第二章視功能檢查ChapterTwoVisualFunctionExamination68課件

第二章視功能檢查

ChapterTwoVisualFunctionExamination五、眩光檢查Ⅴ.

GlareExamination標(biāo)準(zhǔn)視力表所釆取的是具有高度對(duì)比度的黑白對(duì)比視標(biāo)，并不能反映患者生活中的真實(shí)視力。當(dāng)患者存在角膜斑翳、圓錐角膜、角膜水腫、白內(nèi)障、玻璃體混濁時(shí)，標(biāo)準(zhǔn)視力表所查得的視力可能是在正常范圍內(nèi)，但在白天較亮或夜間較暗的光線下，由于眩光的出現(xiàn)導(dǎo)致視力明顯下降。原因在于眼屈光間質(zhì)不均一，使得眼內(nèi)光線散射，從而減低了實(shí)際到達(dá)視網(wǎng)膜的光線的對(duì)比度。Adoptingablackandwhitecontrastindexwithhighcontrast,thestandardvisionchartcannotreflecttherealvisionofthepatientinlife.Whenapatientsuffersfromcornealplaque,keratoconus,cornealedema,cataract,orvitreousopacity,thevisionmaybewithinthenormalrangebyexaminationonthestandardchart,butthevisiondecreasessignificantlyduetotheglareinbrightlightatdayordarklightatnight.Thisisbecausethelightscattersintheeyesduetonon-uniformrefractivestromaoftheeye,whichreducesthecontrastoflightactuallyreachingtheretina.由于各種原因引起低視力患者的眩光，將造成患者的不適或視力下降。特別是物品之間對(duì)比度的降低，將導(dǎo)致低視力患者在室內(nèi)活動(dòng)的困難。Glareinlowvisionpatientsduetovariousreasonswillcausediscomfortorreductionofvision.Inparticular,areductionincontrastbetweenitemswillmakelow-visionpatientshavedifficultiesinmovingindoor.眩光分為：不適眩光和失能眩光。前者是指由于散射光線導(dǎo)致視覺不適，而不影響分辨率或視力的情況。后者是指由于散射光線在眼內(nèi)使視網(wǎng)膜成像重疊、視網(wǎng)膜成像的對(duì)比度下降，降低了視覺效能和清晰度，甚至不能視物。Glareisdividedinto：

discomfortglareanddisabilityglare.Theformerreferstovisualdiscomfortduetodivergencelight,whichdoesnotaffectresolutionorvision.Thelatterreferstothecasewhenvisualefficiencyandclarityarereducedandthepatientisevenunabletoviewobjectsbecausethedivergencelightcreatesoverlappingretinalimagingintheeye,andthecontrastofretinalimagingisreduced.眩光的檢查：常用眩光測(cè)試儀,如InnomedTerry視力分析儀、多種視覺敏感度測(cè)試儀和Miller-Nadler眩光測(cè)試儀等。自動(dòng)型眩光檢查儀及對(duì)比敏感度檢查儀，能同時(shí)進(jìn)行對(duì)比敏感度和眩光敏感度兩項(xiàng)檢查。Theglareexaminationiscommonlyconductedwithglaretesters,suchasInnomedTerryVisionAnalyzer,MultipleVisualSensitivityTesterandMiller-NadlerGlareTester,etc.Takaci-CGT-1000automaticglareandcontrastsensitivitytestercancheckcontrastsensitivityandglaresensitivityatthesametime.該檢查對(duì)低視力患者的視覺康復(fù)有著重要的指導(dǎo)意義和實(shí)用價(jià)值。如某些眼人工晶狀體患者即使視力為1.0,由于眩光的原因，患者會(huì)抱怨在強(qiáng)光下或暗光下無法自如行動(dòng)。因此眩光檢查能反映患者的在日常生活中的實(shí)際視功能，并且可以指導(dǎo)患者在日常生活中盡量避免有害的眩光，改善視覺質(zhì)量。Thisexaminationisimportanttovisualrehabilitationofpatientswithlowvisionbothinguidingsignificanceandpracticalvalue.Forexample,somepatientswithintraocularlenseshave1.0vision,buttheymaycomplainofbeingunabletomovefreelyinhighorlowlightduetoglare.Therefore,itcanreflecttheactualvisualfunctionofthepatient,andguidethepatienttoavoidharmfulglareasmuchaspossibleindailylifeandimprovethevisualqualitythroughtheglaretest.六、立體視覺Ⅵ.StereoscopicVisionExamination深度覺，是感知物體立體形狀及不同物體之間遠(yuǎn)近關(guān)系的能力，立體視覺一般須以雙眼單視為基礎(chǔ)。許多職業(yè)要求有良好的立體視覺，如駕駛員、飛行員、畫家、雕塑家以及從事機(jī)械精細(xì)加工和微電子的人員。Stereoscopicvision,alsoknownasdepthperception,istheabilitytoperceivethethree-dimensionalshapeofanobjectandthedistancebetweendifferentobjects,whichisgenerallybasedonbinocularvision.Manyoccupations,suchaspilots,pilots,painters,sculptors,andpersonnelengagedinmechanicalfineprocessingandmicroelectronics,requiregoodstereoscopicvision.在眼科臨床中，對(duì)斜視、弱視、屈光不正、視力疲勞和某些眼病均需檢查立體視覺。Inclinicalophthalmology,stereoscopicvisionshouldbeexaminedforstrabismus,amblyopia,refractiveerror,asthenopiaandsomeeyediseases.檢查立體視覺可以使用綜合驗(yàn)光儀、同視機(jī)、Titmus、Frisby、顏少明立體視覺檢查圖譜、與計(jì)算機(jī)相連的立體視覺檢測(cè)系統(tǒng)等。常用的有：Thestereoscopicvisioncanbeexaminedbyphoropter,synoptophore,Titmus,FrisbyandYanShaomingstereoscopicvisionexaminationatlas,stereoscopicvisionexaminationsystemconnectedwithcomputer,etc.Detailsareasbelow:1.綜合驗(yàn)光儀

