EYE

From Big Medical Encyclopedia

EYE (Latin. oculus) — peripheral body of perception of photoirritations.

Comparative anatomy and embryology

Fig. 1. Scheme of a scyphoid eye of a bloodsucker: 1 — a pigmental glass; 2 — a visual cell. Visual cells in a cover epithelium are collected by groups and lean on a pigmented layer (glass). Nerve fibrils are absent.

Phylogenesis

the Organ of sight underwent big evolution in the course of phylogenetic developed live organisms. Ability to perceive light even the elementary unicells have. Amoebas, infusorians show negative phototropism, without having at the same time any special body for perception of light. In protoplasm of some elementary (Euglena viridis) there are special inclusions, light-sensitive. True visual cells, a prototype of visual body, appear only at worms. Single or multiple visual cells are located century more thickly than a cover epithelium. In a cell there are an outside receptor device and protoplasm with a kernel, a proximal part of a cell is quite often extended in the form of a fibril. At coelenterates visual cells are located with groups in the form of a glass and contain a nek-swarm quantity of a pigment (fig. 1). Such organs of sight are able to define precisely intensity and the sizes of a beam of light, and also its direction. The organ of sight of arthropods consisting of a set of primitive visual cells is capable to perceive already not only light, but also to define a form of a subject. The visual device at all above-mentioned organisms has purely epithelial origin, as makes its main difference from G. of vertebrate animals.

Vertebrata, in addition to elements of a cover epithelium, cells of an internal nervous ectoderm, originative and to a brain take great interest in G.'s formation.

The visual body at an embryo of vertebrate animals arises already at early stages of fetation — before formation of internals and cardiovascular system.

Ontogenesis

Fig. 2. The scheme of a rudiment of primary eye bubble at a three-week germ of the person: 1 — a layer of an outside ectoderm; 2 — undifferentiated cells of a mesenchyma; 3 — a brain tube; 4 — primary eye bubble.
Fig. 3. The scheme of laying of an eyecup at a one-month germ of the person: 1 — an outside ectoderm; 2 — undifferentiated cells of a mesenchyma; 3 — an outside ectoderm of which in the subsequent the crystalline lens is formed; 4 — an internal multilayer wall of an eyecup; 5 — an outside single-layer wall of an eyecup.

At the person emergence of a rudiment of visual body happens also very much early — on the 3rd week of life of a germ. In this stage of development all germ represents accumulation of yet not differentiated cells surrounded with a layer of an outside ectoderm. On a dorsal surface of a germ the ectoderm forms a small groove — a rudiment future c. N of page. Even before full short circuit in a tube and otshnurovaniye of this rudiment of a brain from an outside ectoderm on lateral faces of the head end of a brain tube there are small protrusions — primary eye bubbles (fig. 2). Gradually both eye bubbles increase in sizes, are extended towards an outside ectoderm. In the place of contact with them the outside ectoderm begins to be thickened and also forms protrusion towards an eye bubble which in turn begins to be rolled in front, forming as if a two-layer bowl — a secondary eye bubble, or an eyecup. The internal wall of this glass is made by the screwed front wall of the former eye bubble, and outside not screwed — its back half. Formation of an eyecup happens because primary bubble does not grow evenly. Rapid growth of dorsal and lateral parts of primary eye bubble while front and ventral parts lag behind in growth is noted. Fast-growing areas acquire front and lower speak rapidly. There the hollow is formed. In this place there are also a germinal crack of G. and a leg of an eyecup. The leg of an eyecup is extended in a long tube — future optic nerve. The internal wall of an eyecup at once begins to be thickened, becomes multilayer while the outside wall remains single-layer and in it pigmental grains begin to be formed. Emboly of an outside ectoderm takes a form of a bubble and gets in an eyecup, gradually otshnurovyvayas from an outside ectoderm and forming a rudiment of future crystalline lens (fig. 3). With a first line of an eyecup — the place of transition of its screwed internal wall in outside — both layers of epithelial cells remain undifferentiated, further they make an epithelial cover of mezenkhimny educations — an iris of the eye (iris) and a ciliary (ciliary) body.

At the age of 1 — 1,5 month the edge of an eyecup from below begins to be turned out gradually, forming the secondary palpebral fissure proceeding from a first line of an eyecup of a kzada up to his leg. Through this crack in an eyecup a large number of surrounding mesenchymal elements which together with the mesenchymal cells which were already earlier in a cavity of an eyecup form vascular network of the forming vitreous and the embryonal vascular capsule of a crystalline lens (tunica vasculosa lentis) here gets. Soon the germinal crack is closed and walls of an eyecup become continuous again.

Fig. 4. Scheme of an eyecup of a three-months germ of the person: 1 — an outside ectoderm — a rudiment of a corneal epithelium; 2 — folds of an outside ectoderm — rudiments of future eyelids; 3 — a crystalline lens with feeding it vascular network occupying the forefront of an eyecup; 4 — mesenchymal vascular network of a vitreous; 5 — a multilayer internal wall of an eyecup; 6 — the single-layer, pigmented outside wall of an eyecup; 7 — mesenchymal fabric around a wall of an eyecup.


At a three-months embryo the eyecup appears already quite issued (fig. 4), in it is available pigmented single-layer outside and multilayer internal walls. In an eyecup there is a gradual formation of mesenchymal vascular network of a vitreous. The forefront of an eyecup is occupied by the crystalline lens which is in the period of the strengthened growth and therefore plentifully supplied by food at the expense of massive vascular network. The cells of a mesenchyma, next to an eyecup, accept layered character, being located along its walls, forming a rudiment of future choroid and a dense fibrous outside wall of G. — a sclera and a cornea (cornea). The forming cornea in front becomes covered by an outside ectoderm — a rudiment of a corneal epithelium. Folds of an outside ectoderm — rudiments of future eyelids are outlined in this stage above and below the location of an eyecup. The pupil corresponds to edge of a germinal eyecup. However in uterine life this opening is not free, it is covered with film (membrana pupillaris) connected with vascular network of a crystalline lens. At 4 — a 5-month embryo all departments of a choroid form and there is a strengthened growth of all rudiment of G. Poyavlyayutsya blood vessels and in a mesh cover (retina) which is finally formed of cells of an eyecup. During this period formation of a fibrous cover of an eyeglobe — a cornea and a sclera comes to an end.

After 6 months at a fruit the eyeglobe is generally issued and involution of a vascular texture of the vitreous and a texture surrounding a crystalline lens begins. By 7 — 8 months the capsule of the vascular texture surrounding a crystalline lens resolves, zapustevat vessels of a vitreous and myelination of fibers of an optic nerve comes to an end. However not always by the time of the birth of the child all difficult cycle of formation and the subsequent involution of embryonal structures of G. is fully complete. E.g., involution of a pupillary film — the rest of the embryonal vascular texture surrounding a crystalline lens or the main germinal artery of a vitreous (a. hyaloidea), sometimes proceeds in the first weeks or even months after the birth of the child.

Anatomy and histology

Fig. 1. A structure of an eye (the vitreous, a part of a crystalline lens and covers of an eye are removed): 1 — sclera; 2 — chorioidea; 3 — retina; 4 — a. ciliaris post, brevis; 5 — n. opticus; 6 — a. ciliaris post, longa; 7 — v. vorticosa; 8 — m. rectus inf.; 9 — circulus arteriosus major; 10 — iris; 11 — cornea; 12 — conjunctiva; 13 — lens; 14 — corpus ciliare; 15 — m. rectus sup.

Of the person represents almost spherical education to dia, about 24 mm. The habit view of G. is in front shown in the figure 5 and tsvetn. fig. 1.

Three covers take part in formation of walls of an eyeglobe: outside — fibrous (tunica fibrosa bulbi), average — vascular (tunica vasculosa bulbi) and internal — a retina (retina).

An outside cover of G., being as if his external skeleton, provides it a certain form and consists of two parts: scleras (see) and corneas (see). The sclera, or a white (tunica albuginea), is opaque, consists of dense collagenic fibers, contains a significant amount of elastic fibers and few cells; thickness of a sclera fluctuates ranging from 0,5 to 1 mm, and she is the most fat behind — near the place of escaping of G. of an optic nerve, and also ahead of an attachment of sinews of muscles of an eyeglobe. Thinnest a sclera in the place of passing of fibers of an optic nerve through it. The sclera is poor in vessels, and only its rather loose outside coating, a so-called episclera (lamina episcleralis), contain the bigger number of vessels. The forefront of a sclera is covered conjunctiva (see).

On a surface of an eyeglobe on border of connection of a sclera with a cornea there is a superficial translucent fillet — a limb (limbus corneae) width apprx. 0,75 — 1 mm.

In a cornea (cornea) distinguish five layers: superficial — is presented by a multilayer epithelium, then the unstructured front boundary plate (a boumenova a cover), is located further — the stroma, to a cut adjoins the unstructured and elastic back boundary plate (a destsemetova a cover) covered from a back surface with one layer of endothelial cells. Anatomo-gistol. feature of a cornea are the correct arrangement of the corneal plates forming its stroma and lack of blood vessels in it. In slit-like spaces between plates of a cornea so-called corneal little bodies — the cells forming the real sincytium thanks to communication of their protoplasmatic shoots are located. Thickness of a cornea in the center apprx. 0,9 mm; on the periphery — apprx. 1,2 mm; diameter of a cornea — apprx. 12 mm; average radius of curvature — 8 mm.

Food of a cornea is carried out generally from network of the capillaries put in a limb and also from chamber moisture. The cornea contains a large number of the sensitive nerve terminations which are located preferential in surface layers.

The average cover of G. consists of three parts: idiovascular cover (chorioidea), ciliary body (corpus ciliare) and iris (iris). Actually choroid of an eye (see) contains arterial and venous vessels of various caliber. The largest of them are located closer to a sclera while the capillary layer (lamina choriocapillaris) is separated from a retina only by a thin cover (Bruch's membrane).

In the forefront of an eyeglobe, at the level of the so-called gear line (ora serrata), the choroid passes into a ciliary body, a cut consists of two layers: outside, muscular, adjacent to a sclera and presented by a ciliary muscle (m. ciliaris), and internal, vascular, the layer which is continuation of a choroid (partly and the retina reduced here to two layers of epithelial cells).

Ciliary body (see) consists of two departments: back — flat, occupying two thirds, and front — otrostchaty. 70 — 80 shoots (processus ciliares) depart from an inner surface of front department. Fibers of a ciliary corbel (a tsinnovy sheaf, zonula ciliaris) which suspend a crystalline lens in G. are attached to shoots.

Between a choroid and a ciliary body on the one hand and an inner surface of a sclera — with another there is a narrow crack — so-called perikhorioidalny space (spatium perichorioidale).

Iris (see) — the forefront of a choroid, the cut is in the center a pupil — plays a role of a diaphragm for the rays of light getting into G., In it distinguish two layers: the front, connective tissue, containing vessels, and back, epithelial, presented by two. layers of the pigmented cells making continuation of a retina undifferentiated here. In an iris there are two muscles: sphincter of a pupil (m. sphincter pupillae) and dilator of a pupil (m. dilatator pupillae).

A retina (see) — the most internal of covers of an eyeglobe. Genetically it is the specialized part of c which is taken out far on the periphery. the N of page and throughout from an optic disk to the gear line consists of the high-differentiated nervous elements. With fiziol, the points of view a retina need to be considered as a peripheral part visual analyzer (see).

The retina, very difficult on the gistol, a structure, is organized so that its outside layers turned to a choroid, are presented by svetovosprinimayushchy elements — a neuroepithelium whereas internal hl are formed. obr. the cells and nerve fibrils which are carrying out nervous irritation.

The cavity of an eyeglobe contains watery moisture [humor aquosus (PNA)], edges carries out front and back cameras; a crystalline lens [lens (PNA)] with its suspending device and a vitreous (corpus vitreum).

The space located between a back surface of a cornea and a front surface of an iris, and in a pupillary part as well a crystalline lens, carries the name of an anterior chamber of G. (camera ant. bulbi). The area of an angle of iris of an anterior chamber plays an important role in the course of circulation of intraocular liquid. The complex system of crossbeams (trabeculas) making a skeleton of a corner plays a role of peculiar «filter» via which watery moisture in the circular vessel put in a sclera leaves G. (helmets the channel) — a venous sine of a sclera (sinus venosus sclerae) and further in system of front ciliary veins.

The space limited to a back surface of an iris, a peripheral («equatorial») part of a crystalline lens and an inner surface of a ciliary body carries the name of the back camera G. (camera posterior bulbi).

Fig. 5. Eye in front: 1 — supercilium; 2 — palpebra sup.; 3 — cilia; 4 — plica semilunaris conjunctivae; 5 — angulus oculi med.; 6 — caruncula lacrimalis; 7 — palpebra inf.; 8 — limbus palpebralis ant.; 9 — limbus corneae; 10 — angulus oculi lat.

