles, treatment. Differential diagnosis with renal and cardiac edema
Anomaly in the position and shape of the eyelids.
Causes (congenital and acquired) Ptosis, complications of ptosis (amblyopia, strabismus). Eversion of the century. Trichiasis. Lagophthalmos. Ankyloblepharon. Coloboma of the eyelids. Epicanthus. Timing and principles of treatment.
Professional selection, labor examination for eyelid pathology.
Pathology of lacrimal organs
Pathology of the tear-producing apparatus.
Congenital anomalies lacrimal gland (absence, underdevelopment, prolapse). Clinic, principles of treatment.
Dacryoadenitis. Etiology, clinical picture, diagnostic methods, course, complications. Principles of treatment.
Sjögren's syndrome (“dry” syndrome with lesions of the lacrimal and other exocrine glands). Clinic. Simultaneous damage to the salivary, bronchial glands, gastrointestinal tract, joints. Diagnostic methods. Method of therapy. The role of the general practitioner in timely diagnosis and complex treatment of Sjögren's syndrome.
Neoplasms lacrimal gland(adenocarcinoma). Clinic, course, diagnostic methods, treatment, prognosis.
Pathology of the lacrimal apparatus.
Congenital and acquired changes in the lacrimal ducts. Absence or dislocation of lacrimal openings; narrowing or obliteration of the lacrimal canaliculi.
Chronic conjunctivitis . Etiological significance of exogenous and endogenous factors Clinic, course, methods of treatment and prevention Chronic conjunctivitis as an occupational disease of workers in the textile, paper, flour-milling, coal, and chemical industries. Professional selection, labor examination for chronic conjunctivitis. The role of the pediatrician, sanitary and school doctors, ophthalmologist in the timely diagnosis of these diseases, the system of isolation of patients with conjunctivitis. Quarantines. First aid, principles of treatment. Outcomes.
Trachoma. Social significance of trachoma. Prevalence of trachoma in the world. The role of Soviet scientists and health care organizers (V. Chirkovsky. A. I. Pokrovsky, A. S. Sovvaitov, A. G. Safonov, etc.) in the study of trachoma, the development of treatment methods and prophylaxis. WHO International Classification Etiology and Epidemiology of Trachoma The role of the atypical virus of the PLT group. Clinical course of trachoma V four stages, forms of trachoma (papillary, follicular). Corneal trachoma, types of trachomatous pannus. Complications of trachoma. Features of the course of trachoma in children Diagnosis is clinical, laboratory (cytological, virological, etc.).
Differential diagnosis of trachoma with paratrachoma, adenoviral keratoconjunctivitis, etc. Dispensary method of treatment of trachoma. Complex medical, technical and surgical treatment. Principles of drug therapy: broad-spectrum antibiotics, supphonamides. long-acting drugs, corticosteroids. General, local, combination therapy. Criteria for cure, procedure for deregistration. A system of organizational measures in the country that made it possible to eliminate trachoma as a mass disease (trachomatous dispensaries, institutes).
Pathology of the cornea and sclera
Occupational diseases of the cornea.
The significance of occupational hazards in the occurrence, course and recurrence of keratitis (various types of dust, gases, vapors, liquids of general toxicity). The role of occupational selection and systematic medical examinations in the prevention of corneal disease. General principles of organizing labor protection and carrying out preventive measures in industry and agriculture
Outcomes of inflammation of the cornea, spot, cloud, simple and complicated cataract and other types of opacities and changes in shape. Irregular astigmatism. Principles of treatment. Types of keratoplasty. Contact lenses Keratoprosthesis.
Pathology of the sclera. Inflammation of the sclera (episcleritis, scleritis). Clinic. The most common reasons for their appearance. Treatment
Pathology of the choroid
Frequency of diseases of the vascular trust among general eye pathologies. Severe outcomes of diseases of the choroid as a cause of low vision and blindness. The structure of diseases of the vascular tract (inflammatory, dystrophic processes, neoplasms, congenital anomalies).
Inflammation of the vascular tract(uveitis) The most common causes of uveitis in people of all ages. Classification of uveitis according to course, localization, clinical and morphological picture, etiology, immunology. Basic morphological, functional signs and mechanisms of development of anterior uveitis (iritis, iridocyclitis). Differential diagnosis with anterior uveitis. Clinic, course, principles of treatment.
Congenital developmental anomalies. Residual pupillary membrane, polygoria, correctopia, colobomas, amyridia. Clinic, diagnosis, state of visual functions in them. Treatment options.
Pathology of the vitreous body and retina
Causes of changes in the vitreous body (inflammation, dystrophy, eye damage). Diagnostic methods. Clinical course of pathological changes in the vitreous body. Principles of treatment Surgical interventions on the vitreous body (vitrectomy).
Classification of diseases retina: vascular diseases, dystrophic processes, congenital developmental anomalies. General characteristics of pathological changes in the vessels and tissue of the retina. Retinal diseases in general and local pathology.
Acute obstruction of the central retinal artery and its branches(spasm, thromboembolism) Etiological significance of rheumatic heart disease, atherosclerosis, obliterating endarteritis, sepsis, air and fat embolism in diagnostic studies. pneumothorax, bone fracture. Ophthalmoscopic picture, dynamics of visual functions, Emergency care, timing of its provision. Treatment, outcomes.
Thrombosis central retinal vein and its branches. The etiological significance of the disease, atherosclerosis, infectious and septic diseases of the body, coagulopathies, orbital tumors, injuries. Ophthalmoscopic picture, dynamics of visual functions. Complications. Treatment methods (principles of angiocoagulant therapy, argon laser coagulation). Outcomes.
Changes in the retina in hypertension and atherosclerosis. Pathogenesis, clinical picture of various stages of hypertensive retinopathy, age-related features of the ophthalmoscopic picture. Complications, outcomes. The importance of fundus examination for diagnosis, assessment of treatment effectiveness, disease prognosis and prevention of complications carried out by a general practitioner.
Changes in the retina during diseases kidney Clinical features, complications, outcomes, importance of ocular symptoms for assessing the effectiveness of treatment and prognosis of the underlying disease
Changes in the retina due to collagenosis. Ophthalmoscopic picture, dynamics of visual functions, treatment and outcomes.
Changes in the retina in diseases of the blood and hematopoietic system(anemia, polycythemia, hemoblastosis, hemorrhagic diathesis, para- and dysproteinemia). Clinical features, complications, outcomes, the importance of ocular symptoms for assessing the effectiveness of treatment and prognosis of the underlying disease.
Retinal changes in diabetes Clinical picture of various stages of fundus changes in diabetes mellitus, complications, outcomes, principles of modern treatment (diet, oral hypoglycemic agents, insulin drugs, angioprotectors, argon laser coagulation). The importance of fundus examinations for diagnosing and assessing the effectiveness of diabetes treatment by an endocrinologist.
Changes in the retina during toxicosis of pregnancy. Clinical features, complications, outcomes The importance of fundus examination for determining the management tactics of a woman during pregnancy and childbirth by an obstetrician-gynecologist.