雙眼前加偏振光鏡片，注視立體視檢査視標(biāo)，左右眼能看到的分別是整體圖形的一部分。雙眼同時(shí)觀看，可以看到全部圖形并有立體感出現(xiàn)，說明有立體視。雙眼同時(shí)觀看，但只能看到一部分圖形，且無立體感，說明無立體視。1.Phoropter:addpolarizedlightlensinfrontofbotheyesofthepatient,whofixesonthestereoscopicvisionexaminationtarget,andcanseeapartofthewholefigurerespectivelyfromtheleftandrighteyes.Ifthepatientwatcheswithbotheyesatthesametimeandcanseeallthegraphicsandhavestereoscopicimpression,itindicatesthatthereisstereoscopicvision.Ifthepatientwatcheswithbotheyesatthesametimebutonlyapartofthefigurecanbeseenandthereisnostereoscopicimpression,itindicatesthatthereisnostereoscopicvision.2.同視機(jī)把兩張立體視畫片放入同視機(jī)的插片盒內(nèi)，雙臂擺在重合點(diǎn)附近，正常人能夠自然地產(chǎn)生立體視覺。根據(jù)畫片讀數(shù)和檢查中患者的反應(yīng)，可以了解患者的立體視功能。2.Synoptophore:Whenputtwostereoscopicpicturesintotheinsertboxofthesynoptophore,andputbotharmsnearthecoincidencepoint,thenormalpeoplecannaturallyhavestereoscopicvision.Thestereoscopicvisionfunctionofthepatientcanbeknownbasedonthepicturereadingandthepatient’sreactionduringtheexamination.3.Titmus立體圖