Crystalline lens (see) represents the transparent elastic body in the form of lentil suspended by means of the special copular device to shoots of a ciliary body. The ciliary corbel suspending a crystalline lens consisting of the mass of fine elastic ends is attached on the one hand to a ciliary body, and with another — to a transparent unstructured elastic bag of a crystalline lens (capsula lentis) in the field of its equator. Under a front bag of a crystalline lens in one row transparent cells of a lenticular epithelium are located. Substance of a crystalline lens is heterogeneous: its central part, a so-called kernel (nucleus lentis), consists of more dense fibers in comparison with the sites lying closer to a bag (so-called bark — cortex lentis). The crystalline lens has neither vessels, nor nerves.

Vitreous (see), lying behind a crystalline lens, occupies the most part of a cavity of. It represents translucent student invisible mass, free of neither blood vessels, nor nerves; from a back surface of a crystalline lens towards an optic disk through a vitreous there passes the channel (canalis hyaloideus).

The cornea, watery moisture, a crystalline lens and a vitreous lying on the way of G. getting inside and the rays of light going to a retina belong to the optical (refracting) System.

Fig. 6. Muscles of an eye (parasagittal drank eye-sockets): 1 — m. levator palpebrae sup.; 2 — t. rectus sup.; 3 — m. rectus lat.; 4 — m. rectus inf.; 5 — m. obliquus inf.; 6 — an eyeglobe.

The muscular device G. (fig. 6) providing its coordinate movements is presented by six muscles: four straight lines (m. rectus lat., m. rectus med., m. rectus sup., m. rectus inf.) and two slanting (m. obliquus sup., m. obliquus inf.). Upper slanting receives an innervation from a block nerve (n. trochlearis), and an outside straight line — from the taking-away nerve (n. abducens). Other outside muscles of G. are innervated from a third cranial nerve (n. oculomotorius).

The eyeglobe from the place of an exit of an optic nerve (behind) and to a cornea is (in front) surrounded with a vagina of an eyeglobe — a tenonovy fascia (vagina bulbi, s. Tenoni), G.'s cut inside and makes the movements just as it occurs in a spherical joint.

The vagina of an eyeglobe by means of numerous connective tissue is attached by tyazhy to bone walls and edges eye-sockets (see) that provides to G. a certain situation in it, without stirring at the same time an opportunity to make the considerable movements.

On an eyeglobe it is accepted to allocate a number of identification points and geometrical lines. The point corresponding to the center of a cornea is called a front pole of G., and corresponding to the center of a macula lutea (macula) — a back pole. The line connecting both poles is called Axis. The greatest circle of G. in the frontal plane carries the name of the equator of G.; and the circles which are mentally carried out through both poles are called meridians.

G.'s blood supply is provided at the expense of an eye artery (a. ophthalmica). The last breaks up to numerous branches: back short and long ciliary arteries (aa. ciliares post, breves et longi) and front ciliary arteries (aa. ciliares ant.). Ciliary arteries are distributed by hl. obr. in an average cover of G. Setchatk receives blood from the central artery of a retina (a. centralis retinae) which is also a branch of an eye artery. A venous blood is taken away from an average cover of G. generally on 4 — 6 vortikozny veins (vv. vorticosae) and partly on front ciliary veins (vv. ciliares ant.). Blood from a retina flows on the central vein (v. centralis retinae). All venous blood from G. and tissues of an eye-socket goes hl. obr. in a cavernous sine (sinus cavernosus).

The sensitive innervation of G. is carried out by an optic nerve (n. ophthalmicus, the I branch of a trifacial). The nosoresnichny nerve (n. nasociliaris) departs from this nerve, from to-rogo in turn there are to G. long ciliary nerves (nn. ciliares longi), and through a ciliary (tsiliarny) node (gangl, ciliare) — short ciliary nerves (nn. ciliares breves). The last, in addition to sensitive fibers, contain also sympathetic, hl, obr. vasculomotor (from a texture of an internal carotid artery). As a part of short ciliary nerves to a sphincter of a pupil and a ciliary muscle pass (through a ciliary node) also motor fibers from a third cranial nerve.

Nerve fibrils in an eyeglobe are distributed preferential in an average cover (a ciliary body, an iris) and a cornea.

Optic nerve (see) it is formed of axial cylinders of ganglionic cells — neurocytes of a retina. These axial cylinders gather to an optic disk (discus nervi optici) and, forming in separate bunches, pass through a trellised plate in a sclera. After escaping of G. the nerve is a round cord with a diameter apprx. 4 mm (together with its covers). Via the visual channel (canalis opticus) it enters a head cavity. The nerve is covered with three covers making continuation of a meninx (firm, web and soft).

Physiology and biochemistry

It is accepted to distinguish G.'s physiology and physiology sight (see). The first studies the processes providing vegetative functions G.: a hemodynamics, hydrodynamics (see the Hemodynamics of an eye, the Hydrodynamics engineer of an eye), regulation intraocular pressure (see), physiology of optical perelomlyayushchy environments (cornea and sclera, crystalline lens and vitreous); functions of a ciliary body and iris; metabolism of a retina and pigmental epithelium; physiology of protective mechanisms.

The physiology of sight investigates the processes which are directly providing vision, physiology of the movement of an eye including. pupillary reflexes (see); photoreception (see. Fotoretseptora ); neurophysiology of a mesh cover, visual pathways and centers; psychophysiology of visual functions; photoperception (see); color sight (see); field of vision (see); solid vision (see); visual acuity (see); recognition of images.

The cornea bears double function: participates in carrying out light on a retina and together with a sclera, being a part of the outside capsule G., protects its components from damage. It — the first and strongest lens of optical system G.; its refracting force — 43,0 or apprx. 70% of all refracting force of this system.

Transparency of a cornea is connected with its features gistol, structures: uniformity of a form and arrangement of cells of an epithelium, endothelium and densely packed collagenic fibrilla of a stroma, lack of vessels.

Distinctions in chemical composition and metabolism of separate layers of a cornea are characteristic (stromas, an epithelium and an endothelium). The stroma consists of 75 — 80% of water and 20 — 25% of proteins (collagen, mucoproteins, elastin) and mucopolysaccharides, in particular glikozaminglikan. Collagenic fibrilla makes «skeleton» of a stroma; at the same time mucopolysaccharides are located in interfibrillar spaces. The epithelium contains many water-soluble proteins and not enough collagen and glikozaminglikan. In it there are highly active enzymes of glycolysis, a tricarbonic acid cycle, etc. The endothelial membrane — a back boundary plate (a destsemetova a cover) consists generally from collagen-elastinovogo of a framework.

The metabolism in a cornea is carried out preferential through chamber moisture and the lacrimal liquid. Especially the high level of exchange in an epithelium of a cornea since the last has high mitotic activity and at damage quickly regenerates. Erozirovaniye and an ulceration of an epithelium depend on activity of proteases which main source the epithelium is. Use of inhibitor of proteases — a pantripin slows down destruction of cells of an epithelium.

Change of activity of some enzymes of a cornea has diagnostic value. So, e.g., at a herpetic keratitis activity of an alkaline phosphatase decreases and activity of acid increases.

The cornea possesses big hydrophily (see). It a long time keeps water balance thanks to an epithelium and an endothelium. At their damage quickly there comes hypostasis of a stroma and its opacification.

Permeability of a cornea for various substances defines efficiency of the medicines applied locally. Other condition of maintenance of a normal water balance of a cornea — preservation of electrolytic and osmotic balance. An epithelium and an endothelium of a cornea, working as pumps, soak up ions of Na + , To + and Cl - in a stroma also allocate them back in the lacrimal liquid and watery moisture of an anterior chamber, supporting the necessary osmotic pressure.

The sclera, unlike a cornea, contains the bigger amount of collagen and elastin is considerable. The main mucopolysaccharide — hondroitinsulfat In — makes a half of all mucopolysaccharides of a sclera; are a part of a sclera also hondroitinsulfat And (chondroitin-4-sulfate) and hondroitinsulfat About (chondroitin-6-sulfate). In a sclera more intensive is observed, than in a cornea, exchange of glikozaminglikan that explains its big (in comparison with a cornea) lability and a susceptibility to various influences, in particular hormonal.

A crystalline lens as well as a cornea, it is transparent. Its index of refraction in an emmetropichny eye (see. Emmetropia ) it is close to index of refraction of other optical environments (a cornea and a vitreous). Being body accommodations of an eye (see), it can change curvature of the surfaces. The crystalline lens as all epithelial structures, grows during all life, but, unlike other epithelial educations, being in the capsule, cannot dump the died cells. Therefore in the course of life of an organism it extremely slowly, but constantly increases in the volume and weight. It contains the greatest amount of proteins in comparison with other parts G. — 35% (soluble alpha and (beta crystallins and insoluble albuminoid). Proteins of a crystalline lens of an organospetsifichna. The person or animal, immunizirovanny to this protein, give anaphylactic reaction.

Except proteins, in a crystalline lens there is a number of carbohydrates and their derivatives (glucose, fructose, a glycogen, sorbitol, inositol, a glycosamine, etc.). The crystalline lens, unlike other educations of G., contains a little water (apprx. 65% of its weight). With age fraction of water in it decreases. Owing to loss of water and compression of its fibers by an old age there is an increase in its optical density. Relative dehydration also is with age one of the reasons presbyopies (see).

The crystalline lens possesses a large number of reducers (glutathione, cysteine, redoxon). He receives nutrients from watery moisture by diffusion and active transport. Its energy demands are provided with generally anaerobic glycolysis. Activity of process of education milk to - you are regulated lactate dehydrogenase (see). During the aging in a crystalline lens decrease in the general activity of a lactate dehydrogenase and its shift in an isofermental range is observed. In the course of metabolism he uses much less oxygen, than other bodies and fabrics (is 8 — 10 times less, than muscles, and 20 times less liver). The partial tension of oxygen in a crystalline lens is lower, than in vaskulyarizirovanny tissues of an eye.

The vitreous at the person (and the majority of mammals) is hydrogel (see. Gels ). Its function — keeping fit and a tone of an eyeglobe, carrying out light and participation in an intraocular metabolism. It consists of a liquid part and the dense rest. A liquid part — water solution hyaluronic acid (see), in a cut the proteins, organic and inorganic matters characteristic of blood serum are dissolved. The dense rest contains so-called residual protein, collagen is a part to-rogo. Hyaluronic to - that penetrates collagenic network as a sponge, giving viscosity and elasticity to a vitreous.

Liquid of a vitreous after removal of hyaluronic acid on structure reminds watery moisture. However there is a considerable gradient of concentration for a number of substances between plasma, watery moisture and a vitreous. It speaks about existence of barriers between them. Tension of oxygen in a vitreous and the speed of its utilization the smallest in comparison with other formations (internal covers and Wednesdays) of an eyeglobe, at the same time waters contains in it from 98 to 98,8%. Water exchange is very high. Each 15 min. a half of water is replaced. It gives the grounds to consider that the vitreous participates in regulation of intraocular tension and promotes deduction of a retina in normal situation. Amotio, fluidifying or wrinkling of a vitreous are one of the factors leading to amotio of a retina. High concentration milk to - you is characteristic of a vitreous that indicates a big role of anaerobic glycolysis.

The ciliary body, as well as a crystalline lens, participates in process of accommodation. Being the most vaskulyarizirovanny part of an eye, the ciliary body has the increased exchange. It produces watery moisture in a back chamber of the eye due to ultrafiltration and active transport of substances from the blood circulating in capillaries of ciliary shoots. Oxidizing processes go especially intensively in not pigmented layer of its epithelium and this layer plays a major role in products of watery moisture.

In a ciliary body a large number oxidizing (suktsindegidrogenaza, cytochrome oxydases) and hydrolases is revealed (hyaluronidases, beta glucosidases, beta galactosidases). In a ciliary epithelium the ATP-ases (Na — K-ATP-ase) playing a large role in the course of active transport of Na for which about 2/3 energy are spent developed in a ciliary body are localized. Active transport of sodium increases an osmomolyarnost of primary watery moisture, leading to receipt in a back chamber of the eye of water due to osmosis.

The large role in metabolism is played by phosphatases which participate in process of absorption and secretion; and activity of acid phosphatase is higher in a pigmented layer of an epithelium, and alkaline — in not pigmental. The epithelium of a ciliary body participates in transport of protein and selectively selects electrolytes from blood in watery moisture; he is the main supplier of glucose in watery moisture and synthesizes the glikozaminglikana coming both to watery moisture and in a vitreous. The major role in ensuring energy needs of a ciliary body is played by a cycle of Tricarboxylic acids (see. Tricarboxylic acids cycle ). Takes place as well anaerobic metabolism with education milk to - you. Activity of enzymes can change under the influence of steroid hormones, thyritropic hormone of a hypophysis, etc., and also at various patol, states.