Changes in the retina. complications of general drug therapy. Side pharmacological effects of ganglion blockers, ergot drugs, as a cause of acute occlusion of the central retinal artery (the main drugs of this group). Toxic effect of rauwolfia preparations. iodine, sulfonamides, phenylbutazone (butadiene), as a cause of retinal hemorrhages and antimalarial drugs, chlorpromazine derivatives, as a cause of retinal dystrophies (the main drugs of this group)
Retinal periphlebitis (Eales disease). The role of tuberculosis, toxoplasmosis. allergies in the development of the disease. Clinic, treatment, complications, prognosis.
External exudative retinitis (Coats disease). Clinic, differential diagnosis with retinoblastoma. Treatment, prognosis.
Retrolental fibroplasia. The role of inadequate oxygen content in the air of incubators for premature babies V the occurrence of this pathology. Clinic depending on the timing and stage of manifestation of the disease. Differential diagnosis with retinoblastoma and Coats disease. Treatment, prognosis. The role of the micropediatrician in the prevention of disease,
Retinal pigmentary dystrophy. Terms of manifestation of the disease, ophthalmoscopic picture, dynamics of decline in visual functions. Methods of diagnosis and treatment. Prognosis. Work ability examination.
Retinal and macular dystrophies The role of hereditary factors, the time of manifestation of the disease in children and adults. Ophthalmoscopic picture, dynamics of visual functions. Treatment. Forecast. Work ability examination
Detachment retina Etiology in children and adults. The role of location and type of rupture in the clinical course of the disease. Ophthalmoscopic picture, dynamics of visual functions. Timing and methods of surgical interventions, the role of photo- and laser coagulation in the treatment of the disease. Outcomes. Labor expertise.
Pathology of the optic nerve
Classification of optic nerve pathology. The incidence of optic nerve diseases in both children and adults.
Optic neuritis nerve. Clinic. Etiology of neuritis in people of different ages. Pathomorphology. Principles of treatment. Outcomes. Forecast
Retrobulbar neuritis. Ophthalmoscopic picture and state of visual functions. Frequency, Role of multiple sclerosis in the occurrence of neuritis. Treatment. Outcomes. Forecast
Ischemic neuropathy. etiology, clinic, emergency care, treatment, outcome. Toxic methyl alcoholic optic nerve dystrophy, clinical picture, emergency care, treatment, outcomes. Tobacco amblyopia.
clinic, treatment, prognosis.
Congestive optic disc. Stages of development of the process and their inherent ophthalmological changes. The state of visual functions in normal and complicated congestive disc. Frequency and causes of occurrence in people of different ages. Differential diagnosis of congestion and optic neuritis. Principles and methods of symptomatic treatment. Outcomes
Pseudoneuritis and pseudocongestion. Ophthalmological picture, state of visual functions and stones of metric studies with loading and unloading tests in the differential diagnosis of pseudoneuritis and pseudocongestion with neuritis and congestive disc.
Optic nerve atrophy. Etiology. Clinic. Diagnostics. Treatment of the disease. Differential diagnosis with retinoblastoma and Coats disease. Treatment, prognosis. The role of the micropediatrician in disease prevention.
Glaucoma
Definitions of glaucoma The social significance of glaucoma as one of the main causes of blindness. Frequency and prevalence of the disease. Types of glaucoma in adults and children. The fundamental difference between glaucoma in children and adults. Works by M. M. Krasnov, A.P. Nesterova, T.I. Broshevsky.
Congenital glaucoma (buphthalmos, hydrophthalmos). Frequency. Etiology. The influence of various pathological conditions of pregnant women on the occurrence of embryonic underdevelopment of the anterior chamber angle. The role of heredity. Systemic diseases combined with congenital glaucoma. The earliest signs of the disease Clinic The role of the local pediatrician in the early detection of congenital glaucoma. Classification of congenital glaucoma. Timing of onset and percentage of blindness from congenital glaucoma. Differential diagnosis of congenital glaucoma with megalocornea, conjunctivitis, parenchymal keratitis, secondary glaucoma with retinoblastoma, Coats disease. Principles, timing and methods of surgical treatment of congenital glaucoma Outcomes Prognosis. Works by E.I. Kovalevsky.
Primary glaucoma. Modern views on etiology. Factors predisposing to the development of glaucoma (impaired central regulation of ophthalmotonus, changes in the diencephalic and hypothalamic region, the state of regional blood circulation and the filtering zone of the eye. Hereditary factors in glaucoma. Classification by M.M. Krasnov, A.P. Nesterov, A.Bunin. Clinical course of open-angle and angle-closure glaucoma. Methods for diagnosing forms of glaucoma, topography, gonioscopy. Subjective and objective symptoms depending on the stage of the disease. State of visual functions: central, peripheral, twilight vision. Tonometric and topographic indicators to judge the state of ophthalmotonus. Clinical course of an acute attack of glaucoma, general and local symptoms Pathogenesis of an acute attack Differential diagnosis with acute iridocyclitis, swelling cataract, conjunctivitis; with a number of common diseases (hypertensive crisis, myocardial infarction, food toxic infection, acute abdomen, etc.). Complex emergency treatment of an acute attack of glaucoma. Principles of conservative treatment of open-angle and closed-angle glaucoma. Medication, local treatment, cholinomimetic, anticholinesterase, sympathomimetic drugs, blockers, mechanism of action, principles of prescribing these drugs depending on the form of glaucoma. The use of general antihypertensive drugs, sedatives, neurological,
ganglion-blocking, osmotic, etc. in the treatment of glaucoma. Regime, diet, employment. Indications for surgical treatment. Principles of pathogenetically oriented operations. Use of physical factors V treatment of glaucoma (lasers, high and low temperatures). Clinical examination of patients with glaucoma. Prevention of blindness from glaucoma. Basic principles of treatment and preventive care for patients with glaucoma Works by A.P. Nesterov, M.M. Krasnov, S.N. Fedorov.
Secondary glaucoma. The role of damage, inflammation, and tumor processes of the eye in the occurrence of secondary glaucoma. Features of the course and baking Outcomes.
Lens pathology
Types and frequency of lens pathology. Diagnostic methods, modern principles of baking. Share in the structure of low vision and blindness.
Anomalies of lens development. Changes in Morphan's disease, Marchesani and other syndromes. Methods and terms of treatment. Outcomes. Aphakia, lenticonus.
Congenital cataracts. Frequency and causes of their occurrence. Classification of cataracts in children according to EI Kovalevsky, Simple, complicated, with accompanying changes. The most common congenital cataracts Indications for surgical treatment depending on the size of the cataract, its location, visual acuity, and the age of the child. Principles of Operations. Prevention of underdevelopment of the macula and obscuration ambpyopia, correction of aphakia. Features of correction of unilateral aphakia Contact lenses. Intraocular lenses.
