Fundus disease
Introduction
Introduction to fundus diseases The cornea, iris, and crystal in front of the eyeball are defined as the anterior segment of the eye by the ophthalmology, and the posterior vitreous, retina, and choroid are defined as the posterior segment of the eye. At the bottom of the posterior segment of the eye is called the fundus. The fundus is composed of the retina, the fundus blood vessels, the optic nerve head, the optic nerve fibers, the macula on the retina, and the choroid behind the retina. The lesions in these areas are collectively referred to as fundus diseases. The fundus is located deep in the inner eye and has a fine structure. The complexity and diversity of the fundus disease make it difficult to treat the fundus disease. Traditional treatment methods include drug therapy and physical therapy, but it is often difficult to work. With the rapid development of high technology, fundus laser has become the main treatment for many fundus diseases. The fundus laser is retinal photocoagulation. The fundus laser uses the thermal effect of the laser to act on the abnormal tissue of the retina, causing it to cause scarring by thermal coagulation to achieve the purpose of treating fundus diseases. Laser treatment of fundus diseases has been more than 30 years, and has a definite effect on diabetic retinopathy, central retinal vein thrombosis, central serous choroid, retinopathy and other fundus diseases. basic knowledge The proportion of illness: 0.05% - 0.1% Susceptible people: no special people Mode of infection: non-infectious Complications: cataracts Chronic progressive extraocular muscle paralysis
Cause
Cause of fundus disease
Viral infectious disease
Influenza: can cause optic neuritis.
Rubella: pregnant women with rubella can not only affect the development of the fetus, but also congenital cataract, congenital glaucoma and retinal pigmentation.
Chickenpox: In severe cases, optic neuritis can also be combined.
Herpes: can cause optic neuritis.
Epidemic encephalitis: optic neuritis, retinal hemorrhage can occur.
Epidemic hemorrhagic fever: can cause retinal hemorrhage, edema, vasospasm. Retinal hemorrhage is a serious manifestation of epidemic hemorrhagic fever.
Acquired immunodeficiency syndrome: Acquired immunodeficiency syndrome (AIDS), commonly known as AIDS.
The manifestations of the eye include: retinal leukoplakia, cytomegalovirus retinitis, choroidal granuloma, retinal hemorrhage, acute optic discitis, retinal vein inflammation, retinal telangiectasia, microaneurysm, retinal detachment, and the like. Among them, retinal leukoplakia and cytomegalovirus retinitis are more common.
Rickettsia
Typhus: retinal optic neuritis and total ocular inflammation.
Ascariasis: retinal hemorrhage and edema.
Bacterial infectious disease
Scarlet fever: A small number of patients can develop optic neuritis.
Epidemic cerebrospinal meningitis: optic neuritis, optic atrophy, retinitis.
Tuberculosis: retinal vein inflammation, myopic papillary choroidal retinitis. Central exudative chorioretinopathy.
Leprosy: retinitis and so on.
Helical disease
Syphilis: retinal choroiditis, optic neuritis, optic atrophy, etc.
Leptospirosis: Some patients may be associated with retinal choroiditis, and yellow-white flocculation or retinal hemorrhage may occur along the retinal vessels.
Lyme disease: optic discitis, retinal vasculitis.
Protozoa and parasitic diseases
Malaria: Ocular symptoms are relatively rare. Sometimes, after an acute attack, optic neuritis may have temporary amblyopia, scattered bleeding at the fundus, and retinal choroiditis.
In the sac of the pig: it can enter the ciliary body and choroid through the bloodstream. At this time, the cystic worm can break through the wall of the capsule and enter the subretinal or the vitreous to form a cyst.
Toxoplasmosis: It can be congenital or acquired. The eye changes mainly include focal old retinal choroiditis at the posterior end of the fundus. In the acquired, the retina has scattered inflammatory lesions and hemorrhage.
Prevention
Fundus disease prevention
The fundus is the only site where the arteries, veins, and capillaries can be directly and visually observed. These blood vessels reflect the dynamics and health of the body's systemic blood circulation. Therefore, fundus examination is not only an important method to examine the vitreous, retina, choroid and optic nerve diseases of the eye, but also a "window" for the monitoring of many systemic diseases.