The retina — the most internal, svetovosprinimayushchy, nervous, thin, transparent cover located between a vitreous and horioidey provides at the most peripheral level of visual system of function a svetovospriyatiya, sacred and color discriminations. These functions are provided with its difficult neural device and extremely high metabolism. Oxygen consumption in it at the person is much higher, than in tissue of a brain. In a retina there are almost no perivascular spaces and there is very small amount of extracellular liquid. The space between vessels and nervous elements is filled with glial elements (Müller's cells, etc.) which undertake a considerable part of transport of nutrients from vessels in nervous elements of a retina. At the level of outside joints of photoreceptors form rhodopsins (see) which process of decomposition used by photoirritation of a retina causes in it primary impulses of excitement in the form of the electric potentials which are transferred on an optic nerve and other visual pathways to the visual centers where there are visual feelings and perceptions.

In a retina carbohydrate metabolism is best of all studied. In it active process of glycolysis is observed, and it is carried out both in anaerobic, and in aerobic conditions. Is of great importance in metabolism of a retina glycogen (see) which contains in significant amounts in all photoreceptor, nervous and neuroglial formations of a retina. Synthesis of protein is also of very great importance. So, at tapetoretinalny dystrophies (see) inclusion of amino acids in proteins of a retina strongly falls. In cytoplasm of sticks and flasks the significant amount of RNA changing at functional light load is revealed. Rather lipidic exchange in a retina is less studied. It is established that it contains phospholipids. Exchange lipids (see) is important for function of a retina, in particular for synthesis of rhodopsins as rhodopsin is a lipoproteid. Lipoproteids enter into structure of rhodopsins and structure of outside joints of photoreceptors. If in the artificial way to remove lipids from rhodopsin, then it loses ability of regeneration after the decomposition. If as a result of intensive photoirritation or oversaturation reoxide oxidation of lipids happens oxygen, then it is followed by a degeneration of outside joints of photoreceptors. In a retina, however, natural educations (antioxidants) which slow down reoxidation of lipids are had. Such antioxidant is, e.g., vitamin E (tocopherol).

The adrenaline which are available in a retina, noradrenaline, acetylcholine, dopamine play a large role in transfer of visual excitement.

The pigmental epithelium of a retina plays an essential role in the course of sight though functions of this structure are studied not enough. He acts as the black neutral filter, absorbing a considerable part of the light rays getting into an eye, reducing thereby light scattering in an eye, and plays an important role in food of periblasts of a retina, and also structures of the central pole of a retina where capillaries of the central artery of a retina do not reach. The pigmental epithelium promotes penetration of metabolites from a horioidea to photoreceptors and in the opposite direction. Fine structure of an epithelium in the field of the seeing part of a retina differs from that, edges corresponds to its unseeing departments on the extreme periphery of an eyeground. At amotio of a retina in those sites where it departs from a pigmental epithelium, regeneration of a rhodopsin stops. Besides, the pigmental epithelium participates in a lysis of «old» apical disks of an outside segment of sticks. At a so-called pigmental retinitis this function is broken that leads to accumulation of fragments of disks, especially in places of the greatest density of sticks, to disturbance of local metabolism and, as a result, to emergence of scotomas under review. Active participation of a pigmental epithelium in photoreception is demonstrated also by emergence of biopotentials in it at illumination of an eye.

Physiology of protective mechanisms of an eye. The main role in protection of an eye against external adverse effects is played: 1) sensitivity of a cornea; 2) movements century; 3) «lubricant» of an eye secret of glands of a conjunctival cavity, in particular secret of the lacrimal glands; 4) pupillary tests.

Extraordinary high sensitivity of a cornea to a touch, bright light etc. causes quickly - a blink reflex (see. Blinking ) and the otdergivany heads that is one of the most important defense reactions of. If the irritating incentive intensive, a reflex of a blinking amplifies and passes into a contracture, to-ruyu already consciously it is impossible to control (see. Nictitating spasm ).

The greatest sensitivity of a cornea in the center; it decreases to the periphery. This change is connected with anatomic distribution of the afferent terminations of fibers of the nerves of a cornea generally sensitive to pain. Nerve fibrils of a cornea are a part of a trifacial and therefore its sensitivity decreases at damage of a nerve. The cornea and a conjunctiva are constantly humidified due to secretion of the lacrimal gland (see. the Lacrimal bodies ) and mucous pieces of iron conjunctivas (see). At hit on a cornea or a conjunctiva of foreign bodys reflex arise a plentiful slezootdeleniye and increase of blink movements that promotes removal of foreign bodys. In a normality for moistening of an eye there is enough secretion of mucous glands of a conjunctiva.

By means of a slit lamp it is possible to see the film created by these liquids on a surface of a cornea. Film thickness is from 7 to 20 microns; it has a nek-swarm stability.

The act of a blinking which is carried out by the movements a century serves as a secret of the lacrimal gland and pieces of iron of a conjunctiva for intermittent lubrication of a cornea that protects an epithelium of a cornea from drying. The movement has a century reflex character.

Pupillary tests play a large role in regulation of hit of light on a retina. At weak lighting the reflex mydriasis promotes bigger penetration of light, at bright light sharp narrowing of a pupil limits intake of light to a retina.

The dioptrics

the Optical apparatus G. consists of four refracting environments: corneas, chamber moisture, crystalline lens and vitreous. Studying of elements of the optical apparatus of human G. became possible for the first time after in 1855 Helmholtz invented and described the oftalmometr and by that laid the foundation for the new section fiziol, optics — ophthalmometry (see). Implementation in a wedge, practice of x-ray methods, oftalmofakometriya, to photo ophthalmometry and especially ultrasonic biometrics allowed to approach studying of the optical Apparatus in a new way. In 1909 A. Gullstrand on the basis of the analysis of the published data removed a number of indicators of basic elements of the optical Apparatus.

However by further researches it was established that all these indicators differ in big variability (tab. 1).

Table 1. Indicators of elements of the optical apparatus of an eye according to A. Gullstrandu and E.Zh.Trona)


The great value is played at the same time by the age characteristic inspected (A. I. Dashevsky, 1956).

The form of curvature of the refracting environments has crucial importance for light refraction. By numerous researches it is established that the front surface of a cornea has no uniform curvature on all the extent. The most exact researches of this question were executed by A. Gullstrand (1909) who showed that the central optical area of a cornea is almost spherical and has identical radius of curvature in different points; to the periphery the cornea is sharply flattened (radiuses of curvature in process of removal from an optical zone gradually increase); this flattening in a nasal half is expressed more sharply, than in temporal, and in an upper half is sharper, than in lower. The form of curvature of surfaces of a crystalline lens is less available to studying. Researches showed that both surfaces of a crystalline lens also have the greatest curvature in the central area and are gradually flattened to the periphery. Feature of optical system of an eye is big inhomogeneity of substance of a crystalline lens. The crystalline lens represents lentil with variable index of refraction. In front back, from an outside part of a cortical layer towards the center, the index of refraction gradually increases, and then again decreases in the direction to back cortical layers.

A. Gullstrand offered the simplified schematic eye which gives the chance rather just to make calculations connected with light refraction in an eye.

The simplified schematic eye and. Gullstranda


Big variability of elements of the optical apparatus of an eye leads to the fact that calculations made on schematic G. can give only the general approximate idea on the studied question. E. Zh. The throne (1953) offered the additional formulas for similar calculations considering variability of elements of the optical apparatus and allowing to obtain more exact data.

Even more simplified system, than schematic G. suitable for some calculations on fiziol, optics, are represented by the so-called reduced G., in Krom all refracting device is replaced with one refracting surface. The most perfect is «the reduced eye» of V. K. Verbitsky (1928).

CONSTANTS OF «THE REDUCED EYE» OF VERBITSKY

The refracting force in dptr, or a refraction 58,82

Index of refraction of a vitreous 1,4

Radius of curvature of a cornea in mm 6,8

Radius of curvature of a surface of a retina in mm 10,2

Length of an eye mm 23,4

Upon transition of rays of light from one environment in another is observed their refraction. Degree of a deviation of a beam depends both on a difference in indices of refraction of Wednesdays, and on a form of a boundary surface. If the boundary surface spherical, then light refraction of subjects is more, than the radius of curvature of a boundary surface, i.e. than more its curvature is less. In the complex optical systems which are consisting from two or more refracting environments, refraction of rays of light depends, besides, on distance between separate boundary surfaces.

In each complex optical system distinguish three couples of cardinal points: front and back focuses, main and nodal points. The beams falling on optical system parallel to an optical axis after refraction gather in back focus. Beams, coming from front focus, after refraction go parallel to an optical axis. The planes passing through the main points of optical system perpendicularly to its axis are designated as the main planes which are characterized by the fact that at the provision of an object in the first main plane in the second main plane the upright image equal by the sizes to an object turns out after refraction. Nodal points also are on an optical axis of system. These are the interfaced points for which the tilt angle of the beams going from an object, and the beams quitting the optical system remains identical. In modern optics nodal points considerably lost the value, and optical systems are characterized only by two couples of cardinal points. Counting of all distances in complex optical systems is made from the main points or the main planes. The distances which are laid off at the same time to the left are considered negative, and postponed to the right — positive. Otstoyany front focus from the front main plane makes front focal length of optical system; an otstoyaniye of back focus from the far main plane — back focal length of system. According to the dioptric calculation offered by A. Gullstrand, the refracting force of optical system is measured by size, inversely proportional to its back focal length. If through f1 to designate back focal length, then the refracting force in dioptries is defined by the following formula: number of dioptries = 1/f1 where f1 is designated in meters.

One dioptry is a refracting force of system with the set focal length in 1 m. The back focal length, the force more refracting is shorter.

The optical apparatus of eyes consists as if of two converging lenses — a cornea and a crystalline lens. If to designate the refracting force of a cornea the letter D1, and the refracting force of a crystalline lens — D2, then the refracting force of an eye (D1,2 — in dioptries) is defined by the following formula: D1,2 = D1 + D2 — σD1D2 where σ designates the distance between the far main plane of a cornea and the front main plane of a crystalline lens (in meters) reduced to air, i.e. divided into index of refraction of a vitreous.

At calculation in dioptries of D designates not only the refracting force of optical system, but also and an otstoyaniye of an object and the image. If and designates an otstoyaniye of an object from the front main plane and b — otstoyany images from the far main plane (in meters), then dependence of provision of the image on the provision of an object and the refracting force of system is defined by a formula: In = And + D), at the same time B and A are expressed in dioptries and are equal: In = 1/b and And = 1/a. In that case when an object or the image are located not in air, and in the environment with other index of refraction, the corresponding distance is reduced to air, i.e. is divided into index of refraction of this environment. So, at refraction in optical system of an eye of b n/b where p — index of refraction of a vitreous lies in a vitreous and therefore In =.

Increase in optical system is expressed by a formula: α/β = B/A, or α*А = β*B, where α — the size of an object and β — the size of the image.

Diopter calculation of A. Gullstrand considerably simplifies the calculations connected with light refraction.

The optical system G. has a number of the imperfections affecting quality of the images received on a retina (see. Aberration of an eye ). Treat them: lack of a tsentrirovka, discrepancy of the visual line with an optical axis G., deviations from sphericity in curvature of surfaces of the refracting environments, spherical and chromatic aberration.

In the centered optical system the center of curvature of all refracting surfaces shall lie on one straight line, edges is called an optical axis of system. The optical system G. is not centered. The perpendicular which is carried out to a front surface of a cornea and passing through the center of a pupil is considered an optical axis of an eye. But the optical axis of a crystalline lens (i.e. the line, on a cut the centers of curvature of front and back surfaces of a crystalline lens lie) does not match an optical axis of an eye, and forms with it a corner in 2 — 3 °.

Visual line (see) passes from the middle of the central pole of a retina through a nodal point of an eye (at the same time it is assumed that both angular points of G. lying close from each other match). The visual line does not match an optical axis of an eye, and makes with it a small corner, approximately in 5 °. Discrepancy of the visual line with an optical axis of an eye leads to the fact that the beams entering optical system of an eye go not parallel to an optical axis G., and at an angle to it. The last leads to the distortion of the refracted beam of light designated as an astigmatism of slanting bunches (see. Astigmatism of an eye ). In a nek-swarm of degree emergence of an astigmatism of slanting bunches is promoted also by lack of a strict tsentrirovka of optical system of an eye.

Parallel beams after refraction in optical system gather in back focus only if they make very narrow bunch going close from an optical axis. If the optical system is entered by wider bunch of parallel beams, then it is noted spherical aberration (see).

At spherical aberration separate groups of beams are crossed at various distance depending on at what distance from an optical axis they enter optical system. The aniseikonia also belongs to optical imperfections of G., at a cut the sizes of images received in both G. from the same object are various. Partially it is caused by a difference in the refracting force of the optical apparatus of both G. (see. Aniseikonia , Refraction of an eye ).