Secondary (postoperative) cataracts Causes, clinical picture, treatment. Regenerative ability of the lens, Adamyuk-Elignig cells. Indications, timing and methods of operations. Outcomes
Consecutive (“new”, “complicated”) cataracts. The occurrence of cataracts due to common infections (diphtheria, donkey, malaria), common diseases (diabetes), eye processes (myopia, glaucoma, uveitis, pigmentary degeneration of the retina, retinal detachment), as a result of poisoning with mercury, nitrates, protein starvation, ionizing radiation , exposure to infrared rays, damage, etc. Clinical picture of these types of cataracts. Prognostic value of the occurrence of successive cataracts in common diseases Treatment of cataracts depending on the etiology of the process and the degree of lens opacity. Works by A.V. Khvatova, V.V. Shmeleva
Age-related (senile) cataracts. Clinic Stages of cataract development Conservative treatment in the initial stages Indications for surgery. Cataract extraction methods. Cryoextraction, phacoemulsification. Aphakia. Signs, principles of correction of aphakia for distance and near vision. Correction of unilateral aphakia Intraocular correction. Contact lenses. Works by S.N. Fedorov and others
Damage to the eye and its adnexa
Place of eye injuries in general traumatism. Prevalence, seasonality, geography and predominant causes, and types of eye damage in people of different ages. Frequency of household, school and work-related injuries. Classification of eye injuries by etiology, localization, severity, presence and properties of a foreign body, etc. Diagnostic methods. Basic types of first aid for eye injuries. Outcomes. Treatment of complications Prevention of eye injuries. Place in the structure and level of low vision and blindness. Works by R.A. Gundareva.
Blunt injuries to the eyeball. Frequency and characteristics of the clinic, course and outcomes in people of different ages. Classification by severity. Clinic of blunt injuries of each degree, from the cornea, anterior chamber, lens, vascular tract, vitreous body, retina and optic nerve. Principles of treatment. Outcomes of blunt injuries and depending on the severity of the injury.
Injuries of the eyelids, conjunctiva, lacrimal organs. First aid for them.
Eye injuries. Classification of eye injuries: non-penetrating, penetrating, through. Penetrating eye injuries are simple (without prolapse and damage to the internal structures), complex (with prolapse and damage to the internal membranes of the eye), with complications (metallosis, uveitis, sympathetic ophthalmia, etc.). Symptoms of perforated wounds. First medical aid. First surgical treatment. Features of the symptom complex of corneal and scleral wounds. Features of the course of perforated wounds of the eyeball in the presence of a foreign body in it. Methods for identifying and localizing foreign bodies.
Metallosis and the timing of its appearance, the mechanism of development of various symptoms in metallosis. X-ray diagnostics of foreign bodies in the eye. Principles of removal of magnetic and non-magnetic foreign bodies, magnetic tests. The significance of age-related features of eye size according to echobiometry data. Complications of penetrating wounds; traumatic non-purulent iridocyclitis, purulent iridocyclitis, vitreous abscess, panophthalmitis. Clinic, course Principles of treatment. Outcomes
Sympathetic ophthalmia. Frequency and timing of occurrence. Etiology General and local treatment. Disease prognosis Preventive measures. Indications for removal of a wounded eye and timing of enucleation surgery.
Orbital damage Frequency and possible causes. Diagnosis, symptoms of bone fractures and damage to the contents of the orbits: muscles, blood vessels, nerves, tenor capsule, lacrimal gland. Causes of exophthalmos and anophthalmos in injuries V orbital regions. Clinic depending on the location and extent of damage. Superior orbital fissure syndrome. Clinical manifestations of optic nerve damage. Ophthalmological picture and changes in visual functions with ruptures and avulsions of the optic nerve. Combined injuries to the orbit, skull bones, linden, brain, etc. First medical aid. Principles of surgical treatment of injuries. Battle injuries. Medical assistance during the evacuation stages.
Features of childhood injuries Causes of childhood injuries, characteristics (domestic nature of injuries, seasonality, age, gender, nature of damaging agents, severity, etc.) Frequency of penetrating injuries, severe complications and outcomes. Prevention and control measures to reduce childhood eye injuries.
Features of combat damage to the organ of vision, frequency of multiple shrapnel wounds, combination with burns, high percentage of penetrating wounds and contusions of the eye, combined injuries of the orbit with injuries to the skull and brain, etc. Medical assistance at the stages of evacuation
Peculiarities industrial injuries organ of vision (industrial, agricultural), microtrauma, causes, clinic. Prevention. Damage to the organ of vision due to toxic factors (carbon monoxide, carbon disulfide, arsenic, lead, trinitrotoluene, mercury, pesticides, etc.),
Methods of individual and public prevention of industrial injuries (canned glasses, masks, respirators, shields, wet metal processing, ventilation, etc.)
Improvement of production technology, automation, sealing. The importance of professional selection in the prevention of occupational injuries. The role of the shop doctor, sanitary supervision in the organization of labor protection at work, in reducing eye injuries.
Burns organ vision" chemical, thermal, radiation. Most of the causes and clinical picture of eye burns in children and adults are classifications of burns according to their severity and prevalence (four stages). Features of the clinic, course and treatment of burns caused by acid, alkali, manganese crystals, aniline dyes. Providing emergency care for chemical burns, in contrast to emergency care for thermal burns. Treatment of burns; conservative and surgical.
Radiation damage to the organ of vision. Exposure to the organ of vision of rays of various lengths, ultraviolet radiation (electro-ophthalmia, snow ophthalmia), blinding; infrared radiation (burns of the eyelids, conjunctiva, cornea; effect on the lens, retina, choroid): X-ray and ionizing radiation; laser radiation in different parts of the spectrum; radio waves, UHF, microwave, ultrasound.
Pathology of the oculomotor system
The most common changes in the oculomotor system. Disorder of deep (binocular) vision, Conjugate and paralytic strabismus. Morbidity statistics. Methods for studying the oculomotor system. Determination of the nature of vision. Principles of prevention and treatment.
Concomitant strabismus Clinic Frequency, timing and causes of concomitant strabismus. Primary and secondary. Constant and periodic strabismus, accommodative and non-accommodative, monolateral and alternating, convergent, divergent, with a vertical component, with and without amblyopia, with and without ametropia. Modern views on origins. Factors contributing to the occurrence of strabismus. Scope of examination of a patient with strabismus. Timing, principles, methods, organizational system, stages, complexity of treatment of concomitant strabismus. Methods of early prevention. Collaboration with educational authorities. Duration of treatment. Outcomes. Works by E.S. Avetisova and others.
Paralytic strabismus. Clinic. The most common reasons. Differential diagnosis of paralytic and concomitant strabismus. Features, timing and difficulties of surgical treatment of paralytic strabismus. Outcomes. Works by Yu.Z. Rosenbpyum.
Hidden strabismus. Heterophoria, their difference from concomitant strabismus. Orthoptic treatment. Professional selection.
Nystagmus. Types and causes of nystagmus Treatment methods for nystagmus. Works by IL.Smolyaninova.
Orbital pathology
General symptoms of orbital diseases: exophthalmos, anophthalmos, displacement of the eyeball to the side, visual disturbances. The most common causes of orbital pathology.
Inflammatory diseases of the orbit: periostitis, abscess and phlegmon of the orbit. Etiology, clinical picture, outcomes. Methods of drug and surgical treatment. Thrombophlebitis of the orbital veins, thrombosis of the cavernous sinus. Clinic, treatment.