雙眼戴偏振光眼鏡，在33cm處注視Titmus立體圖。立體視銳度由粗到細(xì)依次檢查，檢查時(shí)要確保立體圖凸出于印刷平面，直到不能分辨，記錄能分辨的最小視銳度的秒弧數(shù)。立體視銳度如果在100秒弧以下為正常立體視，在100秒弧以上為粗的立體視。如雙眼同時(shí)注視僅僅看到單眼的平面圖形或雪花狀的散點(diǎn)，無立體感，說明無立體視。3.Titmusstereogram:FixonTitmusstereogramat33cmwithpolarizedglassesinbotheyes.Thepatientshallbeexaminedwithstereosharpnessfromthicktothininsequence,duringwhichitshallbeensuredthatthestereogramisprotrudedoutoftheprintingplaneuntilitcannotbedistinguished,anditshallrecordthesecondsofarcoftheminimumvisionthatcanberesolved.Ifthestereoscopicvisionislessthan100secondsofarc,itisnormalstereoscopicvision,andifitismorethan100secondsofarc,itiscoarsestereoscopicvision.Iffixedonwithtwoeyessimultaneously,onlyasingle-eyeplanefigureorsnowflake-shapeddivergencedotscanbeseen,andthereisnostereoscopicimpression,itindicatesthatthereisnostereoscopicvision.常見的色覺障礙是一種性連鎖隱性遺傳的先天性異常，后天性色覺異常又稱獲得性色覺異常，任何從視網(wǎng)膜到大腦視皮層間的視路上所發(fā)生的損害都可以引起后天性色覺異常,如顱腦疾病、某些眼病、全身疾病及中毒等。Thecommoncolorvisiondisorderisasex-linkedrecessivecongenitaldisorder,whileposterioritycolorvisiondisorderisalsocalledacquiredcolorvisiondisorder.Anydamagetothevisualpathfromtheretinatothevisualcortexofthebrain,suchascraniocerebraldisease,someeyediseases,systemicdiseases,andpoisoning,etc.,cancauseacquiredcolorvisiondisorder.1.假同色檢查法

假同色圖檢查法又稱色盲本，是由各種顏色色調(diào)不同而亮度相同，或各種顏色的色調(diào)相同而亮度不同的色點(diǎn)組成的圖形或數(shù)字所構(gòu)成。正常人以顏色來辨別：而色盲者以明暗來識(shí)別；色弱者能正確認(rèn)岀圖形或數(shù)字，但表現(xiàn)出困難或辨認(rèn)時(shí)間延長(zhǎng)。標(biāo)準(zhǔn)的假同色圖并不適用于后天性獲得性色覺異常者，故臨床上不推薦用于后天眼病導(dǎo)致視力障礙的低視力患者的檢查。1.Pseudoisochromaticplates:Pseudoisochromaticplates,alsoknownascolorblindnessbook,arecomposedoffiguresornumbersconsistingofdifferentcolorswiththesamebrightnessordifferentbrightnesswiththesamecolor.Normalpeopleidentifybycolor;color-blindpeopleidentifybybrightness;color-impairedpeoplecancorrectlyidentifyfiguresornumbers,butwithdifficultyorlongrecognitiontime.Thestandardpseudoisochromaticplatesisnotapplicableforpatientswithacquiredcolorvisiondisorder,soitisnotrecommendedforexaminationoflowvisionpatientswithvisualimpairmentcausedbyacquiredeyediseases.七、色覺檢查Ⅶ.ColorVisionExaminationColorvisiontestchart2.彩色毛線試驗(yàn)法

先給被檢查者某一種顏色的毛線，然后將該毛線摻雜在各種顏色的毛線中，囑被檢査者盡快挑選出顏色相同的毛線，根據(jù)所選毛線的顏色是否正確或在挑選中是否顯得猶豫不決來決定有無色覺障礙。Colorwooltestmethod:Firstgiveacertaincolorwooltotheexaminee,thenmixthewoolwithwoolofvariouscolors,asktheexamineetopickoutthewoolwiththesamecolorassoonaspossible,anddecidewhethertheexamineehascolorvisiondisorderbyiftheselectedwooliscorrectoriftheexamineeisindecisiveinselectingthewool.3.FM-100色彩試驗(yàn)和D-16色盤試驗(yàn)