Methods of a research

by the Leading methods of a research in diagnosis of a disease of F. and its auxiliary device are survey at simple or focal lighting, sometimes with use of a binocular magnifying glass, and also an oftalmoskopiya.

Usually survey is begun for about a century. Then examine a conjunctiva a century and an eyeglobe. At day lighting it is possible to find only the expressed changes of front department of an eye (a cornea, an anterior chamber, an iris of the eye and front departments of a crystalline lens). Thinner changes of front department are usually visible in the dark room, at the same time use a method of side or focal lighting. For detailed studying of structures of an eye and establishment of the place and extent of defeat use a method biomicroscopy of an eye (see).

An important method is definition visual acuities (see) or visual disturbances. Peripheral sight decides on the help of perimeter (see. Perimetry ) or a kampimetra (see. Kampimetriya ). Also loss in fields of vision is established by these devices (see. Skotometriya ). At people of some professions (drivers of trains, pilots, drivers, etc.) it is surely investigated color sight (see) by means of special tables. G.'s ability to perceive light and to distinguish various degrees of its brightness is called photoperception (see) and to adapt to various brightness of lighting — adaptation. Adaptation is studied by special devices — adaptometers (see. visual adaptation ).

The condition of a corneal and iridescent corner and front outflow tracts of intraocular liquid define by gonioskop (see. Gonioskopiya ). Studying of reaction of pupils to light has great diagnostic value. Its expressiveness is fixed by means of various devices (see. Pupillografiya , Pupillometriya ). Apply to studying of disturbances of the movement of outside muscles of an eye elektrookulografiya (see).

At an oftalmoskopiya study an eyeground, i.e. a retina, a choroid, an optic disk, a macula lutea (see. Oftalmoskopiya ). For more exact definition of nature of pathology of an eyeground at an oftalmoskopiya various filters (oftalmokhromoskopiya) use. Oftalmoskopiya allows to reveal generally organic changes of internal covers of an eye. Functional disturbances of vascular system of internal covers of an eye are defined with the help oftalmopletizmografiya (see), oftalmodinamometriya (see), reooftalmografiya (see). The intraocular hydrodynamics is studied with the help tonometriya (see), topography (see) and elektrotonografiya. These methods have the greatest value at diagnosis and treatment glaucomas (see). Great diagnostic and predictive value has definition of a functional condition of a retina. Apply to studying of its bioelectric activity elektroretinografiya (see). At various patol, conditions of an orbit use ekzoftalmometriya (see), orbitotonometriya (see), X-ray analysis, X-ray tomography, angiography.

From 50th years 20 century for measurement of parameters of an eye and a crystalline lens the ultrasonic biometrics is used. For identification of amotio of a retina and intraocular tumors at muddy environments of an eye the ultrasonic ekhografiya was widely adopted (see. Ultrasonic diagnosis ). Establishment of an exact cause of illness of eyes requires carrying out a number of clinical laboratory researches depending on an estimated disease (see. Inspection of the patient , in ophthalmology).

Radioisotopes widely use as for differential diagnosis of malignant tumors of an eye and its adnexal device, and for studying of exchange processes, haemo - and hydrodynamics engineers and distributions of medicines in an eye. Most often as a radioactive label apply isotopes 35 S, 14 With, other isotopes which are a part of marked connections are more rare. In an oftalmoonkologiya the greatest distribution was gained by radioisotope of phosphorus 32 P, to a lesser extent — isotopes of iodine 131 I, 132 I.

Radioactive phosphorus 32 P is entered inside or intravenously in the form of disubstituted sodium phosphate 32 Na 2 HPO 4 at the rate of 1 — 2 mkkyur on 1 kg of the weight investigated. Radiometry (see) it is made in the contact way by means of the gas-discharge or scintillation counter in 24, 48, 72 hours after administration of drug, and if necessary and on 4 — the 7th days.

Fig. 7. The curved radiometric gas-discharge SBM-12 counter for a research of an eye.

For a research G. the most convenient is the SBM-12 counter (fig. 7). For registration of beta radiations the counter is connected to the radiometer («Comet», the Yew B-2 installation, etc.). Radioactivity measurement over patol, focus is made within 1 — 2 min. not less than 3 — 4 times after preliminary instillyatsionny anesthesia of a conjunctival cavity. As the control site serves anatomically the identical site of other G., and at its absence — the healthy site of the same G.

Effektivnost of test remote from patol, focus substantially depends on strict observance of rules of the equipment dosimetry (see). It is necessary that a sensitive part of the counter did not exceed the area of the studied center. It is not recommended to conduct researches in the postoperative period, and also in the presence of inflammatory reaction of G. in order to avoid obtaining wrong data.

By the described technique it is possible to investigate tumors the century, epibulbarny and intraocular tumors located in front department of an eyeglobe (ahead of the equator). Before a research ophthalmologic inspection and a diafanoskopichesky research are performed (see. Diafanoskopiya ), the tumors allowing to specify localization. It is necessary to aim at that the place of application of the counter to a sclera was over a tumor. If the new growth is located in back department of an eyeglobe, transconjunctival approach is required (the counter is entered through a section in a conjunctiva on the necessary depth to the place of a projection of a tumor on a sclera). The research is made in 48 or 72 hours after reception 32 P. Results of radio indication are estimated taking into account as level, dynamics of accumulation 32 P.

According to most of researchers, test is considered characteristic of malignant process if the relative gain of speed of the account is higher than 45% in all days of a research.

The method of radio indication is a valuable additional method in a complex research of the patient with suspicion of a tumor of an eye.

Pathology

Defeat of an eyeglobe, its auxiliary device [[ [EYELIDS | century ]] (see), conjunctivas (see)], corneas (see), scleras (see), crystalline lens (see), vitreous (see), retinas (see), optic nerve (see) and eye-sockets (see) can be primary or secondary.

Often G.'s defeat is caused by any disease of internals or systems, being only one of symptoms of the general suffering. Changes from G. are observed at defeats of the central and peripheral nervous system, primary and secondary diseases of vascular system; infectious diseases, intoxications, the broken exchange, innidiation of tumors, parasitic diseases; patol, condition of hemadens; distribution patol, process from the neighboring areas (at diseases of integuments and face bones and the heads, adnexal bosoms of a nose — per continuitatem).

Malformations

Malformations of G. arise as as a result of a delay of a bookmark and formation of various structures at early stages of the embryonal period, and owing to incomplete involution of elements of the germinal fabrics which are subject in normal conditions of an embryogenesis to disappearance or modification. Impacts of mechanical, chemical and infectious factors on a germ, especially in the first three months of an antenatal life most often occur among the reasons of defects; the possibility of malformations, napr, a century, a crystalline lens, a vitreous, a fruit of 4 — 6 months is not excluded.

From malformations of all eyeglobe most often meets mikroftalm (reduction of all its sizes), it is rare — lack of an eye (see. Anophthalmus ). Mikroftalm is quite often combined with the inborn serous cyst which is located usually in a lower eyelid is more rare at the bottom of a conjunctival cavity. Such cysts arise from germinal G.'s elements at untimely closing of a germinal crack. The combination of a mikroftalm to an underdevelopment and a palpebral fissure — the phenomenon of a cryptophthalmia is possible a century.

From malformations the century most often meets ptosis (see) — omission, low-mobility or an immovability of an upper eyelid. Are observed also colobomas (see) — defects of a century triangular or a squared shape. Is available less often epikantus (see) — the fold of skin in the form of a semilunum in internal corners a century going vertically and also torsion and an ectropion a century (see. Torsion of a century , Ectropion of a century ). Sometimes ankyloblepharon, i.e. an union among themselves and with an eyeglobe is found a century (see. Ankyloblepharon ). These defects can be one - and bilateral.

Rather often malformations of a crystalline lens in the form of its polymorphic opacifications — inborn meet cataracts (see). The remains of the vessels feeding an embryonal crystalline lens and a vitreous are quite often observed; they remain after the birth of the child and are shown in the form of a pupillary film (membrana pupillaris perseverans) or the thin, but well seen at a research G. by the ophtalmoscope tyazhik going from an optic disk to a back pole of the lens — the rest of an embryonal artery of a vitreous (a. hyaloidea persistens). Its incomplete dislocation (dislocation), and also sfero-and a mikrofakiya of a crystalline lens as an independent disease or as a symptom of diseases of Marfan or Markezani, besides, occurs among congenital anomalies of a crystalline lens (see. Marfana syndrome , Markezani syndrome ).

Refer changes of a crystalline lens in the form of a front or back lenticonus, and also a coloboma to anomalies of development of G. The front lenticonus — protrusion of a front pole of the lens forward, is formed, apparently, as a result of its abnormal otshnurovyvaniye from an outside ectoderm. The back lenticonus is connected with protrusion of a back pole probably as a result of traction of the spliced crystalline lens with a vitreous or an embryonal vessel. Cases and inborn are known aphakias (see).

Inborn defects of a cornea are characterized most often by increase (macrocornea) or reduction (microcornea) of its sizes, and also different types of inborn opacifications. The ring-shaped opacification which is located along all limb carries the name of embryotoxon. Rough and extensive inborn cataracts of a cornea arise, apparently, as a result of postponed in uterine life patol, process.

Inborn defects of G. are quite often caused by a delay of involution of a secondary germinal crack. At anomalies according to localization of an embryonal germinal crack the defects of an iris of the eye (inborn colobomas of an iris) which are quite often combined with the same localization by colobomas of a ciliary body and an idiovascular cover located below pupillary edge meet. Colobomas of a retina and an optic nerve are possible.

Treat malformations of a choroid a horioideremiya — an underdevelopment of a choroid; in connection with this pathology also the retina sharply suffers. Also changes of a pupil can be considered as peculiar anomalies of a vascular path. So, chances of a polycoria (it is a lot of pupils), and also korektopiya (change of localization). The heaviest malformation of a vascular path is lack of an iris of the eye — aniridiya (see) and the rough anomaly of a raduzhko-corneal corner (a corner of an anterior chamber) connected with it which is quite often leading to glaucoma.

Some changes of an eyeground also belong to inborn malformations of G. In addition to noted coloboma of a horioidea and a retina, colobomas of a macula lutea, and also a number of inborn defects of a structure of an optic disk belong here (a coloboma of a disk, an inborn cone, druses of a disk and a retina, myelin fibers, an aplasia, etc.). Quite often various anomalies of an arrangement, form and development of vessels of a retina can come to light. Among congenital anomaly color-blindness — an achromasia and a dichromasia can take place (see. Color sight ). Pigmental dystrophy of a retina (a pigmental retinitis) and the central tapetoretinalny defeats of a macula lutea are observed as at children in the earliest childhood (infantile dystrophy of Best), and at teenagers (a juvenile form of dystrophy of Shtargardt) and adults (macular dystrophy of Bør). In some cases pigmental dystrophy of a retina is observed at various congenital anomalies: Laurence's syndrome — Muna — Grain stillage — Bidlya (see. Laurence — Muna — Bidlya a syndrome ), an amaurotic idiocy Teja — the Saxophone (see. Amaurotic idiocy ), etc. At members of one family family amaurotic dystrophy of Leber is observed, at a cut dystrophic changes of a mesh cover are combined with atrophic changes of an optic nerve (see. Retina ). Considerable part ametropias (see) or anomalies of a refraction, including and some types short-sightedness (see), has heredo-familial character.

It is necessary to refer also diverse inborn changes from the lacrimal device to number of anomalies of development (lack of the lacrimal gland, hypo - and an alakrimiya, the wrong provision of the lacrimal openings, an obliteration of the lacrimal openings and the lacrimal tubules, diverticulums of a dacryocyst, lack of a nasal duct) and the oculomotor device [inborn squint (see), restriction of mobility of eyes, nystagmus (see), etc.]. Some of these anomalies of the oculomotor device are caused by pathology of development of cranial nerves and a sympathetic innervation.

Damages

Fig. 5. The getting wound of an eyeglobe takes all cornea and partially a sclera.
Fig. 6. Burn of an eye alkali (hydrated lime).

Depending on the operating factor of an injury of G. are divided into mechanical (wounds), chemical, thermal and beam; on localization and character are subdivided into the damages of the auxiliary device of an eye which are not getting and the getting wounds of an eyeglobe, a contusion and burns of an organ of sight (tsvetn. fig. 5 and 6); are divided by severity on easy, moderately severe and heavy. At slight injuries there is no decrease in sight. At moderately severe injuries moderate decrease in sight is observed and there is an insignificant cosmetic defect. Severe injuries are followed by full or considerable permanent decrease in sight.