Diseases orbits due to circulatory disorders:
hematoma, pulsating exophthalmos. Causes, symptoms, course, principles of treatment, prognosis.
Orbital changes in endocrine diseases, blood diseases:
exophthalmos due to Graves' disease; malignant exophthalmos; lymphoma. Clinic Diagnostics Treatment.
Occupational diseases of the organ of vision
Harmful factors of the external production environment leading to the development of occupational pathology of the organ of vision. Groups of occupational diseases of the organ of vision
Occupational diseases of the organ of vision when exposed to radiant energy: microwave, infrared radiation, visible light rays, ultraviolet rays, X-ray and gamma radiation (conjunctivitis, blepharitis, iridocyclitis, keratitis, cataracts). Principles of diagnosis, medical measures, prevention and protection. Damage to the organ of vision due to vibration disease and laser exposure.
Diseases of the organ of vision due to intoxication of the body with chemical substances: neurotropic poisons (methyl alcohol, carbon monoxide, methylene - tetraethyl lead, carbon disulfide; substances affecting the hematopoietic system and liver (trinitrotoluene, arsenic, benzene series substances), substances that accumulate in the body (mercury , silver), aniline dyes, nicotine; substances that have a combined effect on organs and body systems (pesticides).
Professional myopia, factors causing it, prevention. General principles and guidelines for the prevention of occupational diseases. Principles of labor protection and prevention of occupational diseases. Works by A.N. Dobromyslova.
Congenital and acquired ocular tumors
Prevalence and most common locations of eye tumors at different ages. Place in the structure of blindness. Characteristics of congenital and acquired, benign and malignant, extraocular and intraocular (extra- and intraocular). actual ocular and systemic tumors. Methods of ophthalmological, laboratory, X-ray, instrumental and hardware, ultrasound, as well as luminescent and other diagnostics. Surgical, radiation, chemotherapy and combined treatment methods. Cryotherapy. photo-, (light-), laser coagulation. Outcomes. Prognosis for the eye and life. The importance of early diagnosis. Works by A.F. Brovkina. The main causes of decreased vision and blindness, organization of ophthalmological care. Work of draft commissions and VTEK
The main causes of vision loss in people of different ages and genders. Issues of marginal ocular pathology. Characteristics of absolute, subject and everyday, professional blindness. The most common diseases leading to blindness in people of all ages. Differences in the causes of blindness in children and adults. The role of the All-Russian Society of the Blind in organizing comprehensive assistance to the blind. Characteristics of the medical ophthalmological network: eye clinics, inter-district offices for children's vision care, advisory clinics, eye hospitals, dispensaries, emergency rooms Specialized eye sanatoriums, specialized eye kindergartens, sanatorium eye camps and specialized research problem ophthalmological laboratories and institutes scientific and technical complexes eye microsurgery, functions and subordination of these institutions. Schools for the visually impaired and blind, indications for admission to them based on the state of visual acuity and visual field. Measures to protect the vision of children in preschool institutions and schools The scope of necessary examinations of the organ of vision at the time of birth of the child, upon discharge from the maternity hospital, during patronage, by the year of life, by three and seven years, at school (grades 4 and 6), in adults for glaucoma, etc. The role of dispensaries and clinics in prevention and rehabilitation. Works by E.I. Kovalevsky. System of dispensary observation and treatment of patients with glaucoma, progressive myopia, strabismus, tumors, cataracts, complex lesions, chronic inflammatory and degenerative processes V cornea, vascular tract and retina. Principles and methods of selection into the Russian Army, examination of work ability. The main achievements of domestic ophthalmology. Leading ophthalmology scientists and ophthalmological institutions The role of this department in the training of young specialists. Collaboration with health authorities and institutions to protect the population’s vision.
Principles of drug treatment in ophthalmology
Types of medications used for eye pathology. Selection of drugs and their heating to 18-20 C. Sequence in installations, time interval between instillations, frequency and duration of treatment. Forced installations Indications for drug injections. Physiotherapy Works by E. I. Kovalevsky
Concepts for organizing vision care
Formation of prevention (risk) groups for eye pathology (GPGP) Organization of pre-medical eye appointment rooms in clinics. Creation of outpatient ophthalmic city, district, regional interdistrict and other departments. Opening of advisory eye clinics in the regions. Specialized eye hospitals (departments in general hospitals).
bb Topics of practical classes in ophthalmology
at the Faculty of Medicine.
1. Anatomy and physiology of the organ of vision. Research methods. Anamnesis Study scheme. Walking around the clinic Practical skills: external examination, side illumination, examination in transmitted light, eversion of eyelids, side illumination
2. Central vision and methods for determining it. Refraction physical and clinical. Characteristics of emmetropia, myopia, farsightedness. A subjective method of determining clinical refraction. Writing prescriptions for glasses Practical skills: testing visual acuity.
3 Accommodation. Accommodation mechanism. Spasm and paralysis of accommodation. Age-related changes in refraction and accommodation. Correction of presbyopia. Peripheral vision determination of the visual field (its boundaries) approximately and on the perimeter" Ophthalmoscopy Congenital and acquired cataracts. Classification Clinic principles of treatment. Aphakia and its correction. Supervision of patients Practical skills 1 study of the boundaries of the visual field, examination in transmitted light, instillation of drops.
4. Diseases of the cornea. Classification General symptoms Clinic and treatment of corneal ulcers, Forms of herpetic keratitis. Outcomes of keratitis. Determination of sensitivity and integrity of the cornea. Patient supervision. Practical skills for determining corneal sensitivity.
5 Pathology of the choroid. Classification, clinical picture, treatment of choroiditis. Complications of uveitis. Neoplasms of the vascular tract of the eye. Patient supervision
6. Glaucoma, congenital, primary, secondary. Classification, clinical treatment Diagnosis and treatment of an acute attack of glaucoma. Intraocular pressure and methods for determining it. Supervision of patients. Practical skills. study of ophthalmotonus by palpation and tonometry.
7. Damage to the organ of vision. Wounds, concussions, burns. Classification clinic treatment. First medical aid. Removal of foreign bodies from the conjunctiva and cornea.
8. Vision protection in children Congenital diseases and anomalies of the eyelids of the vascular tract Retinoblastoma. Features of childhood traumatism. Binocular vision and methods for its determination. Strabismus, its classification and principles of treatment (work in the vision care office) Practical skills, features of examining the organ of vision in children, checking the angle of strabismus of binocular vision.
9. Diseases of the eyelids, conjunctiva, lacrimal organs Trachoma. Organization of an eye office. Diseases of the orbit. Temporary disability. VTEK. Prof. diseases. City clinic. Practical skills: writing prescriptions for eye drops, ointments
10. Changes in the organ of vision due to general diseases. Acquaintance with the functional diagnostics room, laser room and emergency room of the Regional Clinical Hospital. Clinical examination.