囑患者按色調(diào)將有色棋子依次排列，根據(jù)其排列的順序正常與否，判斷有無色覺障礙及其性質(zhì)和程度。3.FM-100colortestandD-16colordisktest:Instructthepatienttoarrangethecoloredchesspiecesinturnasperthecolor,anddecidewhetherthepatienthascolorvisiondisorderanditsnatureanddegreebyifthearrangementorderisnormalornot4.色覺鏡色覺鏡(anomaloscope)利用紅光與綠光適當(dāng)混合形成黃光的原理，根據(jù)被檢者調(diào)配紅光與綠光的比例是否合適，來判斷是否有色覺異常以及色覺異常的性質(zhì)和種類。4.Anomaloscope:Withtheprincipleofproperlymixingtheredlightandgreenlighttoformyellowlight,anomaloscopedecideswhetherthesubjecthascolorvisiondisorderandthenatureandtypeofcolorvisiondisorderbyiftheproportionofredlightandgreenlightisproperlymixedbythesubject.對(duì)低視力患者的色覺檢查，目的是全面評(píng)價(jià)他們的視功能，為進(jìn)一步的工作定向職業(yè)訓(xùn)練和教育提供指導(dǎo)。Thecolorvisionexaminationinpatientswithlowvisionisaimedtoevaluatetheirvisualfunctionandprovideguidanceforfurtherworkorientation,vocationaltraining,andeducation.視覺電生理檢査是利用儀器檢測(cè)眼部生物電活動(dòng)以了解視覺功能的一種方法。它包括眼電圖(electrooculogram,EOG)、視網(wǎng)膜電圖(electroretinogram,ERG)和視覺誘發(fā)電位(visualevokedpotential,VEP)。Visualelectrophysiologyexaminationisamethodtounderstandthevisualfunctionwithaninstrumenttomeasurethebioelectricactivityoftheeye,whichincludeselectrooculogram(EOG),electroretinogram(ERG)andvisualevokedpotential(VEP).八、視覺電生理檢查Ⅷ.VisualElectrophysiologyExamination1.眼電圖：EOG記錄的是眼的靜息電位，產(chǎn)生于視網(wǎng)膜色素上皮細(xì)胞。暗適應(yīng)后眼的靜息電位下降，此時(shí)最低值稱為暗谷；轉(zhuǎn)入明適應(yīng)后，眼的靜息電位上升，逐漸達(dá)到最大值,即光峰。產(chǎn)生EOG的前提是光感受器細(xì)胞與RPE的接觸及離子交換，因此，EOG異?？煞从砇PE、光感受器細(xì)胞的疾病，以及中毒性視網(wǎng)膜疾病。一般情況下，EOG反應(yīng)與ERG反應(yīng)一致，EOG可用于某些不接受ERG角膜接觸鏡電極的兒童被檢者。它的異常反映的是視網(wǎng)膜色素上皮和光感受器復(fù)合體的異常。眼電圖也可用于測(cè)定眼球位置及眼球運(yùn)動(dòng)的生理變化。1.Electrooculogram:EOGrecordstherestingpotentialoftheeyethatisproducedbyretinalpigmentepithelialcells.Afterthedarkadaptation,therestingpotentialoftheeyedecreasedtothelowestvalueatthistime,whichwascalledthedarktrough;Afterthelightadaptation,therestingpotentialoftheeyeincreasedandgraduallyreachedthemaximum,i.e.thelightpeak.TheEOGproductionisonthepremiseofthecontactandionexchangebetweenphotoreceptorcellsandRPE.Therefore,abnormalEOGcanreflectRPE,diseasesofphotoreceptorcellsandtoxicretinaldiseases.Ingeneral,theEOGresponseisconsistentwiththeERGresponse,soEOGcanbeusedinsomepediatricsubjectswhorejectERGcontactlenselectrodes.Itsdisorderreflectsthedisorderofretinalpigmentepitheliumandphotoreceptorcomplex.EOGcanalsobeusedtodeterminethepositionoftheeyeballandphysiologicalchangesineyeballmovement.2.視網(wǎng)膜電圖

ERG記錄的是閃光或圖形刺激視網(wǎng)膜后，從角膜電極記錄到視網(wǎng)膜的動(dòng)作電位。它又分為閃光ERG、圖形ERG和多焦ERG,閃光ERG主要反映整個(gè)視網(wǎng)膜的功能狀態(tài)；圖形ERG反映視網(wǎng)膜神經(jīng)節(jié)細(xì)胞的功能狀態(tài)；多焦ERG能同時(shí)記錄中央30°視野內(nèi)100多個(gè)視網(wǎng)股位點(diǎn)上的ERG,反映不同位點(diǎn)視網(wǎng)膜的功能狀態(tài)，2.Electroretinogram:ERGrecordstheactionpotentialsfromcorneaelectrodestotheretinaelectrodesafterflashorpatternstimulationoftheretina,whichisdividedintoflashERG,graphicERGandmultifocalERG.TheflashERGmainlyreflectsthefunctionalstateofthewholeretina;thegraphicERGreflectsthefunctionalstateoftheretinalganglioncells;themultifocalERGcan,reflectthefunctionalstateoftheretinaatdifferentsitesbecauseitcansimultaneouslyrecordERGsatmorethan100retinalsitesinthecentral30°FOV.3.視覺誘發(fā)電位

