Eye problems & conditions — symptoms and when to see a doctor
Learn about common eye problems and vision symptoms, causes, and when to seek care from an ophthalmologist.
Active Retinopathy of Prematurity
## Biomicroscopy, ophthalmoscopy, DNA diagnostics (determination History indicates prematurity; Always bilateral involvement. History indicates prematurity; Always bilateral involvement. Absence Vitreous hemorrhage Metastatic endophthalmitis Persistent fetal vasculature (persistent hyperplastic primary vitreous) pronounced sequelae of uveitis, rapidly developing cataract. The disease, as a rule, always ends with atrophy of the eyeballs. For most children mental retardation (60%) and deafness (30%) are characteristic. Hemorrhages on the fundus, as a rule, appear in full-term, with high birth weight, newborns, immediately after birth and are the result of severe birth trauma. Changes on the part of the optic disc in isolation from characteristic peripheral manifestations, may be erroneously regarded as manifestations of intracranial hypertension and various pathological conditions of the CNS with development of congestive
Read moreBlepharitis
## Definition: Blepharitis is an inflammation of the eyelid margin that has a chronic course [1,3].
Read moreCataract
## Definition [1-5]: Cataract is any congenital or acquired opacity of the lens capsule or lens substance, the outcome of which is a change in transparency and refractive indices, leading to varying degrees of visual impairment.
Read moreConjunctivitis
## Definition: Conjunctivitis is an inflammation of the mucous membrane of the eyelids and eyeball caused by bacteria, viruses, allergic or immunological reactions, mechanical irritation, or medications [1].
Read moreDacryoadenitis, other diseases of the lacrimal gland, epiphora
## Definition: Dacryoadenitis is inflammation of the lacrimal gland [1]. Dry eye syndrome is an ocular disease caused by dryness of the eyes, which in turn is caused either by decreased tear production or increased tear evaporation [2]. Epiphora is tear stasis and excessive tearing beyond normal limits, in which tears may flow down the cheek area [3].
Read moreDegenerative conditions of the eyeball
## Definition [1-7]: Degenerative conditions of the eyeball are conditions arising as a result of the degenerative process and ultimately leading to complete blindness. 8. Classification [1,2]: Stage I – stage of initial changes; anteroposterior axis of the eye from 23 to 18 mm, cicatricial changes of the cornea and sclera, corneal dystrophy, traumatic cataract (swelling, membranous), floating and single fixed opacities of the vitreous body, flat limited retinal detachment. 2 Stage II – stage of developed changes; axis of the eye 20-17 mm, coarse vascularized corneal scars, reduction of its diameter, coarse retracted scleral scars, atrophy and vascularization of the iris, pupillary occlusion, cataract in the form of dense tissue membranes with newly formed vessels, multiple fixed opacities of the vitreous body, extensive detachment of the retina and ciliary body. Stage III – far advanced changes; axis of the eye 17-15 mm and less, reduction, flattening of the cornea and its cicatricial degeneration, rubeosis and atrophy of the iris, dense tissue membranous neoplasms in the lens area, extending into the anterior chamber and vitreous body, fibrosis and schwarte formation in the vitreous body, total retinal detachment.
Read moreDiabetic retinopathy
## Definition: Diabetic retinopathy (DR) is a specific late neuromicrovascular complication of diabetes mellitus, developing, as a rule, sequentially from changes associated with increased permeability and occlusion of retinal vessels to the appearance of newly formed vessels and fibroglial tissue, leading in the terminal stage to complete blindness [1-3]. Diabetic maculopathy (DM) is a lesion of the macular zone that can develop at any stage of DR. Diabetic macular edema (DME) is thickening of the retina associated with fluid accumulation in the intercellular space of the neuroepithelium due to disruption of the internal blood-retinal barrier and a mismatch between fluid outflow and the reabsorption capacity of pigment epithelium cells.
Read moreKeratitis
## Definition: keratitis is an inflammation of the cornea of the eyeball resulting from the impact of exogenous factors (preceding trauma, local infection) or endogenous factors (general infectious, systemic diseases). It is accompanied by corneal syndrome [1, 2].