11. Protection of medical records. Summing up the cycle.
TOPICS OF PRACTICAL LESSONS IN OPHTHALMOLOGYAT THE FACULTY OF PEDIATRICS
1. Anatomy and physiology of the organ of vision. Research methods. Anamnesis Study scheme. Walking around the clinic. Practical skills: external examination, lateral illumination, transmitted light examination, eversion of eyelids, lateral illumination
2. Central vision and methods for its determination. Refraction physical and clinical. Characteristics of emmetropia, myopia, farsightedness. Subjective method for determining clinical refraction Prescribing glasses. Practical skills for examining visual acuity.
3.Accommodation. Mechanism of accommodation Spasm and paralysis of accommodation. Age-related changes in refraction and accommodation. Correction of presbyopia. Peripheral vision, determination of the field of view (its boundaries) approximately and on the perimeter. Ophthalmoscopy. Cataracts, congenital and acquired Classifications. Clinic, principles of treatment. Aphakia and its correction. Supervision of patients. Practical skills: examination of the boundaries of the visual field, examination in transmitted light, instillation of drops.
4. Diseases of the cornea. Classifications. General symptoms. Clinic and treatment of corneal ulcers. Forms of herpetic keratitis. Outcomes of keratitis. Pathology of the choroid of the eye. Classification, clinical picture, treatment of choroiditis. Complications of uveitis Neoplasms of the vascular tract of the eye. Patient supervision. Practical skills: determination of corneal sensitivity.
5Glaucoma: congenital, primary, secondary. Classification, clinic, treatment. Diagnosis and treatment of an acute attack of glaucoma Intraocular pressure and methods for its determination. Patient supervision. Practical skills: examination of ophthalmotonus by palpation and tonometry
6. Damage to the organ of vision. Wounds, concussions, burns. Classification, clinic, treatment. First medical aid Removal of foreign bodies from the conjunctiva and cornea
7.Vision protection in children Congenital diseases and anomalies of the eyelids, vascular tract Retinoblastoma. Features of childhood traumatism Binocular vision and methods for its determination. Strabismus, its classification and principles of treatment (work in the vision care office). Practical skills" features of examining the organ of vision in children, checking the angle of strabismus of binocular vision.
8. Diseases of the eyelids, conjunctiva, lacrimal organs. Trachoma. Organization of the eye office. Orbital diseases. Temporary disability. VTEK, Prof. diseases. City clinic Practical skills: writing prescriptions for eye drops, ointments.
9.Changes in the organ of vision in common diseases. Acquaintance with the functional diagnostics room, laser room and emergency room of the Regional Clinical Hospital. Clinical examination. Protection of medical records. Summing up the cycle
TOPICS OF PRACTICAL CLASSES IN OPHTHALMOLOGY AT THE FACULTY OF DENTISTRY
1. Anatomy and physiology of the organ of vision. Research methods. Anamnesis Study scheme. Walking around the clinic. Practical skills: external inspection, side lighting, research V transmitted light, eversion of eyelids, side lighting
2. Central vision and methods for determining it. Refraction physical and clinical. Characteristics of emmetropia, myopia, farsightedness. Accommodation. Accommodation mechanism. Age-related changes in refraction and accommodation Correction of presbyopia. Binocular vision. Ophthalmoscopy. Writing prescriptions for glasses. Practical skills: visual acuity examination, subjective method of determining clinical refraction.
3. Congenital and acquired cataracts, Classification. Clinic, principles of treatment. Aphakia and its correction. Patient supervision. Practical skills, examination of the boundaries of the visual field, examination in transmitted light, instillation of drops,
4. Diseases of the cornea. Classification. General symptoms. Clinic and treatment of corneal ulcers. Forms of herpetic keratitis. Outcomes of keratitis. Pathology of the choroid of the eye. Classification, clinical picture, treatment of uveitis. Complications. Patient supervision. Practical skills: determination of corneal sensitivity.
5. Glaucoma, congenital, primary, secondary. Classification, clinic, treatment. Diagnosis and treatment of an acute attack of glaucoma Intraocular pressure and methods for its determination. Patient supervision. Practical skills: study of ophthalmotonus by palpation and tonometry, perimetry.
6. Damage to the organ of vision. Wounds, concussions, burns. Classification, clinical treatment. First medical aid. Removal of foreign bodies from the conjunctiva and cornea. Clinic,
7. Diseases of the eyelids, conjunctiva, lacrimal organs and orbit. Protection of medical records. Summing up the cycle.
List of medications usedin ophthalmology
Eye drops:
1. Adrenaline hydrochloride 0.1%
2. Mezaton 1%
3. Atropine sulfate 1%
4. Aceclidine 3%
5. Vitamin drops: glucose 2% - 10.0%; riboflavin 0.002%: ascorbic acid 0.02%
6 Vitaiodurol
7. Hydrocortisone 0.5%
8. Glycerin 50% (for oral administration)
9. Homotropine hydrobromide 1%
11. Dicaine 0.25% (0.5%) 12 Potassium iodide 3%
13. KeretsidO,1%
14. Clonphylline 0.5%
15. Collargol 3%
16. Levomycetin 0.4%
17 LidazaO,1%
18. Trypsin
19. Optimol 0.25%
20. Pilocarpine hydrochloride 1%
21 Platifilina hydrotortrate 1%
22. Prozerin 0.5%
23. Scopolomine 0.25%
24 Sulfacyp sodium 30% (20%)
25. Tosmilen 0.25%
26. Fethanol 3% - 5%
27. Furacillin 0.02%
28. Zinc drops 0.25%, 0.5% -1%
29. Ezerine 0.25%
Ointments:
1. Aceclidine 3%
2. Bonofton ointment 0.05%
3. Hydrocortiene 0.5%
4. Yellow mercury ointment 1%-3%
5. Call raks3%
6. Xeroform 3%
7. Prednisolone 0.5%
8. Sulfacyl sodium 20%
9. Tetracycline 1%
Sample recipe: Rp: Sol. Sulfacylici natrii 30% - 10 ml
D. S. Eye drops. Instill 2 drops 3 times a day into the right eye
Rp: Ung. Tetracyclini ophtalmik1% -10.0
D.S. Eye ointment. Place behind the lower eyelid 3 times a day in the right eye
PRACTICAL SKILLS Visual acuity examination
Visual acuity is the ability to distinguish separately two points or parts of an object. To determine visual acuity, children's Orlova tables, Sivtsev-Golovin tables, or Landolt optotypes placed in a Roth apparatus are used. If the study is carried out on children, then first the child is shown a table with pictures at a close distance, and then the visual acuity is checked with both eyes open from a distance of 5 m. Subsequently, the visual acuity of each eye is checked, closing one or the other eye with a shutter. The display of pictures or signs starts from the top lines. School-age children and adults should start showing letters in the Sivtsev-Golovin table from the very bottom lines. If the subject sees almost all the letters of the 10th line, with the exception of one or two, then his visual acuity is 1.0. This line should be located at the eye level of the subject . The exposure time of the optotype is no more than 1-2 s.
When assessing visual acuity, it is necessary to remember the age-related dynamics of central vision, therefore, if a 3-4 year old child sees signs of only the 5-7th line, this does not indicate the presence of organic changes in the organ of vision. To exclude them, it is necessary to carefully examine the anterior segment of the eye and determine at least the type of reflex from the fundus with a narrow pupil.