Damages of the auxiliary device of an eye. Wounds can be combined a century with damages of an eyeglobe, surrounding soft tissues and bones of an eye-socket and person. The habit view of a wound of a century, its character and the sizes quite often do not correspond to weight of damage. Sometimes careful audit of a wound allows to establish the true nature of defeat. Especially carefully it is necessary to inspect a condition of an eyeglobe, its function, degree of transparency of environments G. and an eyeground. Existence of hypodermic emphysema demonstrates disturbances of an integrity of bones of a nose and okolonosovy bosoms (adnexal bosoms of a nose). The small superficial horizontally located wounds of a century do not demand surgical intervention. Vertically located wounds, as a rule, gape as a result of a cross section of muscle fibers. In these cases surgical treatment is required. If processing was not made timely, then it can be executed even in several days after wound in the absence of symptoms of suppuration. In view of good blood supply of a century there is engraftment even few fabrics viable at first sight.

Fig. 8. The scheme of suture at a perforating wound of a century: 1 — threads are stretched through a conjunctiva and a cartilage of a century; 2 — noose sutures on skin and intermarginalny space of a century are put.
Fig. 9. The scheme of suture on area of a wound of the lower lacrimal tubule: 1 — introduction of the probe of the Pole to the broken-off tubule; 2 — stitches on edges of a wound are put, the probe is strengthened on skin of a century by an adhesive plaster.

At through wounds a century the two-row stitch is surely put. The first row — a conjunctiva and a cartilage, the second — skin of a century (fig. 8). At a separation of a century from a lateral or medial corner it is necessary to hem it (for a cartilage) respectively to lateral or medial commissure and only then to put stitches on skin and a conjunctiva.

Wounds of the lacrimal tubules, a dacryocyst, a nasal duct, the lacrimal gland are, as a rule, combined with wounds of surrounding fabrics. The rupture of an upper lacrimal tubule of special events for recovery of its function does not demand in view of its small role in a slezootvedeniya. At a rupture of the lower lacrimal tubule it is sewed on the special probe of the Pole (fig. 9) which is previously entered into a tubule. The probe is left in a tubule on 5 — 6 days.

Not getting wounds of an eyeglobe. At an erosion and scratches of a cornea are observed dacryagogue and nictitating spasm (see). At an instillation in a conjunctival sac of 1% of solution of a flyuorestsein the place of disturbance of an integrity of an epithelium is painted in bright orange color. Appoint eye disinfecting drops (0,25% solution of synthomycin, 30% solution of Sulfacylum-natrium, etc.), for eyelids put eye disinfecting ointments (1% an emulsion of levomycetinum, 20 — 30% a sulfacetamide - sodium ointment).

Foreign bodys of a cornea can be various character (see. Foreign bodys , eyes). On depth of implementation they are subdivided on superficial and deep. Superficial easily are removed after anesthesia of a cornea of 0,25 — 0,5% solution of Dicainum by means of hardly curtailed piece of cotton wool or a special lanceolated needle. At implementation of a foreign body in deep layers of a cornea or at a vystoyaniya of one end in an anterior chamber of G. it should be taken only in the conditions of an eye hospital. Removal of such foreign body appears quite often complex challenge in view of danger of its moving to an anterior chamber.

Small wounds of a conjunctiva, sclera do not demand special processing. At more extensive wounds of a conjunctiva suture is shown. At suspicion of a perforation of a sclera audit of a wound is necessary.

The getting wounds of an eyeglobe have direct and indirect signs. Treat straight lines: a perforating wound in a cornea or a sclera, loss of an iris, existence in it of an opening, loss of a ciliary body, vitreous, detection of a foreign body in an eye. Treat indirect signs: small or abnormally deep anterior chamber of an eye, an anguish of pupillary edge of an iris, a segmented phacoscotasmus, the expressed hypotonia

to G. Kroma of penetration of an infection in G. at the getting wounds quite often are observed loss of covers and its contents, hemorrhage in G., implementation of foreign bodys in his cavity. Disturbance owing to wound of an integrity of the outside capsule G. (tightness) leads to G.'s hypotonia, change of exchange of intraocular liquids and to frustration of a trophicity of fabrics.

The ambulatory care the patient with suspicion of the getting wound of an eye consists in survey of an eye (better after instillation in a conjunctival sac of 0,25 — 0,5% of solution of Dicainum or 2 — 3% of solution of cocaine). After survey dig in 30% solution of a sulfacetamide of sodium, 0,25% solution of synthomycin. For prevention of a possible infection immediately begin to enter intramusculary antibiotics of a broad spectrum of activity. After imposing of a sterile binocular bandage of the patient it has to be urgently sent to a hospital. The main objectives during the rendering the specialized help to such patients are the fastest sealing of a wound of an eye and prevention of an infection.

Linear small (usually to 3 mm) the getting wound of a cornea or sclera with well adapted edges without infringement or loss of internal covers does not demand surgical treatment.

The gaping wound of a cornea, corneal and scleral area or a sclera (tsvetn. fig. 5) demands surgical treatment — sealing of a wound by imposing of corneal or scleral seams.

Processing of the getting wounds of an eyeglobe shall be carried out at good anesthesia and an immobilization of. In most cases it can be seen off under local anesthesia. However at children and irritable patients it is better to carry out operation under the general anesthesia. As a suture material apply silk, capron, a female hair, supramidny threads.

At loss in a wound of internal covers (an iris, a ciliary body, a choroid) they are set or deleted. It is necessary to watch that in a wound were not restrained the remains of covers carefully. At damage of a crystalline lens only the lenticular masses which dropped out in a wound is removed. At loss of a vitreous it or is set (impose approximately for several minutes a lump of the sterile cotton wool moistened 0,9% with solution of sodium chloride t ° 4 °) or exsected. At big losses of a vitreous it is necessary to make change of a cadaveric tinned vitreous. At the getting wound of a sclera of a kzada from the gear line of an eye the choroid and a retina are damaged. Sometimes at the same time * despite the correct surgical treatment of an eye, amotio of a retina develops (see).

After processing of the getting wound of an eyeglobe the binocular bandage is applied and the bed rest is appointed to 5 — 7 days.

At perforating wounds of an eyeglobe process both entrance, and output openings (if they are more than 3 — 4 mm). However processing of outlet opening, a cut it is, as a rule, located in a sclera far from a limb, it is not always possible. Sometimes for these purposes it is necessary to cross one or several direct muscles of an eye. Despite correctly carried out processing, at big wounds of an eyeglobe it is not always possible to save it — G.'s hypotonia develops, iridocyclitis (see) and fading of visual functions. In such cases, considering possible danger of a sympathetic ophthalmia (see), G. should remove and replace artificial (see. Prosthesis eye ).

Contusions of an eyeglobe. Distinguish direct and indirect, and on weight — easy, moderately severe and heavy. The changes of an eye caused by a contusion are very various. Horn and iridescent covers, a crystalline lens, internal covers of an eyeglobe are damaged, quite often there is hemorrhage in an anterior chamber (see. Hyphema ), a vitreous (see. Hemophthalmia ). At very strong prelum of an eye there can be a rupture of a sclera (more often subconjunctival). The contusion of a cornea is shown by opacifications of its various layers, hypostasis, ruptures of an endothelium and a back boundary plate, treatment by blood, etc. At a contusion of an iris are observed traumatic miosis (see) or, on the contrary mydriasis (see) owing to ruptures of a sphincter, partial (iridodialysis) or full (aniridiya) a separation of its root, hemorrhage in an anterior chamber. Contusions of a ciliary body are followed by severe pains, a pericorneal injection. Quite often develops iridocyclitis (see). At a contusion of an eyeglobe there can be dislocation or an incomplete dislocation of a crystalline lens and a cataract owing to disturbance of an integrity of the capsule (see. Cataract ). Dislocation or an incomplete dislocation of a crystalline lens can be followed by increase in intraocular pressure. The so-called ring of Fossius — adjournment of a brown pigment from pupillary edge of an iris on the front capsule of a crystalline lens is characteristic of contusional damages of a crystalline lens. At a contusion of an eyeglobe there can be ruptures of a choroid, concussion of a retina — so-called berlinovsky opacification, preretinalny, retinal and subretinal hemorrhages, ruptures of a retina to its amotio, gaps and separations of an optic nerve. At an indirect heavy contusion of an eyeglobe dislocation and a separation of an eyeglobe (avulsio bulbi oculi) are very seldom observed. At easy degree of a contusion treatment conservative. In case of hemorrhages in G.'s cavity appoint iodide drugs, fabric therapy, a lidaza. Patients with average and heavy degree shall be sent to a hospital. Surgical treatment is shown at the subconjunctival ruptures and dislocations of a crystalline lens breaking hydrodynamics of an eye.

Burns of an eyeglobe and its auxiliary device in the conditions of peace time make 8 — 10% of all damages of an organ of sight. On degree (depth of damage) and weight they are divided into lungs (the I degree), moderately severe (the II degree), heavy (the III degree) and especially heavy (the IV degree); for the reason — on thermal, chemical and thermochemical. In separate group allocate defeats of an organ of sight with a radiant energy.

Thermal burns and an eyeglobe are a century a consequence of effect of steam, hot liquid, a flame, the heated particles of metal, etc. In the conditions of peace time such burns meet more often on productions where there is hot working of metal, etc.

Corrosive burns are caused by various chemical substances. Weight of defeat is defined by character of substance, its concentration and duration of impact on fabrics. Such burns meet both on production, and in life.

Burns alkalis (caustic potassium and sodium, ammonia, lime, spirit of ammonia, etc.) and acids are most frequent (sulfuric, salt, etc.) «It should be noted that burns alkalis proceed heavier, than burns acids. At burns coagulation of proteins (coagulating) happens acids that interferes with deep penetration of substance into fabrics. Alkalis quickly get through a cornea into an anterior chamber, and their damaging action continues within several days therefore happens that in the beginning the burn can seem to lungs, and through a nek-swarm time defeat gets a heavy current.

The burn of the I degree is characterized by a dermahemia and conjunctivas a century, an eyeglobe, defeat of an epithelial layer of a cornea (gentle opacification, sometimes an erosion). This degree of a burn irrespective of its extent is considered easy. Such burns usually do not leave any effects. In case of accession of an infection can develop conjunctivitis (see) and superficial keratitis (see).

At a burn of the II degree, in addition to a dermahemia a century and conjunctivas, bubbles on skin a century and a chemosis appear. The cornea becomes grayish and muddy, 1% is strongly painted by solution of a flyuorestsein (defeat of surface layers of a stroma). Burns of the II degree irrespective of extent are considered moderately severe. After such burns there can be little cicatricial changes of skin a century and superficial opacifications of a cornea. If the infection joins, then effects are heavier.

Burns of the III degree are characterized by a necrosis of skin a century and all thickness of a conjunctiva, a necrosis, infiltration and hypostasis of surface layers of a cornea and its own fabric (the cornea takes a form of ground glass). These burns are considered heavy irrespective of their extent. At out of time begun treatment such burns are resulted sometimes by an union a century among themselves and with an eyeglobe, change of a form a century. The infection worsens the course of process. Usually after such burns it is formed cataract (see).

At a burn of the IV degree the necrosis or a carbonization of all thickness a century, a necrosis of a conjunctiva and the subject sclera, defeat of all layers of a cornea are observed (the cornea gains porcelain-white color). Such condition of a cornea often happens at the accompanying deep burn of area of a limb. Especially heavy burns quite often come to an end in death of an eye if the infection joins.

At easy, superficial corrosive burns the conjunctiva becomes covered by whitish, grayish-yellow films which in several days are torn away. The sensitivity of a conjunctiva (lowered at a burn) is recovered and there occurs regeneration of an epithelium on affected areas. At the heavy burns which are followed by a necrosis of fabric of a conjunctiva hems are formed, there can be an union a century among themselves and with an eyeglobe. Burns of area of a limb proceed especially hard since the limbalny network of the vessels feeding a cornea is damaged.

At a superficial burn of a cornea its epithelial cover is surprised, the trophicity is broken, sensitivity goes down, the epithelium is exfoliated, the surface of a cornea becomes erozirovanny. At deeper burn in corneal fabric there occur necrotic changes (tsvetn. fig. 6) with the subsequent formation of hems. In hard cases fusion of a cornea is observed. The chemical reagent getting in an eyeglobe causes inflammatory process of a choroid with development of the complicated cataract (see) and secondary glaucomas (see). At accession of a purulent infection can develop entophthalmia (see) and panophthalmia (see).

First aid at burns is of exclusively great importance. The further course of process depends on it to a certain extent.

At thermal burns affected areas of skin should be oiled a century sterile liquid, fish oil and to dig in these substances in a conjunctival sac. It is possible to use for these purposes and ointment (sulfatsilovy, penicillinic, tetracycline, sintomitsinovy, etc.). If the particle of the heated metal got into a conjunctival sac, it should be removed.

