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Examinarea clinica
oftalmologica
Semiologia oftalmologica
Examinarea la lumina zilei
•Pacientul -> spre sursa de lumina
•Se examineaza 1.ANEXELE
2.POL ANTERIOR
1. PLEOAPELE
• congenitale
• Modificari de pozitie
• inflamatii
• trauma
2. CONJUNCTIVA
3. APARATUL LACRIMAL
• Glanda lacrimala- ascunsa in foseta glandei lacrimale
• Capacitate secretorie – TEST SCHIRMER
• Permeabilitatea: 1. Fluoresceina
2.Spalatura
4. ORBITA
EXAMINAREA POLULUI ANTERIOR
CORNEEA
• dimensiune-= 10mm/11mm
• Raza de curbura – examinare din profil
CORNEEA
• Transparenta  inflamatii, modificare continut de apa, procese
cicatriciale
• CEL MAI SENSIBIL ORGAN !!!
CAMERA ANTERIOARA
• Profunzimea  privind pacientul din profil
crescuta = luxatie/subluxatie cristalin
scazuta= glaucom
• Continut  perfect transparent !
produsi patologici – decliv- sange / puroi
IRISUL
• Diafragm circular perforat in mijloc
• Modificari  1. congenitale = corectopia (pupila deplasata), colobom
2. dobandite= iridodializa (dezinsertie post-trauma) ,
colobom
PUPILA
• Dimensiune= 2-2,5 mm  modificata in iridociclite ↓ , glaucom ↑
• Dinamica= mioza  lumina
midriaza intuneric
• Forma= modificata in iridociclite  sinechii iriene posterioare
• Culoarea= neagra ; poate fi cenusie= cataracta sau reflex rosu=
hemoragie in vitros
• Reflexe pupilare 1. fotomotor direct
2. fotomotor consensual
3.acomodatie-convergenta-mioza
FUNCTIA VIZUALA
• Excitantul specific analizatorului vizual= LUMINA
• Repartitia celulelor fotoreceptoare INEGALA
celule cu conuri = macula = 6 milioane = VEDEREA DE ZI
celule cu bastonase = periferie macula = 130 milioane =
VEDEREA DE NOAPTE
ACUITATEA VIZUALA
•Capacitatea pe care o are regiunea centrala a
retinei = FOVEEA = de a percepe detaliile
obiectelor
•Se determina de la 5 m = “infinitul oftalmologic”
•Monocular, se incepe OD
•Se considera randul din care s-au recunoscut
50% din cifre
ACUITATEA VIZUALA
• Daca pacientul citeste ultimul rand VOD=1 , daca citeste pana la
randul 5 VOD= 0.5
• Daca nu citeste primul rand  se apropie treptat de ortotip pana
cand recunoaste primul rand [VOD=3/50 citeste primul rand la 3 m]
• Daca nu vede nici la 1m  numara degetele pe parcursul distantei
pana la 1 m [VOD=nr degetele la 10,20,50 cm]
• Daca nu numara degetele la 10 cm se misca mana in fata ochiului si
daca este vazuta VOD= pmm
• Daca nu pmm se proiecteaza lumina in ochi
OPTOTIP
OPTOTIP
ACUITATE VIZUALA DE APROAPE
•Rugam pacientul sa poarte ochelari de
aproape daca are
•Monocular apoi binocular
•Se face la o distanta de 30 cm
Punctul stenopeic
•Daca acuitatea vizuala se
imbunatateste  erori de
refractie, opacitati cristaliniene
/corneene
•Daca acuitatea vizuala nu se
imbunatateste  leziuni retiniene,
de nerv optic sau cerebrale
Tipps
• Se testeaza AV la distanta prima data
• Se incepe cu OD prima data
• Daca exista ptoza se ridica usor si apoi se testeaza AV
• Anestezie locala daca – eroziuni corneene dureroase
• Se testeaza si AV la distanta si AV la aproape
• Se testeaza AV inainte de dilatarea pupilei !!!
CAMPUL VIZUAL
• Testarea functiei retinei periferice
• Reprezinta aria din mediul inconjurator perceputa vizual de unul sau
ambii ochi in timp de fixeaza un punct central stationar
CAMPUL VIZUAL
• Limitele periferice  obstacole naturale – nasul si regiuea
suprasprancenoasa
• Pata oarba= scotom fiziologic – celule vizuale la nivelul PNO
CAMPUL VIZUAL
• MODIFICARI IN PERIFERIE
STRAMTORARI
HEMIANOPSII – lipsuri simetrice a cate o jumatate din CV al
fiecarui ochi
CAMPUL VIZUAL
• Modificari in interior
caracter insular= scotoame
CAMPUL VIZUAL
• EXAMINARE= perimetrie cinetica/statica
SENZATIA DE CULOARE
• Indivizii cu vedere cromatica normala = tricomazie normala (tri=trei
culori)
• Perceptia cromatica  conurile din regiunea maculara
• Indicator sensibil al functiei NO
Grupate in tulburari congenitale, ereditare si castigate
SENZATIA DE CULOARE
• Examinare
1. Denumirea culorii
2. Egalizare
3. Comparare
4. Discriminare = Ishihara

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aml stagiu.pptx

  • 2. Examinarea la lumina zilei •Pacientul -> spre sursa de lumina •Se examineaza 1.ANEXELE 2.POL ANTERIOR
  • 8.