During testing, visual acuity may be below 0.1; in such cases, the subject should be brought to the table (or optotypes should be brought to him) until he begins to distinguish letters or pictures of the first line. Visual acuity should be calculated using the Snellen formula: V= u/O. Where V- visual acuity; and - the distance from which the subject sees the Letters of a given line. O - the distance from which the strokes of letters differ at an angle of 5 minutes (i.e., with visual acuity equal to 1.0).
If visual acuity is expressed in hundredths of a unit, then calculations using the formula become impractical. In such cases, it is necessary to resort to showing the patient his fingers (against a dark background), the width of which approximately corresponds to the strokes of the letters of the first line, and note at what distance he reads it.
With some lesions of the organ of vision, patients may lose objective vision, then they cannot even see fingers raised to their face. In these cases, it is very important to determine whether he still has at least the sensation of light or whether there is absolute blindness. This can be checked by monitoring the direct reaction of the pupil to light, or by asking the patient to note the presence or absence of light perception if his eye is illuminated with an ophthalmoscope.
However, it is not yet enough to establish the presence of light perception in the subject. It is necessary to find out whether all parts of the retina are functioning sufficiently. This is determined by examining the correctness of light projection. It is most convenient to check it on a patient by placing a pump behind him and directing a beam of light at different angles to the pupil area. If the light projection is correct, the patient must point to the light source, otherwise the light projection is considered incorrect
When determining visual acuity in children, it is necessary to take into account the age-related dynamics of visual acuity. A child under 6 months of age should recognize familiar toys and navigate an unfamiliar room. Visual acuity in children increases gradually, and the rate of this growth is different. Thus, by the age of 3, visual acuity in at least 10% of children is 1.0. 30% have 0.6-0.8. the rest are below 0.5. By the age of 7, most children have visual acuity of 0.8-1.0. In cases where visual acuity is 1.0, you should remember that this is not the limit, and continue the study, since it can be (in about 15% of children) and much higher (1.5 and 2.0 or even more ).
After birth, the human visual organs undergo significant morphofunctional changes. For example, the length of the eyeball in a newborn is 16 mm, and its weight is 3.0 g; by the age of 20, these figures increase to 23 mm and 8.0 g. During development, the color of the eyes also changes. In newborns in the first years of life, the iris contains little pigment and has a bluish-grayish tint. The final color of the iris is formed only by 10-12 years.
The development of the visual sensory system also goes from the periphery to the center. Myelination of the optic nerve pathways ends by 3-4 months of life. Moreover, the development of sensory and motor functions of vision occurs synchronously. In the first days after birth, eye movements are independent of each other, and accordingly, coordination mechanisms and the ability to fix an object with the gaze are imperfect and are formed between the ages of 5 days and 3-5 months. Functional maturation of the visual areas of the cerebral cortex, according to some data, occurs already before the birth of a child, according to others - somewhat later.
The optical system of the eye also changes during ontogenetic development. In the first months after birth, a child confuses the up and down of an object. The fact that we see objects not in their inverted image, but in their natural form is explained by life experience and the interaction of sensory systems.
Accommodation in children is more pronounced than in adults. The elasticity of the lens decreases with age, and accommodation decreases accordingly. As a result, some accommodation disorders occur in children. Thus, in preschool children, due to the flatter shape of the lens, farsightedness is very common. At 3 years of age, farsightedness is observed in 82% of children, and myopia in 2.5%. With age, this ratio changes and the number of myopic people increases significantly, reaching 11% by 14-16 years. An important factor contributing to the appearance of myopia is poor visual hygiene: reading while lying down, doing homework in a poorly lit room, increased eye strain, and much more.
During development, a child’s color perceptions change significantly. In a newborn, only rods function in the retina; cones are still immature and their number is small. Newborns apparently have elementary functions of color perception, but the full involvement of cones in their work occurs only by the end of the 3rd year. However, even at this age level it is still incomplete. The sense of color reaches its maximum development by the age of 30 and then gradually decreases. Training is of great importance for the formation of color perception. It is interesting that the child most quickly begins to recognize yellow and green colors, and later - blue. Recognition of the shape of an object appears earlier than recognition of color. When meeting an object, preschoolers' first reaction is caused by its shape, then its size, and lastly its color.
With age, visual acuity increases and stereoscopy improves. Stereoscopic vision changes most intensively up to 9-10 years of age and reaches its optimal level by 17-22 years of age. From the age of 6, girls have higher stereoscopic visual acuity than boys. The eye level of girls and boys aged 7-8 years is significantly better than that of preschoolers, and has no gender differences, but is approximately 7 times worse than that of adults. In subsequent years of development, boys' linear eye becomes better than girls'.
The field of vision develops especially intensively in preschool age, and by the age of 7 it is approximately 80% of the size of the field of vision of an adult. Sexual characteristics are observed in the development of the visual field. At 6 years old, boys have a larger visual field than girls; at 7-8 years old, the opposite ratio is observed. In subsequent years, the size of the visual field is the same, and from the age of 13-14 years, its size is larger in girls. The specified age and gender characteristics of the development of the visual field should be taken into account when organizing individual education for children, since the visual field (the bandwidth of the visual analyzer and, consequently, learning capabilities) determines the amount of information perceived by the child.
During ontogenesis, the capacity of the visual sensory system also changes. Until the age of 12-13, there are no significant differences between boys and girls, but from the age of 12-13 in girls, the throughput of the visual analyzer becomes higher, and this difference persists in subsequent years. Interestingly, by the age of 10-11 this figure approaches the level of an adult, which is normally 2-4 bits/s.
A newborn is born with a visual perception system very different from that of an adult. Subsequently, both the optical apparatus and those organs that are responsible for receiving the “picture” and its interpretation by the brain undergo very significant changes. Despite the fact that the development process is completely completed by the age of 20-25, the most significant changes in the visual organs occur in the first year of a child’s life.
Features of vision in young children
During the entire period of intrauterine development, the baby has virtually no need for vision organs. After birth, the visual perception system begins to develop rapidly. The main changes are:
- Eyeball. In a newborn, it looks like a ball, strongly flattened horizontally and elongated vertically. As the eye grows, the shape of the eye approaches spherical;
- Cornea. The thickness of the main refractive disk in the center of a baby in the first months of life is 1.5 mm, the diameter is about 8 mm, and the radius of curvature of the surface is about 7 mm. The growth of the cornea occurs due to the stretching of the tissue that forms it. As a result, as the child grows older, this organ becomes wider, thinner and acquires a more rounded surface. In addition, the cornea of a newborn is almost devoid of sensitivity due to the poor development of some cranial nerves. Over time, this parameter also returns to normal;
- The baby's lens is an almost regular ball. The development of this most important element of the optical system follows the path of flattening and transformation into a biconvex lens;
- Pupil and iris. A peculiarity of vision in children who have just been born is the lack of a coloring pigment in the body - melanin. Therefore, the iris of babies is usually light (bluish-grayish). The muscles responsible for pupil dilation are poorly developed; Normally, the pupil of newborns is narrow;
- The main element of the visual analyzer is the retina; in children in the first months of life, it consists of ten layers with different structures and has a very low resolution. By the age of six months, the retina stretches, six out of ten layers become thinner and completely disappear. A yellow spot is formed - the zone of optimal focusing of light rays;
- The anterior chamber of the eye (the space between the cornea and the surface of the iris) deepens and widens in the first years of life;
- Bones of the skull forming the eye socket. In babies, the cavities in which the eyeballs are located are not deep enough. Because of this, the axes of the eyes turn out to be slanted, and such a feature of vision in children arises as the appearance of convergent strabismus.