Fundus lesions occur in high blood pressure, hyperlipidemia, kidney disease, diabetes, certain blood diseases, and central nervous system diseases. Ophthalmologists will find many problems in the subtle changes in the fundus map, thus providing important information for the diagnosis and treatment of systemic diseases.
Ophthalmologists recommend that children and young adults should have a fundus examination for half a year, while the elderly and the "three high" population need to be examined once every three months. Before the elderly can detect the fundus, it is best to do the intraocular pressure test first, because the fundus is thoroughly examined in detail, and sometimes it needs to be dilated, and the elderly with high intraocular pressure and glaucoma tend not to dilate.
Complication
Fundus complication Complications cataract chronic progressive extraocular muscle paralysis
1. Iris neovascularization and neovascular glaucoma.
2. The formation of conjunctival microangioma.
3, temporary refractive changes, regulatory paralysis.
4, cataract: true diabetic cataract and senile disability with diabetic cataract.
5. Diabetic retinopathy.
6, extraocular muscle paralysis.
Symptom
Symptoms of fundus diseases Common symptoms Fundus abnormalities Eyes congestion Contrast eye pressure Increases fundus changes Eyeball tenderness Fundus hemorrhage and exudation of retinal artery obstruction The fundus is found in the fundus... Eyeball perforation
Congenital abnormality
Albinism, optic nerve papillary membrane, optic papillary anterior membrane, optic papilla defect, choroidal defect, morning glory syndrome, macular defect, macular ectopic, papillary pigmented nevus, congenital optic papillary vasospasm, congenital retinal hemangioma , congenital retinal folds.
Optic nerve disease
Visual papillitis, papilledema, optic atrophy, optic disc vasculitis, ischemic optic neuropathy, ischemic optic papillary lesions.
Fundus vascular disease
Central retinal artery occlusion, central retinal vein occlusion, retinal vein inflammation, retinal arteritis, hypertensive retinopathy, nephrotic retinopathy, diabetic retinopathy, coats, retinal hemangioma, choroidal hemangioma .
Macular disease
Central serous chorioretinopathy, central exudative chorioretinopathy, age-related macular degeneration, myopic macular degeneration, yolk-like macular degeneration, juvenile macular dystrophy, macular anterior fibrosis, macular edema, idiopathic Macular hole, traumatic macular hole.
Degenerative disease
Primary retinitis pigmentosa, congenital retinoschisis, retinal choroidal atrophy, pigmented retinal atrophy.
Retinal detachment
Rhegmatogenous retinal detachment, retinal detachment caused by foreign bodies in the eye, contusive retinal detachment.
Retinal choroidal inflammatory disease
Disseminated choroidal retinitis, diffuse retinal choroiditis, periorbital optic choroidal retinitis, localized chorioretinitis, map-like retinal choroiditis, map-like retinal choroidal atrophy, acute retinal pigment epitheliitis, acute multiple posterior pole Squamous pigment epithelial lesions, retinal pigment epithelial detachment, uveitis.
Fundus tumor
Optic papillary melanoma, choroidal melanoma, retinoblastoma.
Eye trauma
Eye trauma can lead to: retinal concussion, macular perforation, choroidal rupture, contusive choroidal hemorrhage, contusive optic papillitis, contusive optic nerve changes, contusive optic atrophy, optic nerve head avulsion, hemorrhagic pigment epithelial detachment, contusive pigment epithelium Damage, traumatic optic nerve retinal damage, contusive retinal proliferative lesions, contusive optic retinal atrophy around the optic papilla.
Fundus parasite
Subarachnoid cysticercosis.
Examine
Examination of fundus diseases
Fundus examination is an important method for examining vitreous, retinal, choroidal and optic nerve diseases. Exams should be used to check the fundus. At present, direct ophthalmoscopy is used to check, which is practical and convenient, and the fundus is seen as a positive image. The power supply is arranged in the handle below the ophthalmoscope, and the front end is an optical device with a convex lens and a triangular prism. The upper end of the prism has a viewing hole, and a rotating mirror plate is arranged under the prism.