  • 9. 3. APARATUL LACRIMAL • Glanda lacrimala- ascunsa in foseta glandei lacrimale • Capacitate secretorie – TEST SCHIRMER • Permeabilitatea: 1. Fluoresceina 2.Spalatura
  • 11. EXAMINAREA POLULUI ANTERIOR CORNEEA • dimensiune-= 10mm/11mm • Raza de curbura – examinare din profil
  • 12. CORNEEA • Transparenta  inflamatii, modificare continut de apa, procese cicatriciale • CEL MAI SENSIBIL ORGAN !!!
  • 13. CAMERA ANTERIOARA • Profunzimea  privind pacientul din profil crescuta = luxatie/subluxatie cristalin scazuta= glaucom • Continut  perfect transparent ! produsi patologici – decliv- sange / puroi
  • 14. IRISUL • Diafragm circular perforat in mijloc • Modificari  1. congenitale = corectopia (pupila deplasata), colobom 2. dobandite= iridodializa (dezinsertie post-trauma) , colobom
  • 15. PUPILA • Dimensiune= 2-2,5 mm  modificata in iridociclite ↓ , glaucom ↑ • Dinamica= mioza  lumina midriaza intuneric • Forma= modificata in iridociclite  sinechii iriene posterioare • Culoarea= neagra ; poate fi cenusie= cataracta sau reflex rosu= hemoragie in vitros • Reflexe pupilare 1. fotomotor direct 2. fotomotor consensual 3.acomodatie-convergenta-mioza
  • 16. FUNCTIA VIZUALA • Excitantul specific analizatorului vizual= LUMINA • Repartitia celulelor fotoreceptoare INEGALA celule cu conuri = macula = 6 milioane = VEDEREA DE ZI celule cu bastonase = periferie macula = 130 milioane = VEDEREA DE NOAPTE
  • 17. ACUITATEA VIZUALA •Capacitatea pe care o are regiunea centrala a retinei = FOVEEA = de a percepe detaliile obiectelor •Se determina de la 5 m = “infinitul oftalmologic” •Monocular, se incepe OD •Se considera randul din care s-au recunoscut 50% din cifre
  • 18. ACUITATEA VIZUALA • Daca pacientul citeste ultimul rand VOD=1 , daca citeste pana la randul 5 VOD= 0.5 • Daca nu citeste primul rand  se apropie treptat de ortotip pana cand recunoaste primul rand [VOD=3/50 citeste primul rand la 3 m] • Daca nu vede nici la 1m  numara degetele pe parcursul distantei pana la 1 m [VOD=nr degetele la 10,20,50 cm] • Daca nu numara degetele la 10 cm se misca mana in fata ochiului si daca este vazuta VOD= pmm • Daca nu pmm se proiecteaza lumina in ochi
  • 21. ACUITATE VIZUALA DE APROAPE •Rugam pacientul sa poarte ochelari de aproape daca are •Monocular apoi binocular •Se face la o distanta de 30 cm
  • 22. Punctul stenopeic •Daca acuitatea vizuala se imbunatateste  erori de refractie, opacitati cristaliniene /corneene •Daca acuitatea vizuala nu se imbunatateste  leziuni retiniene, de nerv optic sau cerebrale
  • 23. Tipps • Se testeaza AV la distanta prima data • Se incepe cu OD prima data • Daca exista ptoza se ridica usor si apoi se testeaza AV • Anestezie locala daca – eroziuni corneene dureroase • Se testeaza si AV la distanta si AV la aproape • Se testeaza AV inainte de dilatarea pupilei !!!
  • 24. CAMPUL VIZUAL • Testarea functiei retinei periferice • Reprezinta aria din mediul inconjurator perceputa vizual de unul sau ambii ochi in timp de fixeaza un punct central stationar
  • 25. CAMPUL VIZUAL • Limitele periferice  obstacole naturale – nasul si regiuea suprasprancenoasa • Pata oarba= scotom fiziologic – celule vizuale la nivelul PNO
  • 26. CAMPUL VIZUAL • MODIFICARI IN PERIFERIE STRAMTORARI HEMIANOPSII – lipsuri simetrice a cate o jumatate din CV al fiecarui ochi
  • 27. CAMPUL VIZUAL • Modificari in interior caracter insular= scotoame
  • 28. CAMPUL VIZUAL • EXAMINARE= perimetrie cinetica/statica
  • 29. SENZATIA DE CULOARE • Indivizii cu vedere cromatica normala = tricomazie normala (tri=trei culori) • Perceptia cromatica  conurile din regiunea maculara • Indicator sensibil al functiei NO Grupate in tulburari congenitale, ereditare si castigate
  • 30. SENZATIA DE CULOARE • Examinare 1. Denumirea culorii 2. Egalizare 3. Comparare 4. Discriminare = Ishihara