Some babies are born with defects in the eyelids, as well as in the lacrimal glands or tear ducts. In the future, this may cause the development of vision pathologies.
Features of vision in children of different ages
The specific structure of the visual apparatus of a newborn is the reason that the baby sees poorly. Over time, the image perception system improves, and vision deficiencies are corrected:
- Changing the configuration of the eyeball leads to the correction of congenital farsightedness, which is observed in the vast majority of newborns (about 93%). Most three-year-old children have almost the same eye shape as adults;
- Normal innervation of the cornea occurs already in a one-year-old child (by 12 months the corresponding cranial nerves are fully developed). The geometric parameters of the cornea (diameter, radius of curvature, thickness) are finally formed by the age of seven. At the same time, the refractive power of this element of the optical system is optimized, physiological astigmatism disappears;
- The muscles that dilate the pupil become able to work normally when the baby is 1-3 years old (this is a very individual process). The melanin content in the body also increases differently in all children, so the color of the iris may remain unstable until 10-12 years of age;
- Changes in the shape of the lens occur throughout a person's life. For babies, the decisive moment is the development of the skill of accommodation (the ability to focus their gaze at different distances), which occurs in the first months of life. In addition, as the lens develops, its refractive power increases;
- Optimization of the size and shape of the orbit due to the growth of the skull bones, which is completed by 8-10 years.
The main feature of vision in children is the congenital imperfection of the optical apparatus and image interpretation system. If the baby develops normally, by the age of three months he gains spatial perception skills, and by six months he can see objects in a three-dimensional image and distinguishes colors perfectly. Visual acuity, very low in children, reaches the level characteristic of adults at approximately 5-7 years.
You can easily distinguish the eyes of a child from the eyes of an adult.
Bluish sclera, blue iris located close
to the cornea, narrow pupil, eyeballs brought to the bridge of the nose.
The eyes of a newborn have only light sensitivity. Under the influence of light, mainly protective reactions are caused (constriction of the pupil, closing of the eyelids, turning of the eyeballs).
A newborn is unable to distinguish between objects and colors. Central vision appears at 2-3 months of life (low - 0.1), by 6-7 years - 0.8-1.0.
Color perception is formed at the age of 2–6 months (primarily with the perception of red color). Binocular vision is formed later than other visual functions - at the 4th year of life.
The newborn eye has a significantly shorter anteroposterior axis (17–18 mm) than the adult eye (23–24 mm). Front camera
by the time of birth it is formed, but small (up to 2 mm) in contrast to an adult (3.5 mm). Cornea of small diameter (8–9 mm). The amount of aqueous humor in newborns is less (up to 0.2 cm 3) than in adults
(up to 0.45 cm 3).
The refractive power of a newborn's eye is higher (80–
90.9 diopters), mainly due to differences in the refractive power of the lens (43 diopters in children and 20 diopters in adults). The eye of a newborn usually has hypermetropic refraction (farsightedness). The lens of newborns has a spherical shape, its composition is dominated by soluble proteins (crystallins).
The cornea and conjunctiva are insensitive. Therefore, during this period, it is especially dangerous for foreign bodies to enter the conjunctival sac, which do not cause eye irritation and can cause severe damage to the cornea (keratitis) up to its destruction. The pupil in children under 1 year of age is narrow - 2 mm (in adults - 3–4 mm) and reacts poorly to light, since the dilator almost does not function. In newborns, lacrimation is present only due to the production of tears by the accessory lacrimal glands of the conjunctiva, so newborn babies cry without tears. Tear production from the lacrimal gland begins at 2–4 months. The ciliary body is underdeveloped and accommodation is absent.
The sclera of newborns is thin (0.4 mm) and has a bluish tint, because the choroid is visible through it. The iris of newborns has a bluish color, because there is almost no pigment in the anterior mesodermal layer and the posterior pigment plate is visible through the stroma. The iris acquires permanent color by the age of 10–12 years.
The axes of the newborn's orbits converge anteriorly, which creates the appearance of convergent strabismus. The extraocular muscles are thin at birth.
In the first 3 years, intensive growth of the eye occurs. The growth of the eyeball continues until 14–15 years.
DEVELOPMENT OF THE EYE AND ITS ANOMALIES [†]
The eyeball is formed from several sources (Table).
The retina is a derivative of the neuroectoderm and is a paired protrusion of the wall of the diencephalon in the form of a single-layer vesicle on a stalk (Fig. 10). Through invagination of its distal part, the optic vesicle turns into a double-walled optic cup. The outer wall of the glass is transformed into the pigment wall, and the inner wall into the neural part of the retina. The processes of retinal ganglion cells grow into the stalk
glasses and form the optic nerve.
The superficial ectoderm adjacent to the optic cup invaginates into its cavity and forms the lens vesicle. Last
turns into a lens after filling the cavity with growing lens fibers. Through the gap located between the edges of the glass and the lens, mesenchymal cells penetrate into the glass, where they participate in the formation of the vitreous body.
The vascular and fibrous membranes develop from the mesenchyme. The separation of the corneal mesenchyme from the lens leads to the appearance of the anterior chamber of the eye.
Striated muscles are derived from the myotomes of the head.
The eyelids are folds of skin that grow towards each other and close together in front of the cornea. In their thickness, eyelashes and glands are formed.
Anomalies in the development of the organ of vision in humans are the cause of blindness in 50% of cases; they arise due to hereditary mutations
and the influence of teratogenic factors.
In the first 4 weeks of embryonic life, major malformations occur due to the pathological development of the optic vesicle. For example, anophthalmos is the congenital absence of the eye, microphthalmia is a condition in which the optic vesicle is formed, but its further normal development does not occur; all structures of the eye are pathologically small.
Cloudiness of the lens (congenital cataract) is in first place among congenital eye pathologies. More often it develops as a result of improper detachment of the lens vesicle from the ectoderm. If there is a violation of the detachment of the lens vesicle from the ectoderm, or weakness of the anterior capsule, an anterior lenticonus is formed - a protrusion on the anterior surface of the lens. Among other types of congenital pathology of the lens, it is necessary to note its displacement
from the usual location: complete (dislocation, luxatio) and incomplete (subluxation, subluxatio). The cause of such ectopia and lens displacement
developmental anomalies of the ciliary body and ciliary girdle usually appear in the anterior chamber or vitreous body. In case of violation or
slowing down the reverse development of the vascular bag of the lens, its remains
in the form of pigment deposits, they form network-like structures on the anterior capsule - pupillary membranes. Sometimes congenital aphakia (absence of the lens) occurs, which can be primary (when
there is no formation of the lens) and secondary (its intrauterine resorption).