VEP是視網(wǎng)膜受到閃光或圖形刺激后，經(jīng)視路傳遞，在視皮層枕葉誘發(fā)出的生物電活動(dòng)。它可用于判斷視神經(jīng)和視路疾病。3.

Visualevokedpotential(VEP):VEPisthebioelectricactivityinducedintheoccipitallobeofthevisualcortexaftertheretinaisstimulatedbyflashorpattern,whichcanbeusedforjudgingopticnerveandvisualpathdiseases.視覺電生理檢查是一種客觀視功能檢查方法，因此可用于檢查不合作的兒童、智力低下的患者及偽盲者的視功能。對(duì)低視力患者，還可以判斷使用助視器和功能性訓(xùn)練的治療效果。Asanobjectivevisualfunctiontest,visualelectrophysiologyexaminationcanbeusedtoexaminethevisualfunctionofuncooperativechildren,mentallyretardedpatients,andpseudo-blindpeople.Forpatientswithlowvision,itcanalsobeusedtojudgethetherapeuticeffectofusingvisualaidsandfunctionaltraining.低視力患者應(yīng)接受常規(guī)的眼科檢查，包括一般檢查、裂隙燈生物顯微鏡檢查、檢眼鏡檢查和眼科必要的輔助檢查，如眼底血管造影和眼科影像學(xué)檢查等。如果患者的眼部病變?nèi)栽诨顒?dòng)，則應(yīng)先治療眼部活動(dòng)性病變；只有當(dāng)眼部活動(dòng)性病變得到有效地控制變?yōu)殛惻f性病變時(shí)，而且經(jīng)眼科的各種治療手段治療無效時(shí)，要考慮使用助視器應(yīng)用。Patientswithlowvisionshouldacceptroutineophthalmicexaminations,includinggeneralexaminations,slit-lampbiomicroscopeexamination,ophthalmoscopeexamination,andophthalmologicalnecessaryauxiliaryexaminations,suchasfundusangiographyandophthalmicimaging.Theactiveoculardiseasesofpatientshouldbetreatedfirstiftheyarestillactive;onlyiftheactiveoculardiseasesareeffectivelycontrolledtobecomeobsoletediseases,andthetreatmentwithvariousophthalmictreatmentsisineffective,itshallconsidertousevisualaids.眼部的一般檢查主要觀察對(duì)象是眼附屬器的情況，包括:Inthegeneralexaminationoftheeye,themainobservationobjectistheconditionoftheadnexaoftheeye,including:1、眼瞼：注意眼瞼及瞼緣的位置是否正常、瞼裂是否對(duì)稱、上瞼提起及瞼裂閉合是否正常、眼瞼及瞼緣有無異常充血水腫等。1.Eyelid:Theexaminationincludeswhetherthepositionoftheeyelidandtheeyelidmarginisnormal,whetherthepalpebralfissureissymmetrical,whethertheuppereyelidisliftedandthepalpebralfissureisclosednormally,whetherthereisabnormalcongestionandedemaattheeyelidandtheeyelidmargin,etc.2、淚器：注意淚囊區(qū)有無紅腫壓痛.擠壓淚囊有無分泌物溢出。2.Lacrimalsac:Theexaminationincludeswhetherthereisswellingandtendernessinthelacrimalsacarea,andwhetherthereissecretionoverflowwhensqueezingthelacrimalsac.3、結(jié)膜：注意結(jié)膜有無異常充血水腫.有無濾泡、疤痕、瞼球粘連等。3.Conjunctiva:Theexaminationincludeswhetherthereisabnormalcongestionandedema,follicle,scar,symblepharon,etc.atconjunctiva.4、眼球：位置及運(yùn)動(dòng)注意眼球大小有無異常、位置是否對(duì)稱、運(yùn)動(dòng)有無障礙。4.Eyeball:Theexaminationincludeswhetherthesizeoftheeyeballisabnormal,whetherthepositionissymmetrical,andwhetherthereisanyobstacleinthemovement.九、眼部一般檢查Ⅸ.GeneralExamination5、眼眶：注意兩側(cè)眼眶是否對(duì)稱，眶緣觸診有無缺損、壓痛或腫物。5.Orbit:Theexaminationincludeswhetherbothorbitsaresymmetrical,andpalpatetheorbitalmarginsfordefects,tenderness,ormasses.6、眼壓：低視力患者的眼壓檢查是必要的項(xiàng)目之-。因?yàn)樵诘鸵暳﹂T診經(jīng)常有患者被檢出眼壓高于正常而被轉(zhuǎn)回青光眼門診繼續(xù)治療。6.Intraocularpressure:Intraocularpressureexaminationisoneofthenecessaryitemsforpatientswithlowvision,becausemanypatientsweretransferredbacktotheglaucomaclinicforcontinuedtreatmentaftertheyweredetectedwithhigher-than-normalIOPatthelowvisionclinic.裂隙燈顯微鏡由兩系統(tǒng)組成，即供照明的光源投射系統(tǒng)及供觀察的放大系統(tǒng)。可在強(qiáng)光下放大6~16倍，不僅能看清楚表淺的病變，而且可以調(diào)節(jié)焦點(diǎn)和光源寬窄，形成光學(xué)切面，看清深部組織及其前后關(guān)系。