Read moreMalignant neoplasms of the orbit
## Definition: Malignant neoplasms of the orbit - malignant lesion of the orbit. NB! This protocol does not cover metastatic tumors of the orbit. Malignant neoplasms of the orbit comprise approximately 1/3 of all orbital tumors. They may be primary, secondary (invading the orbit from adjacent anatomical structures, most commonly from the paranasal sinuses), and metastatic. Among primary malignant tumors of the orbit, the most frequently encountered are lacrimal gland carcinoma, sarcomas, and lymphomas [9,21] (LE A). Anatomical parts of the orbit – the eyeball and its accessory organs: muscles, ligaments and fascia; periorbita; adipose tissue; eyelids, conjunctiva; lacrimal apparatus (lacrimal gland, canaliculi, sac).
Read moreOptic nerve atrophy
## Definition: Optic nerve atrophy is a degenerative process of the optic nerve that occurs as a result of pathological changes located from the retina to the lateral geniculate body [1,2].
Read morePurulent endophthalmitis
## Definition: Purulent endophthalmitis is an acute inflammation of the internal membranes of the eye with abscess formation in the vitreous body [1,2]. 9. Clinical classification [4,5]: By origin: exogenous endogenous By etiology: traumatic fungal postoperative phacoanaphylactic endophthalmitis purulent By form: focal 2 diffuse mixed panophthalmitis 10. Indications for hospitalization with indication of hospitalization type: Indications for emergency hospitalization: severe eye pain; sharp decrease in visual acuity; eyelid edema, corneal edema; mixed conjunctival injection; precipitates, hypopyon in the anterior chamber; absence of fundus reflex, cells and detritus in the vitreous body. Indications for planned hospitalization: none.
Read moreRefractive errors
## Definition [1]: Myopia (nearsightedness) – a refractive error in which, in the state of accommodation at rest, the focal point of light rays parallel to the optical axis from infinitely distant objects is located in front of the retina. Hypermetropia (farsightedness) – a refractive error in which, in the state of accommodation at rest, the focal point of light rays parallel to the optical axis from an infinitely distant object is located behind the retina. Astigmatism – a refractive error in which light rays parallel to the optical axis do not focus at a single point. Anisometropia – a difference in refractive power between the eyes exceeding 1.00 D.
Read moreRetrieval and preservation of the eyeball from a post-mortem donor
Approved by the Joint Commission on Quality of Medical Services of the Ministry of Health of the Republic of Kazakhstan dated September 26, 2024 Protocol No. 215
Read moreSecondary glaucoma due to other eye diseases
## Definition: Secondary glaucoma is a group of diseases that are complications or consequences of various eye diseases (trauma, tumors, inflammation of the eyeball) or exposure to various medications, in which an increase in intraocular pressure occurs. Secondary glaucoma is characterized by a wide variety of etiological factors.
Read moreStrabismus in children
## Definition: Strabismus is a constant or intermittent deviation of one of the eyes from the common point of fixation, characterized by impaired binocular vision. Strabismus manifests as an external defect – deviation of the eye/eyes toward the nose or temple, upward or downward [2,8]. 9. Clinical classification [2,8]: By time of onset: congenital (infantile - present from birth or develops in the first 6 months of life); acquired. By sign of stability of eye deviation: inconstant (intermittent); constant. By eye involvement: monolateral; alternating. Depending on direction of deviation: horizontal (esotropia, exotropia); vertical (hypertropia, hypotropia); torsional; mixed. Causes of occurrence: comitant (accommodative, partially accommodative, non-accommodative); incomitant (paralytic, non-paralytic); secondary (sensory, consecutive). Esotropia: Comitant esotropia 1) Accommodative Refractive (normal AC/A) Non-refractive (high AC/A) Mixed (Partially refractive (normal AC/A)) 2) Non-accommodative Essential infantile esotropia (begins in the first 6 months of life) Basic (simple, basic) esotropia Esotropia associated with increased convergence Esotropia associated with decreased divergence Esotropia combined with myopia Cyclic esotropia Acute-onset esotropia 3) Microesotropia 4) Nystagmus blockage syndrome Incomitant esotropia 1) Paralytic 2) Non-paralytic With A and V patterns Retraction syndromes Mechanically restrictive (congenital fibrosis of EOM, acquired restrictions resulting from trauma, myopathy, etc.) Secondary esotropia Sensory Consecutive Exotropia: Comitant exotropia (may be constant or intermittent in nature): 1) Infantile (congenital) exotropia 2) Primary exotropia Divergence excess (deviation at distance greater than at near by 7° or more) Basic (basic) exotropia (deviation at distance and near are equal) Convergence insufficiency (deviation at distance less than at near by 7° or more) Pseudo divergence excess 3) Secondary exotropia: Sensory Consecutive Incomitant exotropia 1) Paralytic. 