As a result of incomplete closure of the embryonic fissure at the optic cup stage, colobomas are formed - fissures of the eyelids, iris, optic nerve, choroid.
Incomplete resorption of mesoderm in the corner of the anterior chamber leads to
to disruption of the outflow of intraocular fluid from the anterior chamber of the eye
and the development of glaucoma. If there is an abnormality in the drainage system of the eye, aniridia may occur - the absence of the iris.
Corneal abnormalities include a microcornea, or small cornea, which is reduced in comparison with the age norm by more than
1 mm, i.e. the diameter of the newborn’s cornea may not be 9, but 6–7 mm; megalocornea, or macrocornea - a large cornea, i.e. its size is increased compared to the age norm by more than 1 mm; keratoconus - a condition of the cornea in which its central part protrudes significantly in a cone shape; keratoglobus - characterized by the fact that the surface of the cornea has an excessively convex shape throughout.
One of the anomalies of the primary vitreous is its hyperplasticity. It occurs when the reverse development of the vitreous artery is disrupted, which grows through the vascular fissure into the cavity of the optic cup.
A common anomaly - drooping of the upper eyelid (ptosis) - can occur due to underdevelopment of the muscle that lifts the upper eyelid, or as a result of a violation of its innervation.
In case of disruption of the formation of the palpebral fissure, the eyelids remain fused - ankyloblepharon.
The occurrence of optic nerve abnormalities is associated with the closure of the palpebral fissure during embryogenesis at the stage of formation of the secondary optic vesicle or optic cup, with a delay in the ingrowth of nerve fibers into the stalk of the optic cup - hypoplasia (decreased
diameter) and aplasia (absence) of the optic nerve or with persistence (delayed development) of the vitreous - prepapillary membranes over the optic nerve head, as well as with abnormal growth
myelin behind the cribriform plate of the sclera into the eye - myelinated fibers of the optic nerve.
Many eye anomalies can be diagnosed using echography of the fetal facial structures already in the 2nd trimester of pregnancy.
Dictionary of eponyms [‡]
Meibomieva ( Meibomian) iron- eyelid cartilage gland
Schlemmov ( Schlemm) channel- venous sinus of the sclera
Bowmenova ( Bowman´s) membrane - anterior limiting plate
cornea
Bruch's membrane ( Bruch´s) - border plate of the choroid proper
Brucke muscle ( Brocke´s) - meridional fibers of the ciliary muscle
Descemetova ( Descemet´s) membrane- posterior limiting plate of the cornea
Fontanovs ( Fontana) spaces - spaces between the fibers of the corneoscleral trabecula
Horner muscle ( Horner´s) - part of the orbicularis oculi muscle that goes to the lacrimal sac (pars lacrimalis)
Iron Krause ( Krause) - lacrimal gland
Trabecula Leonardo da Vinci ( Leonardo's da Vinci) - corneoscleral trabecula
Moll's gland ( Moll´s) - ciliary gland that opens at the edge of the eyelid
Müller's muscle ( Müller´s) - part of the muscle that lifts the upper eyelid
Tenonova ( Tenoni) capsule- vagina of the eyeball
Cinna ( Zinn) ring- common tendon ring
Belt of Zinn ( Zinn) - eyelash band
Zeiss glands ( Zeis) - ciliary glands that open at the edge of the eyelid
Introduction........................................................ ........................................................ 3
Optical system of the eye........................................................ ......................... 3
Accommodation of the eye................................................... .................................... 5
Hydrodynamics of the eye................................................... ........................... 7
Muscles of the eye................................................... ........................................... 9
Binocular vision......................................................... ........................... 11
Blood supply to the eye................................................... ........................... 12
Lacrimal apparatus........................................................ .................................... 15
Retina and visual pathway.................................................... ........................... 18
Age-related features of the eye structure.................................................................... .. 23
Development of the eye and its anomalies.................................................... ................... 24
Literature................................................. ............................................... 29
[*] The term optical system of the eye, used clinically, in anatomy refers to the inner nucleus of the eye.
[†] Anomalies (Greek anömalia) are congenital persistent, usually non-progressive, deviations from normal structure and function.
[‡] Eponym (Greek epönymos, epi - after, onoma - name) - names bearing someone’s name (usually the name of the one who discovered this organ or gave it a detailed description). The eponyms most commonly used in clinical practice are highlighted in bold.
Visual functions are a complex of individual components of the visual act that allow one to navigate in space, perceive the shape and color of objects, and see them at different distances in bright light and at dusk.
It is customary to distinguish between five main visual functions: central or form vision, peripheral vision, light perception, color perception and binocular vision.
Central vision.
Central vision is carried out by the cone apparatus of the retina. Its important feature is the perception of the shape of objects. Therefore, this function is called form vision.
The state of central vision is determined by visual acuity.
Visual acuity
Visual acuity is determined by the eye's ability to perceive small details at a great distance or distinguish between two points located at a minimum distance from each other. The smaller the detail that the eye distinguishes, or the greater the distance from which this detail is visible, the higher the visual acuity and, conversely, the larger the detail and the shorter the distance, the lower it is.
To study visual acuity, tables are used containing several rows of specially selected characters, which are called optotypes. Letters, numbers, hooks, stripes and drawings, etc. are used as optotypes.
To examine literate and illiterate people of different nationalities, Landolt proposed using open rings of different sizes as an optotype. In 1909, at the XI International Congress of Ophthalmologists, Landolt rings were adopted as an international optotype. They are included in most modern tables.
In our country, the most common table is Golovin - Sivtsev.
With lower visual acuity, it is suggested to distinguish the fingers or movements of the examiner’s hand. Distinguishing them from a distance of 30 cm corresponds to a visual acuity of 0.001.
When vision is so poor that the eye does not distinguish objects, but perceives only light, visual acuity is considered equal to light perception.
If the subject does not even sense light, then his visual acuity is zero.
Visual acuity in children undergoes a certain evolution and reaches a maximum by 6-7 years.
The degree of decrease in visual acuity is one of the main signs by which children are sent to preschool institutions and schools for the visually impaired or blind.
Along with tables, other devices are also used to study visual acuity, incl. portable. These include:
· transparent devices, in which test marks printed on a translucent plate are illuminated by a light source located inside the device;
· projection devices (projectors), with the help of which test signs are projected from transparencies onto a reflective screen;
· collimator devices that contain test signs on transparencies and a special optical system that creates their image at infinity, which allows the presented signs to be placed in close proximity to the eye being examined.
When the optical media of the eye are clouded, retinal visual acuity is determined. For this purpose, interference retinometers, such as laser ones, are used. Using a coherent light source, an image of a grating formed by alternating light and dark stripes is created on the retina of the eye, the width of which can be arbitrarily changed. The state of vision is judged by the minimum distance between the stripes. This method allows you to determine visual acuity in the range of 0.03 - 1.33.