At chemical, thermochemical burns it is necessary to wash out as soon as possible G. a water jet (better than room temperature). For this purpose it is possible to use a special undinka, a rubber pear or the cotton wool moistened in water, to-ruyu squeeze out over G., irrigating the burned surface. Carefully to wash out G., it is necessary to twist eyelids. Solid particles of chemical substance need to be removed immediately from a conjunctival sac with wet tampons, tweezers, previously having entered the anesthetizing solution (0,5% of solution of Dicainum). After washing and removal of foreign bodys in a conjunctival sac dig in 10 — 30% solution of Sulfacylum-natrium, 0,25% solution of synthomycin and for eyelids put one of the specified ointments or dig in a thin liquid paraffin, fish oil.

At burns II, III and IV degrees for the warning of an infection to the patient it is necessary to enter antitetanic serum and antibiotics. Patients with such burns should be sent to an eye hospital.

At sharply expressed chemosis of a sclera which is observed often after a chemical burn in early terms it is recommended to make a sector konjyunktivotomiya. This operation can be executed also in out-patient conditions. Thanks to cuts from under a conjunctiva toxic transudate follows, ischemic sites of a conjunctiva become hyperemic.

At heavy burns of the eyes which are followed by a deep necrosis of fabric of a conjunctiva and a cornea on a considerable surface it is necessary to make urgently operation of change of the mucous membrane taken from a lip of the patient, or a rag of the cadaveric conjunctiva preserved within 1 — 4 days at t ° 2 — 4 °.

This operation yields a positive take if it is made no later than 1 — 1,5 days after a burn.

In respect of complex treatment of burns it is necessary to appoint vitamins widely (And, B1, B2, C), intravenous injections of 40% of solution of glucose. Further it is necessary to recommend fabric and medicamentous therapy to promote a rassasyvaniye of inflammatory infiltrates, opacifications of a cornea and the prevention of formation of rough hems. At burns of eyes in the subsequent unions between the eyeglobe and a century (symblepharon) demanding, as a rule, surgical treatment can be formed.

At impossibility of the immediate direction of the patient in a hospital treatment should be begun on an outpatient basis. It is possible to irrigate a cornea with a defibrinated blood burned, at the same time carry out introduction under a conjunctiva of blood of the patient around a limb together with solution of penicillin. Blood for injections is taken from a vein and entered in number of 0,15 ml, adding to it 1 ml of the solution containing 25 000 PIECES of benzylpenicillin of sodium salt. Injections do daily or every other day depending on weight of process (only 6 — 7 times). Introduction under a conjunctiva of a sclera of oxygen and irrigation of eyes of 40% by solution of glucose, intravenous administrations of 40% of solution of glucose is shown. For strengthening of assimilation by fabrics of glucose it is offered to enter subcutaneously insulin.

Prevention of damages of G. is of great importance. In the USSR the system of prevention of damages of G. to the industry, agriculture, sport, life is developed. Are provided in this system both public, and individual (see. Points , protective) actions for protection of an eye (see. Traumatism , prevention).

Fighting injuries of eyes can be put to fire, cold, nuclear, chemical (OV), laser and bacterial. weapon, and also incendiary means and aggressive components of rocket fuel.

For the first time the scientific description of these injuries in domestic literature is given by N. I. Pirogov in 1863 — 1864. Before World War I among damages bullet wounds prevailed. Improvement of firearms led to increase in quantity of missile wounds of eyes in World War II. The modern weapons of mass destruction cause new g earlier not being found damages.

There is no standard uniform classification of fighting damages. The most detailed is the klassifi-nation B. The Pole (1972), in a cut are reflected: type of damage (wound, contusion, burn, etc.); character of weapon (cold weapon, bullets, splinters, nuclear, chemical, etc.); prevalence (mono - or binocular damage), isolated or combined; combined with different types and weight of damage. On kliniko-anatomic signs fighting damages divide into the wounds of the auxiliary device G. which are not getting and getting and also through wounds of an eyeglobe; destructions of an eye, contusion century and eyeglobe; burns of outside departments of an eyeglobe or its auxiliary device; burns of an eyeground; injuries of an eye-socket. Wound of any localization can be followed by implementation of foreign bodys (see. Foreign bodys, eyes).

Perforated wounds and contusions divide depending on existence or absence of hemorrhages in a cavity of an eye, loss in a wound of internal covers or a vitreous and a traumatic cataract.

For carrying out evakuatsionnotransportny sorting, especially at the advanced stages of the medical help and it is preferential at mass a dignity. losses, the simplified classification of damages with their division on easy, moderately severe and heavy is necessary.

Carry to small damages: burn century and eyeglobe of the I degree; not through wounds of a century; superficial foreign bodys of a conjunctiva and cornea; unsharply expressed conjunctivitis after influence of OV or a penetrating radiation; a miotic form of defeats by organophosphorous OV, temporary dazzle for a period of up to 5 min.

Moderately severe damages: a burn a century and an eyeglobe of the II degree, a gap or a partial separation of a century without big defect of fabric; not perforated wound of an eyeglobe; defeat of OV with the phenomena of the expressed conjunctivitis and insignificant opacification of a cornea; temporary dazzle for the term of 5 — 10 min.

Heavy injuries of eyes: widespread burn century and conjunctivas of III and IV degrees; a burn of an eyeglobe with considerable opacification of a cornea or with damage of a retina, perforated wound of an eyeglobe; wound of an eye-socket with injury of bones or with an exophthalmos; contusion of an eye with decrease in visual acuity, wound a century with a major defect of fabric, severe defeats of a cornea OV and a penetrating radiation.

Fighting injuries of eyes seldom happen isolated. Often they are combined with damages of maxillofacial area and other parts of the head. Almost in 33% of all cases at the getting wounds of eyes in them there were foreign bodys. In 77,5% of cases of wound of eyes were melkooskolochny with a size of wound up to 5 mm. At wounds more than 15 mm come final fracture of an eyeglobe.

In World War II to 26% of all splinters were non-magnetic or poorly magnetic that worsened outcomes of wounds of G. since excluded a possibility of extraction of foreign bodys by the least traumatic method by means of magnets. At explosions of nuclear charges the frequency of nonmetallic splinters (a stone, glass, concrete) will increase, and modern elements of bombs — plastic balls even more will complicate the nature of rendering the specialized help.

G.'s contusions are caused by direct action on it a blast wave or blow by blunt objects (secondary splinters, butts of weapon, etc.), and also as a result of concussion of fabrics G. at damage of fabrics of the neighboring areas of the head by bullets and splinters.

Fig. 10. A human face with effects of a burn napalm.

Burns of eyes are often combined with burns on the face (fig. 10), necks, extremities. At nuclear explosions the frequency of thermal burns on the face, a century and an eyeglobe considerably will increase and they will have character «profile» (defeat only of the party turned to nuclear explosion). Burns quite often will be combined.

Especially heavy are burns of eyes from incendiary mixes like napalm. On the mechanism of action they are thermochemical and differ in extensiveness and depth of defeat, causing destruction a century and covers of an eyeglobe.

Ionizing (gamma-rays, neutrons and beta particles) also not ionizing radiation (ultraviolet, visible, infrared rays) are the reason of radiation damages of eyes at nuclear explosion. At impact approximately of ionizing radiation in a dose to 600 I am glad the beam cataract develops, and at higher doses radiation burns on the face, a century and an eyeglobe. At hit of radioactive materials in G. there can be inertly current blefarokonjyunktivit. G.'s damages by ionizing radiation are, as a rule, shown after the eclipse period measured in the days, and concerning a beam cataract — weeks and months.

At nuclear explosion not ionizing radiation causes a nuclear ophthalmia, edges is shown by the expressed photophobia several hours later after explosion; besides, these radiations can be the cause of local burns of an eyeground which are especially dangerous at defeat of area of a macula lutea. At night explosions, causing disadaptation to darkness, light radiation leads to temporary dazzle.

At an acute radial illness in G., as well as in other bodies, characteristic multiple hemorrhages in a conjunctiva, a vitreous and a retina are observed. Laser beams depending on the wavelength, character and power of radiation cause various reversible and irreversible changes in.

At influence of long infrared waves there are burns on the face, a century, conjunctivas and corneas, short infrared and visible beams cause local burns of a retina and a retinal apoplexy and a vitreous, ultraviolet rays — a picture of a laser ophthalmia, similar nuclear.

Toxic agents like yperite and a lewisite can be the cause of heavy chemical burns a century, conjunctivas, corneas and scleras. At hit of drops of a lewisite the first minutes there is severe pain, burning, hypostasis, hemorrhages, and then necroses of tissues of eye. Effect of liquid yperite is shown in several hours. Vapors of yperite and a lewisite cause easier damages. Organophosphorous OV (herd, sarin, etc.) even in weak concentration in inhaled air cause sharp narrowing of a pupil (miosis), and also a spasm of accommodation.

Aggressive propellants of rockets on the action are similar to drop and liquid OV, and their burn action comes at once.

Among complications of fighting injuries of eyes, according to M. Krasnov (1951), traumatic iridocyclites are on the first place (I eat.), the made 48,1% to number of all wounds, further a panophthalmia (see), an entophthalmia (see) — 10,1%, a corneal infection — ulcers and abscesses of a cornea — 5,5%. Secondary glaucoma, persistent dacryagogue, an union with an eyeglobe — symblepharon, traumatic amotio of a retina were less often observed a century.

The sympathetic inflammation in days of the Great Patriotic War was observed only in 0,048% of cases.

At damages of a facial nerve, and also at retraction a century after heavy burns on the face and a century development of a lagophthalmia (see) — a nesmykaniye of a palpebral fissure and drying of a cornea — with formation of heavy lagophtalmic helcomas is possible. Frequency of complications is in direct dependence on weight of damage, terms and quality of rendering the specialized help. In days of the Great Patriotic War early surgical treatment and suture on wounds a century, the lacrimal ways and an eyeglobe (in the first 2 days) prevented emergence of complications. However .iskhoda depended on character and weight of damage more often.

Diagnosis of damages depends on a fighting situation and a stage of medical aid. At the advanced stages simple survey is made by naked eye. Specialized hospitals apply all arsenal of inspection.

First aid is carried out by imposing of a bandage on wounded G. by means of a first-aid kit.

At mass burns on the face (and a century) at nuclear explosions and disturbance at victims of orientation owing to a nictitating spasm (see) and photophobia (see) it is necessary to organize not only export, but also a conclusion from the center of defeat. Therefore for acceleration of sorting at the advanced stages of evacuation it is reasonable not to put a bandage on a face. G.'s washing by water is made only at hit of drop and liquid O B or aggressive propellants of rockets.

The first medical assistance on PMP (and in the conditions of GO on OPM) comes down: to imposing of a bandage on the damaged G. (at through wounds and G.'s contusions with existence of decrease in sight the bandage is applied both G.); to administration of antitetanic serum and antibiotics; at defeat of FOV in both G. solution of homatropine or amizyl repeatedly dig in 1%. If the situation allows, then the doctor of PMP (OPM) according to indications can remove superficial foreign bodys of a cornea and a conjunctiva, to put 5% a sintomitsinovy emulsion for eyelids at thermal burns of G.; to plentifully wash out G. water or converters at chemical burns.

The qualified medical aid (in MSB or OMO, in the conditions of GO — country head hospital) is strictly limited. The main place is allocated to sorting struck and evacuations to destination here. If necessary the surgeon, except the actions listed for stage PMP, undertakes only some interventions: suture on a wound of a century if the free edge is not damaged; enucleation of an eye (see) according to urgent indications (the destruction of an eyeglobe which is followed by life-threatening bleeding from an eye-socket). All victims with heavy damages are subject to evacuation in specialized HPPG quickly. At moderately severe damages evacuation in specialized HPPG is made regularly. At small damages final medical aid can be rendered in MSB (OMO) or victims are sent to GLR. Special attention is paid on the fact that at perforated wound of G. or its contusion which is followed by decrease in sight, the bandage is applied for both. At the specified damages, and also at wounds of an eye-socket evacuation of wounded is carried out in a prone position, and from automobiles preference shall be given to aircraft.

Specialized ophthalmologic help is given only in specialized HPPG, and in the conditions of GO in country specialized hospitals. Enter urgent interventions: surgical treatment of perforating wounds of G.; operations at heavy burns of a cornea; imposing of guides and the protective isolating seams at separations of a century; removal of superficial foreign bodys of a cornea. At perforated wounds of an eyeglobe without defect of fabrics preference shall be given to a method of imposing of corneal and scleral seams, in case of defect of fabrics it is necessary to apply plastics on Kunta.

Extraction of intraocular foreign bodys can be postponed after rendering the acute surgical management to all victims for 3 — 4 days. Extraction of intraocular foreign bodys is made after their careful X-ray localization (see. Foreign bodys, radiodiagnosis), during operation use transillumination, and at an opportunity an ultrasonic ekhografiya (see. Ultrasonic diagnosis, in ophthalmology).