The mirror plate is equipped with a 1-25 diopter convex lens (marked with a black "+") and a concave lens (marked with a red "+"). It is used to correct the refractive error of the examiner and the patient to clearly show the fundus. The convex lens on the mirror plate focuses the light emitted by the light source to enhance the luminosity; the triangular prism refracts the focused light into the patient's eye to observe the image of the fundus.
1. The examination should be carried out in the dark room, and the patient should take more seats, and the examiner can sit or stand. When checking the right eye, the examiner is located on the right side of the patient, with the right hand holding the mirror and the right eye; when checking the left eye, it is located on the left side of the patient, with the left hand holding the mirror and the left eye.
2. Before the formal examination of the fundus, first check whether the refractive interstitial of the eye is turbid by the method of stereography. Use your fingers to turn the ophthalmoscope tray to +8 -- +10 (black) diopter, 10-20 cm from the eye to be inspected, and shoot the optician light into the pupil of the eye to be examined. Normally, it is orange-red reflective. If the cornea, aqueous humor, crystal or vitreous is turbid, there is a black shadow in the orange red reflection.
At this time, the patient turns the eyeball. If the black shadow and the eyeball rotate in the same direction, the turbidity is located in front of the crystal. If the direction is opposite, it is located in the vitreous body; if the position is not moving, the turbidity is in the crystal.
3. Check the fundus: The patient looks straight ahead, dials the mirror back to 0, and moves the ophthalmoscope to the fundus about 2 cm in front of the examined eye. If both the examiner and the patient are facing the eye, you can see the image of the fundus. When you can't see it, you can use the mirror to see it. Check the nerve nipples first, then press the retinal arteriovenous branches, check each quadrant separately. Finally, check the macula.
When examining the optic nerve head, the light is shot at about 15 degrees from the temporal side; when the macular is examined, the patient looks at the light source of the ophthalmoscope; when examining the peripheral part of the fundus, the patient looks and turns the eyeball in the upward, downward, left, and right directions, or Change the angle of the ophthalmoscope. Observe the shape, size, color and sharpness of the optic nerve head. Observe the retinal arteries and veins, pay attention to the thickness of the blood vessels, the diameter of the blood vessels, the reflection of the wall, the branch angle, and the presence or absence of compression or arch bridge at the intersection of the artery and vein. The ratio of the normal artery to the vein diameter is 2;
Observe the macula, pay attention to its size, the presence of foveal reflexes, edema, hemorrhage, exudation and pigmentation disorders. Observe the retina, pay attention to edema, exudation, bleeding, peeling and new blood vessels.
4. Fundus examination records: to illustrate and record the location of the fundus lesions and their size range. Usually the optic nerve head, the central retinal veins, veins, and the macula are marked, indicating the positional and directional relationship between the lesion and these markers. The distance and range are generally calculated on the basis of the optic nerve head diameter PD (1PD = 1.5 mm).
Recording the degree of lesion bulge or depression is calculated by looking at the difference between the retinal surface around the lesion and the diopter (D) at the highest point of the lesion or at the lowest point of the depression. Each diopter (3D) is equal to 1 mm.
Diagnosis
Diagnosis of fundus disease
diagnosis
Fundus examination can be diagnosed.
Differential diagnosis
Identification of eye diseases such as macular disease (edema), cataract, glaucoma, refractive changes, and iridocyclitis caused by diabetes.
1. Cataract: It is the opacity of the lens in the eye that changes from transparent to opaque, hindering light from entering the eye, thus affecting vision.
2. Glaucoma: Glaucoma is a series of eye diseases caused by impaired optic nerves.
3, iridocyclitis: is one of the common blind eye diseases, is the most common type of uveitis. The main clinical manifestations are redness of the eyes, decreased vision, turbidity of the aqueous humor and post-corneal deposition. If the treatment is not timely, serious complications such as secondary glaucoma, cataract and eyeball atrophy may occur.