Theslitlampbiomicroscopeisconsistedoftwosystems,includingalightsourceprojectionsystemforilluminationandamagnificationsystemforobservation.Itcanbemagnified6~16timesunderstronglight,notonlytoseethesuperficialdiseaseclearly,butalsotoclearlyseethedeeptissueandtherelationshipbetweenthefrontandbackafteradjustingthefocusandthewidthofthelightsourcetoformanopticalsection.（一）裂隙燈顯微鏡檢查（Ⅰ）SlitlampBiomicroscopeExamination裂隙燈顯微鏡檢查是眼科最常見的檢査方法，主要用于眼前節(jié)如結(jié)膜、角膜、前房、虹膜、晶狀體和前部玻璃體的檢查。附加前置鏡、接觸鏡、前房角鏡、三面鏡，可檢查前房角、玻璃體和眼底。再配備前房深度計(jì)、壓平眼壓計(jì)、照相機(jī)，其用途更為廣泛。Asthemostcommonmethodofexaminationinophthalmology,slitlampbiomicroscopeismainlyusedtoexamineanteriorsegmentsoftheeyesuchasconjunctiva,cornea,anteriorchamber,iris,lens,andanteriorvitreous.Theanteriorchamberangle,vitreousandfunduscanbeexaminedafteraddingfront-endlenses,contactlenses,gonioscopes,andthree-mirrorcontactlens.Anditcanprovidemoreextensivefunctionsafterequippedwithanteriorchamberdepthgauge,applanationtonometer,camera.角膜檢查是裂隙燈顯微鏡檢查的重點(diǎn)。在對(duì)低視力患者的病因的所作研究中，角膜混濁是低視力的常見病因之一，而病毒性角膜炎又是導(dǎo)致角膜混濁的常見病因之一。裂隙燈顯微鏡檢査首先要辨別角膜是否有活動(dòng)性病變存在，如有，則應(yīng)轉(zhuǎn)診至角膜病門診繼續(xù)治療；其次，要辨別角膜混濁的程度，是云翳、斑翳還是白斑，角膜混濁程度是否與實(shí)際視力相符合，如果角膜僅有輕度云翳而視力低于0.1,應(yīng)該進(jìn)一步檢查（如擴(kuò)瞳檢查眼底、電生理檢査等），有助于發(fā)現(xiàn)角膜以外的眼病。Cornealexaminationisthefocusofslitlampbiomicroscope.Inthestudyofthecausesoflowvisionpatients,cornealopacityisoneofthecommoncauses,meanwhile,viralkeratitisisoneofthecommoncausesofcornealopacity.Intheexaminationofslitlampbiomicroscope,itshallfirstidentifywhetherthereisanactivediseaseinthecornea.Ifso,itshouldbetransferredtothekeratopathyclinicforfurthertreatment;Secondly,itshallidentifythedegreeofcornealopacity,whetheritisnebula,maculaorleucoma,andwhetherthedegreeofcornealopacityisconsistentwiththeactualvision.Ifthecorneaisonlywithslightnebulabutthevisionislessthan0.1,itshallperformfurtherexamination(suchasmydriaticexaminationoffundus,electrophysiologicalexamination,etc.)tohelpfindouttheoculardiseasesotherthanthecornea.常用的檢眼鏡有直接和間接兩種。Therearetwocommontypesofophthalmoscope,directandindirect.直接檢眼鏡檢查,所見眼底為正像，放大約16倍。通常可不散瞳檢查，若需詳細(xì)檢查則應(yīng)散瞳。Forthedirectophthalmoscopeexamination,thefunduswasseenasapositiveimageatapproximately16Xmagnification.Ingeneral,thepupilmaynotbedilated,butifdetailedexaminationisrequired,thepupilshouldbedilated.