At heavy thermal and thermochemical burns of G. the layer-by-layer necretomy with early layer-by-layer corneal or corneal sclero-conjunctival plastics preserved gomotkanyam is made, and at their absence an autoplasty of a mucous membrane from lips. In cases of the expressed hemoz the sector konjyunktivotomiya is made.

At heavy chemical burns the paracentesis of an anterior chamber is made. Therapy of burns of G. shall be complex and include use of the antibiotics, the drugs constraining vascularization and accelerating epithelization at not heavy burns and, on the contrary, accelerating vascularization and constraining epithelization at heavy burns of eyes (N. A. Ushakov, 1972).

Diseases

Inflammatory processes of G. most often are caused by a pneumococcus, a streptococcus, staphylococcus, gonokokky, Koch's stick — Uiksa (see. Koch-Uixa bacterium ), Leffler's stick, Moraks's diplobacillus — Aksenfelda (see. Moraksa-Aksenfelda bacterium ), intestinal and hay bacterium, and also viruses (e.g., adenoviruses). A special role is played by a pneumococcus. It is the causative agent of acute conjunctivitis which sometimes has character of epidemics, especially among the children's population (see. Conjunctivitis ). Other typical display of a pneumococcal infection of G. is the creeping helcoma (see. Keratitis ). Very often the pneumococcus in itself or together with other microorganisms is the activator dacryocystitis (see), in this case especially high virulence of a pneumococcus is noted. In addition to the specified forms, the pneumococcus sometimes causes an iritis, an iridocyclitis, a panophthalmia, phlegmon of an eye-socket, a metastatic ophthalmia, pseudomembranous conjunctivitis, etc. The streptococcus quite often is the reason of pseudomembranous conjunctivitis; together with other activators it is found at dacryocystites, it serves as the reason of a phlegmonous form of this disease; at defeats of a cornea the streptococcus plays usually a role of consecutive infection and causes a heavy current of a keratitis; in rare instances it causes a creeping helcoma; it is found in pus at panophthalmias after perforated wounds of G.; it is the causative agent of phlegmon of an eye-socket and especially often metastatic ophthalmias.

Staphylococcus can cause a blepharitis, especially ulcer; together with other activators it is found at dacryocystites, an atypical purulent keratitis, postoperative infections; seldom it causes, acute conjunctivitis, pseudomembranous conjunctivitis. At the staphylococcal septicopyemias caused by hl. obr. Staphylococcus aureus, are noted severe forms of a metastatic ophthalmia in a look endo-and panophthalmias.

A specific role in G.'s pathology is played by Koch's stick — Uiksa, edges morphologically and is biologically close to a stick of an influenza (Haemophilus influenzae), as creates difficulties in differential diagnosis. Both of these sticks are sometimes on a healthy conjunctiva, and their carriers can be responsible for epidemic conjunctivitis, however usually the activator of these epidemics is Koch's stick — Uiksa that the hl is observed. obr. in spring and autumn months.

Diphtheritic stick (Cor. diphtheriae) is the causative agent of the hardest infections of G.; morphologically it is close to a xerotic stick. The damage to a conjunctiva caused by it meets hl. obr. at children's age. The disease of a conjunctiva can be the only display of diphtheria, in other cases diphtheritic conjunctivitis is accompanied by diphtheritic defeats of a nasal cavity, a pharynx and throat.

Moraks's diplobacillus — Aksenfelda is the reason of one of the most widespread infections of G. — hron, conjunctivitis with sharp erubescence in corners a century. In more exceptional cases this diplobacillus, striking a cornea, gives a picture of the deep ulcer reminding a creeping helcoma.

Fig. 11. A face of the patient with a malignant anthrax a century of the left eye (a stage of gangrenous disintegration of fabrics of a century).

About the causative agent of trachoma — see Trachoma. Anthracic bacillus (you. anthracis) can cause a complication in the form of an anthrax and gangrene of a century (fig. 11).

Among rare diseases in eye pathology it should be noted ophthalmomycoses (see). As the activator seldom meets a hay bacterium, edges the intestinal and pyocyanic stick can play a nek-ry role in postwound fevers, however the last gives the hardest complications leading often to death of an eye.

Fig. 12. An intraocular cysticercus in the field of a macula lutea (it is specified by an arrow).

Parasitic diseases of eyes result or direct implementation of a parasite, most often from helminth, in an eyeglobe or in its covers, or as a result of impact on G. of the toxins emitted by the parasite who is in other bodies and fabrics. Only the few from the helminths parasitizing in a human body can get in G. Naiboley often cysticercosis which results from development in G. of a cysticercus — a larval stage of a pork tapeworm is observed. In 40,5% of cases of cysticercosis of G. the bubble is located in a vitreous, in 32,7% — subretinalno, in 16,4% — subkonjyunktivalno, in 4,6% — in an anterior chamber, in 1,8% — in an eye-socket and 4,0% — in other places of. According to it the most struck fabric G. at cysticercosis are mesh and vascular covers. Despite preferential localization of a cysticercus in the most back departments of G., it is frequent in the field of a macula lutea (fig. 12), inflammatory changes always extend to an iris and a ciliary body. At long a prebyva of scientific research institute of a cysticercus in G. of the phenomenon iridocyclitis (see) symptoms of defeat of back department of are expressed even more sharply, than. Treatment of cysticercosis of G. only surgical. At a subretinal arrangement of a bubble removal is technically simpler than it and the effect is better, than in cases of its arrangement in a vitreous. However and in these cases operation is necessary since the intraocular cysticercus leads to heavy degenerative changes and death struck.

The echinococcal bubble has the big sizes and is located preferential in retrobulbar cellulose. Therefore the most characteristic symptom of echinococcosis of G. is inflammatory exophthalmos (see), degree of manifestation to-rogo depends on speed of development of an inflammation. Urgent surgical intervention is shown in all cases. The bubble should be deleted entirely since at its opening the streaming liquid can make toxic impact on Fabrics.

Fig. 13. A filaria of Loa-loa under a conjunctiva of an eye.

G.'s filariasis results from penetration under a conjunctiva (fig. 13) or, occasionally, in an eyeglobe of a roundworm — a filaria. At the same time are observed an incremental picture of conjunctivitis (see), and at an intraocular arrangement of a parasite also symptoms choroiditis (see). Long stay of a filaria in G. can lead to decrease in visual acuity.

G.'s trichinosis is characterized by an exophthalmos, a face edema, a unilateral ptosis, a diplopia, weakness of convergence, and also pains at the movements. There can be both an internal ophthalmoplegia and intraocular hemorrhages.

Cases of stay in G. and larvae of an ascarid are described. However the changes in G. caused by this helminth are connected not so much with presence of a parasite how many with influence of its toxins. At an ascaridosis retinal hemorrhages, visual and oculomotor disturbances are observed. Toxic impact on G. is made also by some other parasites. So, the ankylostoma causes intraocular hemorrhages; oksiura provoke a rash of fliktenopodobny small knots on a conjunctiva. In these cases all eye symptoms disappear soon after deworming of the patient.

Sometimes very severe defeats of G. are caused by maggots, hl. obr. gadfly and volfartovy fly (ophthalmomyases). Getting into a conjunctival sac of G., females of these insects throw out a large number of larvae. The most part of larvae is washed away by a tear, but a part them is late in the thickness of a conjunctiva, bringing to hron, to conjunctivitis. Some larvae get through a limb into an anterior chamber and even into a vitreous, causing hron, an iridocyclitis with the heavy wavy current reminding a tubercular uveitis. Process can end with G. Inogd's death there is a nodular keratoconjunctivitis as a result of hit in a conjunctiva of hairs of a caterpillar of a silkworm during the periods of its mass reproduction.

Tumors of a conjunctiva of an eyeglobe can be high-quality and malignant. Treat high-quality a hemangioma (see), dermoid (see), lipodermoid, papilloma (see Papilloma, a papillomatosis), fibroma (see. Fibroma, fibromatosis ), pigmental and not pigmental birthmarks (see. Nevus ); to malignant — a melanoma (see), epithelioma (see).

The cornea and a sclera are usually involved in process at distribution of a new growth from a conjunctiva or from an average cover

of G. V to an average cover (an iris, a ciliary body, a choroid) benign and malignant tumors also develop: high-quality — a leiomyoma (see), neurinoma (see), a nevus (see), neurofibroma (see); malignant — a melanoma (the SI.). The internal cover of G. is surprised at Gippel's disease — Lindau (see Gippelya-Lindau a disease); it is a high-quality angiomatosis of a retina. The only malignant tumor of a retina is the retinoblastoma (see).

Occupational diseases

the Greatest value have mechanical, physical, volumetric and physical and chemical production factors, smaller — biological is considerable. Professional harm cause disturbances of many bodies and systems of an organism; G.'s changes most often are only one of the accompanying symptoms.

Mechanical factors. Fine earth dust, about a cut formers in foundry production deal, the century and an eyeglobe causes only slight irritation of a conjunctiva. Emery dust, edges arises during the sharpening of cutters, often leads to anesthesia of a cornea as a result of an injury of an epithelium and sensory nerves located in it. The damaged epithelium quickly is recovered, however the broken function of sensory nerves of a cornea is observed for a long time. At hron, influence sensitivity of a cornea is lost that leads to weakening of a protective blink reflex, thanks to Krom normal moistening and G.'s protection from harmful external effects is provided. Measures of usual protection of G. (safety spectacles, guards) give only some effect, the most efficient preventive action is use of the powerful exhausters which are sucking away emery dust at the place of its emergence.

Influence of volumetric and physical and chemical factors. G.'s irritation gases and reactive dust meets at working at textile, tanning, sugar, chemical, tobacco and other companies. Hydrogen sulfide causes acute irritation and pain in G., dacryagogue and a photophobia, a hyperemia and puffiness of a conjunctiva, hypostasis of a corneal epithelium in service personnel of sulfur baths. Only after topical treatment by a liquid paraffin and cold lotions the clinic of acute conjunctivitis disappears. Similar the wedge, a picture is observed at the persons which are treated to action of arsenous dust or vapors of arsenic that occurs at workers of agriculture at a protravlivaniye of seeds before crops, and also at working at the fur and pharmaceutical enterprises. In very hard uncured cases there is exfoliating of an epithelium and impregnation of a cornea the most fine particles of arsenic. Sealing of productions allowed to liquidate almost completely cases of intoxication arsenic on production. At working in workshops of chemical purification of silver sometimes impregnation of a cornea and limb and characteristic blackening of a conjunctiva is observed — an argyrosis G. Argiroz does not cause G.'s irritation, but the formed deposits of metal long do not resolve.

At working at the pharmaceutical enterprises as a result of hit of powder of quinacrine in a conjunctival sac there can be a keratoconjunctivitis. Sometimes at the same time also symptoms of poisoning with quinacrine are observed — xanthopsia (see). In development of these phenomena having passing character matters not only local impact of quinacrine on an organ of sight, but also its absorption through a respiratory organs, digestion and skin. G.'s defeat is followed by a hyperemia and a bright yellow shade of a conjunctiva. The cornea is dim, yellow-greenish color. At elimination of the reason signs of irritation of G. quickly pass.

Fig. 14. An optical cut of a crystalline lens at biomicroscopy of an eye of the patient having the cataract caused by poisoning with trinitrotoluene. In various layers of a crystalline lens uneven granular opacifications (light points) are expressed.

Heavy vision disorders (phacoscotasmus) meet at working with trinitrotoluene. The cataract at the same time results from adjournment of trinitrotoluene in fibers of a crystalline lens (fig. 14).

Influence of physical factors of radiations. Even simple photoirritation of G. at very high intensity can cause the phenomenon of an ophthalmia (see). Heavier changes are observed at action on G. of intensive ultra-violet and infrared radiations. So, at the wrong use of safety spectacles G. of film workers and electric welders suffer. Most often the cornea and a conjunctiva are surprised. In several hours after influence of radiation sharp pains in G., a hyperemia and a chemosis develop. Apply cold water lotions, an instillation in a conjunctival sac of 0,25% of solution of Dicainum and liquid vaseline to reduction of pains. As a rule, the phenomena of an ophthalmia pass within several days. If the light flux is especially rich with an infrared invisible heat, then deeper departments of G. are damaged (a crystalline lens etc.). At glass blowers, founders, smiths the phacoscotasmus — a so-called cataract of glass blowers can be observed. Improvement of conditions of production, use of achievements of science and technology completely excluded action of infrared beams for. The radiations arising at generation of currents of the high frequency (microwave oven) can also be the reason of development of a cataract. For prevention of this complication of the person, working in the electromagnetic field microwave oven (personnel of radar stations, etc.), are constantly observed at ophthalmologists, strict limits of an allowed time of stay under the influence of this field are set.