2) Non-paralytic (dissociated - isolated or with DVD, excyclotropia; others). CYCLOVERTICAL DEVIATIONS: Comitant vertical deviations Paretic vertical deviations Deviations with unilateral overaction of inferior oblique muscle DVD Combined vertical deviations SPECIAL FORMS OF STRABISMUS: Duane syndrome Brown syndrome Sagging eye syndrome Fixed strabismus Strabismus in high myopia EOM fibrosis Endocrine ophthalmopathy Acute orbital myositis Cyclic heterotropia Acquired motor fusion deficiency Orbital wall damage Ocular myasthenia Chronic progressive external ophthalmoplegia ## List of main and additional diagnostic measures: 11.1 Main (mandatory) diagnostic measures performed at the outpatient level [3,4,5]: collection of disease and life history; (LE - C)[2,8,9,10]; determination of visual acuity without and with spectacle correction (LE - A)[2,8,9,10]; determination of the angle of strabismus without and with spectacle correction, at distance and near (cover test, cover-uncover test, compensation of refixation movements using a set of prismatic lenses, measurement of deviation angle by Hirschberg (°) or in prism diopters (∆)) in gaze positions straight ahead, right, left, up, down, right up, right down, left up, left down (LE - A)[2,8,9.10]; determination of motility and range of eye movements (LE - B)[2,8,9]; examination of convergence (LE - C)[2,8]; biomicroscopy (LE - C)[2,8,9,10]; ophthalmoscopy (direct, indirect) (LE - C)[2,8,9,10]; determination of objective refraction under cycloplegia (skiascopy or retinoscopy) (LE - A)[2,8,9.10]. ## Instrumental studies: determination of visual acuity without and with spectacle correction – visual acuity may be reduced/within age normal range (LE - A)[2,8,9,10]; in microtropia (monofixation syndrome) there is persistent reduction of visual acuity in one (squinting) eye. In the presence of amblyopia there is reduction of best corrected visual acuity of one or both eyes of varying degrees. determination of the angle of strabismus without and with spectacle correction, at distance and near (cover test, cover-uncover test, compensation of refixation movements using a set of prismatic lenses, measurement of deviation angle by Hirschberg (°) or in prism diopters (∆)) in gaze positions straight ahead, right, left, up, down, right up, right down, left up, left down – depending on the nature of strabismus there is constant or inconstant deviation of the eye from the common point of fixation (LE - A)[2,8,9]; in accommodative strabismus the angle of deviation is compensated (eye position is symmetrical) by adequate spectacle correction. determination of objective refraction under cycloplegia (skiascopy or retinoscopy) – presence or absence of refractive error (myopia, hypermetropia, astigmatism) (LE - B)[2,8,9.10]; determination of the nature of vision – impairment of binocular vision (LE B)[2,8,9]; In the forced head position, the binocular nature of vision is preserved. traction test – a positive result means that passive eye movements are impeded, indicating the presence of mechanical restrictive strabismus (LE - B)[2,4,8]; After local anesthesia, the eye is fixed with two forceps at the conjunctiva near the limbus and rotated in the direction opposite to the suspected mechanical restriction. The traction test is necessary for differential diagnosis of the cause of strabismus: paralysis (paresis) of the EOM or mechanical restrictive condition of its antagonist (myositis, EOM contracture, conjunctival or Tenon's capsule contracture, etc.). It is important not to exert pressure on the eye. Bielschowsky head tilt test - a symptom characteristic of paresis of the superior oblique muscle innervated by the trochlear nerve; the patient tries to keep the head tilted toward the healthy shoulder, forward and downward; if asked to tilt the head toward the paretic shoulder and backward, the strabismus becomes especially noticeable and diplopia becomes pronounced (LE - B)[2,4,8]; Parks three-step test – has diagnostic significance in trochlear nerve lesions (LE - B)[2,4,8]; First – assess which eye is hypertropic in primary position. Second – determine where the hypertropia is greater - on right gaze or left gaze. Third - Bielschowsky head tilt test - identify the paretic muscle.
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