（二）檢眼鏡檢查（Ⅱ）OphthalmoscopeExamination雙目間接檢眼鏡

一般需散瞳檢查。所成的倒虛像位于檢查者和透鏡之間，具有立體感。與直接檢眼鏡相比，放大倍數(shù)較小，但可見范圍較大，能比較全面地觀察眼底,不易漏診眼底病變。輔以鞏膜壓迫器，可看到鋸齒緣，有利于查找視網(wǎng)膜裂孔。Forindirectbinocularophthalmoscopeexamination,usuallythepupilshouldbedilated.Theresultinginvertedvirtualimageislocatedbetweentheexaminerandthelenswithastereoscopicimpression.Comparedwiththedirectophthalmoscope,themagnificationoftheindirectissmallerbutthevisiblerangeislargertocomprehensivelyobservethefundussothatthefundusdiseasesarenoteasytobemissed.Withascleralcompressor,itcanseetheserratededgetohelptofindretinaltears.眼底檢查記錄內(nèi)容:視盤大小、形狀、顏色、邊界和病理凹陷;視網(wǎng)膜血管的管徑大小是否均勻致、顏色、動(dòng)靜脈比例、形態(tài)、有無搏動(dòng)及交叉壓迫征:黃斑部及中心凹光反射情況:視網(wǎng)膜有否出血、滲出、色素增生或脫失，描述其大小形狀、數(shù)量等;視網(wǎng)膜有無裂孔、網(wǎng)脫:眼底有無隆起不平，如腫物、炎癥.滲出和寄生蟲等:眼內(nèi)有無異物。

Recordcontentsoffundusexamination:Size,shape,color,boundaryandpathologicaldepressionofopticdisc;whetherthediameterofretinalbloodvesselisuniformandconsistent,color,ratioofarteryandvein,andshapeofretina,whetherthereispulsationandcrosscompressionsign;lightreflexofmaculaandfovea;whetherthereishemorrhage,exudation,hyperpigmentationorlossofretina,anditssize,shapeandquantity,etc.shallbedescribed;whetherthereistearordetachmentofretina;whetherthereisbulgeandunevennessoffundus,suchastumor,inflammation,exudationandparasite;whetherthereisforeignbodyineye.十、眼科影像檢查Ⅹ.OphthalmicImagingExamination1.X線檢查和電子計(jì)算機(jī)斷層掃描(computedtomography,CT)

通常的X線和CT掃描，在評(píng)價(jià)眼眶和顱內(nèi)病變等方面很有用。特別是CT掃描已經(jīng)成為外眼視覺通道的組織結(jié)構(gòu)病變定位和定性最廣泛應(yīng)用的方法。眼部異常包括眼眶骨折、異物、腫瘤、腫瘤鈣化、炎性腫物等，都可由X線或CT掃描顯示出來。1.X-rayandcomputedtomography(CT):ConventionalX-rayandCTscanplayagreatroleinevaluatingorbitalandintracranialdiseases.Inparticular,CTscanninghasbecomethemostwidelyusedmethodforthelocalizationandcharacterizationofdiseasesintheexternalvisualchannels.X-rayorCTscancanalsorevealocularabnormalities,includingorbitalfractures,foreignbodies,tumors,tumorcalcification,inflammatorymasses,etc.2.磁共振成像(magneticresonanceimaging,MRI)