Changes of an eye at diseases of internals and systems

Fig. 15. A face of the patient with paralysis of a third cranial nerve: 1 — a ptosis of a century of the right eye and a fissura orbitalis superior syndrome of the left eye; 2 — at a raising of an upper eyelid of the right eye paralytic squint (paralysis of upper, internal and lower direct muscles, the lower oblique muscle and muscle raising an upper eyelid) is defined.

Changes of an eye at diseases of a nervous system. The subjective and objective symptomatology at defeat of the central and peripheral nervous system can be presented in the form of the following groups: a) outside changes of G. — a lagophthalmia (see) at paralysis of the item facialis, the pulsing exophthalmos (see) at break of an internal carotid artery in sinus cavernosus, herpes zoster at defeat of the first branch of a trifacial, etc.; b) disturbances of pupillary tests — Argayll Robertson's symptom (see Argayll Robertson a symptom) at back to tabes, a miosis — at paralysis of a sympathetic nerve and excitement of a third cranial nerve, a gemianopichesky immovability of pupils at defeats of visual decussation and paths and so forth; c) changes from an eyeground — congestive disks of optic nerves (see. A congestive nipple) at tumors, abscesses, hemorrhages in a brain, hydrocephaly, optokhiazmalny pia-arachnites and at other processes which are followed by cerebral hypertensia; neuritis of optic nerves (see) at basal meningitis, abscesses of a brain, encephalitis, etc.; atrophies of optic nerves — primary, napr, at tumors of a brain * injuries of a skull, back to tabes, and secondary after neuritis, etc.; d) changes of visual functions (visual acuity and field of vision); visual acuity in a nevrooftalmodiagnostika is not important so as a condition of a field of vision, however decrease in visual acuity (see) is one of the main symptoms at damages of an optic nerve (neuritis of optic nerves, primary and secondary atrophies of optic nerves); changes of a field of vision are shown in the form of the central scotomas at defeat of papillomakulyarny fibers, bitemporal scotomas and a hemianopsia at defeats of an optic chiasm, gomonimny scotomas and a hemianopsia at defeats of a visual tract and the central neurone of a visual way (see the Hemianopsia, Scotoma), and also the cortical visual centers and so forth; e) changes of the oculomotor device — at defeats of separate motor nerves, namely: III, IV, VI pairs of cranial nerves (fig. 15), and also their joint defeat at ophthalmoplegias (fissura orbitalis superior syndrome); e) changes of sensitivity of skin a century, conjunctivas and corneas at damage of the V cranial nerve; g) trophic defeats — a nevroparalitichesky keratitis (see) at damages of the V nerve, a heterochromia of an iris at sufferings of a sympathetic nerve (see Bernard — Horner a syndrome); h) the local symptomatology, edges has a big variety.

Changes of an eye at diseases of bodies of blood circulation, the hemopoietic bodies and blood. Especially characteristic changes are observed at defeat of the vessels having a direct bearing on G. (an aorta, carotid arteries and their branches). At heart diseases, especially at aortic incompetence, the characteristic pulsation of the central artery of a retina, sometimes — capillary pulse in the form of alternate reddening and blanching of disks of optic nerves, expansion and tortuosity of veins of a retina is observed. Sometimes at inborn heart diseases there is a cyanosis of an eyeground. At build-up of pressure in the pool of an upper vena cava there are retinal apoplexies and glaucoma, especially at the persons predisposed to this disease can develop. Aneurisms of a chest aorta and the branches departing from an arch with a pressure upon a sympathetic nerve can cause anisocoria (see), retinal apoplexy. At intracranial aneurisms, especially basal, along with the general and local brain symptoms congestive disks of optic nerves, neuritis and atrophies of optic nerves, defeats III, IV, V and VI pairs of cranial nerves can be observed. At the general arteriosclerosis, in addition to an angiosclerosis of a retina, hemorrhages in a conjunctiva, a retina, a vitreous, thrombosis of vessels of a retina, an atrophy of optic nerves owing to a sclerosis of the small vessels feeding them, and also as a result of a prelum by their internal carotid arteries at an internal opening of the channel of an optic nerve are observed. At an idiopathic hypertensia at the bottom of G. various changes are observed, beginning from functional (narrowing of arteries of a retina) to heavy organic like a hypertensive arteriosclerosis of a retina and retinopathies (see). At diseases of blood and the hemopoietic bodies the greatest changes are observed on eyeground (see). At anemia of various genesis coloring of an eyeground pale, at leukoses — a yellowish shade. Besides, at leukoses the atrophy of optic nerves even after small blood losses, and on centuries, under a conjunctiva is observed, in an eye-socket sometimes there are lymphoma. At hemorrhagic diathesis (hemophilia, Verlgof's disease, etc.) hemorrhages in various Fabrics are most characteristic.

Changes of an eye at diseases of kidneys. The retinopathy is often observed at hron, intersticial nephrites (contracted kidney). This symptom has diagnostic and predictive value. Most of patients who have a retinopathy perishes within 2 years after emergence of changes on an eyeground.

Congestive optic disks, secondary amotio of a retina the century also swelled at this disease have diagnostic and predictive value. Sometimes at nephrite the uraemic amaurosis is observed.

Changes of an eye at diseases of the digestive system and disbolism. At disturbance of the general food are observed muscular and akkomodativny asthenopia (see), hemeralopia (see), it is frequent with existence of xerotic plaques on a conjunctiva. Children as a result of long ponos have a xerosis, a keratomalacia (see) with the subsequent panophthalmia (see) and an atrophy of an eyeglobe. An endointoxication, coming from went. - kish. a path, can be the cause of barley, a blepharitis, conjunctivitis, an episcleritis, an iridocyclitis, neuritis and an atrophy of optic nerves with the corresponding visual frustration, paralysis of outside muscles of G. and disturbance of accommodation. At gout of change parts G. in the form of a keratitis, a sclerite, an episcleritis, an iritis are preferential observed in before-1 it. The persistent current and a frequent recurrence are inherent in these diseases. At rickets the so-called zonular cataract, usually bilateral meets; also the damages of optic nerves which are coming to an end in their atrophy are noted.

Fig. 16. A face of the patient with the myxedematous edema a century of both eyes which developed after a strumectomy.
Fig. 17. A face of the sick child with metastatic abscesses of lower eyelids of both eyes at a furunculosis after the postponed measles.

Changes of eyes at endocrine diseases. At hyperfunction of a thyroid gland the exophthalmos, a symptom Gref (lag of an upper eyelid from the movement of an eyeglobe from top to bottom), a symptom of Shtellvaga (a rare blinking), Möbius's symptom (weakening of convergence), etc. takes place; paresis of direct muscles of G., the strengthened slezootdeleniye is sometimes observed. At a myxedema are observed a myxedema a century (fig. 16), in rare instances — an inflammation and an atrophy of optic nerves.

At a diabetes mellitus barley, retinal apoplexies, a vitreous meet; an episcleritis and a sclerite (see); iritis and iridocyclitis; diabetic cataract. Serious changes in a retina are observed at a so-called diabetic retinopathy; quite often struck there is also an optic nerve in the form of simple or retrobulbar neuritis. Eye symptoms at diabetes have diagnostic and predictive value (see a diabetes mellitus).

Fixed is considered communication between hypofunction of epithelial bodies and a cataract (see). However development of a cataract can be as well at hyper - and hypofunctions of various hemadens. At an addisonovy disease (see) dark brown spots in a conjunctiva and on an eyeground are sometimes observed.

Changes of an eye at infectious diseases. Metastatic transfer of contagiums in G. — the most frequent reason of its defeat. Sometimes changes from G. are a consequence of toxic defeat of a nervous system (e.g., paralysis of accommodation after diphtheria). At distribution of infectious process from surrounding G. of fabrics an erysipelatous inflammation the century, conjunctivitis, a keratitis are observed. Can suffer not only from an infection, but also from various complications arising at it (e.g., a retinopathy of a renal origin at scarlet fever). There is a certain pattern concerning localization patol, process in G. under the influence of various systemic infections: ostrolikhoradochny infectious a dieback (measles, a sapropyra, smallpox) strike cover fabrics G. — skin a century (fig. 17), a conjunctiva, a cornea; gematogenno the extending septicopyemic diseases lead to defeat of a choroid (see Irites, Iridocyclites, Choroidites) and retinas (see Retinites).

Change of an eye at diseases of face skin. At diseases of face skin of G. are surprised or as a result of transition of process to a conjunctiva and a cornea or by endogenous distribution of toxicants on Fabric. At eczema often there is eczema of skin a century, conjunctivitis, a keratitis. Acne rosaceae is complicated by scaly blepharitis (see), rozatsea-conjunctivitis in the form of limited sites of irritation on a conjunctiva or in the form of the nodes on a conjunctiva at a limb reminding phlyctenas. The pemphigus can be followed by bubbles on a conjunctiva which quickly give epithelial defects, pruinose. They in the subsequent lead to cicatricial wrinklings of a conjunctiva and formation of full symblepharon, a xerosis of a cornea and loss of sight.

Changes of an eye at diseases of a nose and its adnexal bosoms, an ear and oral cavity. Acute sinusitis sometimes leads to neuralgia of upper or lower orbital branches of a trifacial, photophobia, dacryagogue, a nictitating spasm. At damages of a wedge-shaped bosom and a trellised labyrinth of bosoms neuritis of optic nerves can be observed.

Fig. 18. A face of the patient at a mucocele of adnexal nasal cavities: sharp protrusion and shift of the left eye from top to bottom and knaruzh; protrusion of an eye developed very slowly, within 20 years.

At sinusitis the periostitis, an inflammation of cellulose, thrombophlebitis, phlegmon of an eye-socket, a keratitis, neuritis and an atrophy of optic nerves, damage of direct muscles of an eye sometimes develops. Mucocele sinus frontalis et ethmoidalis is followed by an exophthalmos, shift of an eyeglobe and restriction of its mobility (fig. 18). The purulent processes in a middle ear complicated by otogenic meningitis, abscess of a brain, thrombosis of brain sine are followed by an optic neuritis, its congestive disk, paralysis of motor nerves of G. and a trifacial. In the subsequent phlegmon of an eye-socket can develop. At diseases of a labyrinth of an inner ear and at Menyer's disease the nystagmus is sometimes observed (see).

Damage of teeth sometimes proceeds with a nictitating spasm, dacryagogue, a hyperemia of a conjunctiva of reflex character. At caries of teeth, granulomas and kistogranulema in the field of a top of fangs, periostites the iritis and an iridocyclitis, a periostitis of an eye-socket, phlegmon and thrombophlebitis of her veins can develop. Some diseases of G. are caused acute and hron, diseases of almonds and a pharynx: inflammations of a conjunctiva, optic nerve, choroid, ciliary body, iris of the eye.

Medical tactics at some diseases and injuries of an eye is stated in tab. 2.

Operations

there is a large number of various surgical interventions on an eyeglobe and its auxiliary device which volume and character depend from patol, process. A number of operative measures is directed to normalization of function a century and the lacrimal device (see the Blepharoplasty, the Canthoplasty, the Dacryocystorhinostomy, etc.). At pathology from the muscular device G. apply reconstructive operations (see Squint, treatment). The most frequent in Ophthalmolum. to practice the operations directed to improvement or recovery of sight are (see. Cataract , treatment, Keratoplasty , Keratoprotezirovaniye, Keratomilez, Keratofakiya, etc.), decrease in the increased intraocular pressure (see Glaucoma, treatment, Gonitomiya, a gonipunktura, Iriden, Kleyzis, the Sinusotomy, Trepanation of a sclera, the Cyclodialysis).

At tumors their excision (see Corectomy, Iridotsiklektomiya) or removal of an eyeglobe is made (see Enucleation of an eye). G.'s injuries operations use for the purpose of recovery of the broken anatomic ratios of fabrics and sealing of an eyeglobe.

Interventions on fine structures of G. with use of operative microscopes, lasers (see), ultrasound and special devices for creation of low temperatures to — 70 ° are eurysynusic (see Cryotherapy).

Before the operations connected with opening of a cavity of an eyeglobe, definition of a condition of purity of a conjunctival sac is of great importance. In the presence of pathogenic microflora (pneumococci, staphylococcus, a pyocyanic stick, etc.) careful sanitation of a conjunctival cavity is necessary. Non-compliance with this rule can lead to a purulent inflammation of internal covers of G. and its death.


Table 2. The most frequent diseases and injuries of an eye, their main clinical manifestations and medical tactics

Bibliography

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M. L. Krasnov (annate., injuries.); A. I. Bogoslovsky (physical.); V. V. Volkov (soldier.); B. S. Kasavina (biochemical); V. I. Morozov (annate., mt. issl., pathology, injuries., prof., hir.); A. Ya. Samoylov (annate., pathology, prof. zab.); S. I. Talkovsky (pathology); 3. L. Stenko (I am glad.); E. Zh. Tron (dioptrics); author of the tab. V. I. Morozov.

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