MRI在眼眶和顱內(nèi)診斷方面有很多應(yīng)用。MRI可以很好地分辨含水量不同的組織，所以在水腫、脫髓鞘及血管等病變的成像方面優(yōu)于CT。但MRI禁忌探測(cè)磁性異物。2.Magneticresonanceimaging(MRI):MRIiswidelyappliedinorbitalandintracranialdiagnosis.Asitcandistinguishtissueswithdifferentwatercontents,MRIisbetterthanCTintheimagingofedema,demyelination,andvasculardiseases.However,MRIisforbiddentodetectmagneticforeignbodies.3.眼部超聲檢查

眼部超聲檢查就是利用聲能的反射特性，構(gòu)成波形或圖像，來研究一些不能直接看到的組織結(jié)構(gòu)，可以用來探測(cè)眼球或眼眶。目前臨床常用的有A型超聲、B型超聲、超聲Doppler、超聲生物顯微鏡(ultrasoundbiomicroscope,UBM),用于眼部活體組織生物測(cè)量以及眼內(nèi)或眶內(nèi)腫物、視網(wǎng)膜和脈絡(luò)膜脫離、眼外傷和眼內(nèi)異物探査等。3.Ocularultrasoundexamination:Byusingthereflectioncharacteristicsofacousticenergytoformwaveformsorimages,ocularultrasoundexaminationistostudysometissuestructuresthatcannotbeseendirectly,applicabletodetectingtheeyeballororbit.Atpresent,thecommonlyusedmethodsinclinicalpracticeincludeA-modeultrasound,B-modeultrasound,Dopplerultrasound,ultrasoundbiomicroscope(UBM),whichareusedforbiometryofocularbiopsy,intraocularororbitaltumor,retinalandchoroidaldetachment,oculartrauma,andintraocularforeignbodyexamination.4.眼底血管造影

將造影劑從肘靜脈注入，利用特定濾光片和眼底照相機(jī)，拍攝眼底血管及其灌注特征。分為熒光素眼底血管造影(fundusfluorescenceangiography,FFA)及吲哚青綠血管造影(indocyaninegreenangiography,ICGA)兩種。前者以熒光素鈉為造影劑，主要反映視網(wǎng)膜血管的情況；后者以吲哚青綠為造影劑，反映脈絡(luò)膜血管的情況，有助于發(fā)現(xiàn)脈絡(luò)膜新生血管、滲漏等。4.Fundusangiography:Afterinjectingcontrastmediumfromthecubitalvein,itcanphotographthefundusvesselsandtheirperfusioncharacteristicswithaspecificfilterandfunduscamera.Thereweretwotypesofcontrastmedium,includingfundusfluoresceinangiography(FFA)andindocyaninegreenangiography(ICGA).Theformerusesfluoresceinsodiumascontrastmediumtomainlyreflectretinalbloodvessel,whilethelatterusesindocyaninegreenascontrastmediumtoreflecttheconditionofchoroidalbloodvessel,whichishelpfultofindchoroidalneovascularizationandleakage.5.光學(xué)相干斷層掃描(opticalcoherencetomography,OCT)

OCT技術(shù)是一種高分辨率、非接觸性的生物組織成像技術(shù)，這項(xiàng)技術(shù)可以在活體上獲得類似于眼組織病理改變的影像，提高了人們對(duì)一些疾病發(fā)生發(fā)展過程的認(rèn)識(shí)，是繼眼科放射診斷、磁共振技術(shù)、超聲診斷后又一全新的影像學(xué)診斷技術(shù)。5.Opticalcoherencetomography(OCT):Asahigh-resolution,non-contactbiologicaltissueimagingtechnology,OCTtechnologyisusedtoobtainimagessimilartothepathologicalchangesoftheeyetissueinvivotoimprovepeople'sunderstandingoftheoccurrenceanddevelopmentprocessofsomediseases,whichisabrand-newimagingdiagnosistechnologyaftertheophthalmicradiologicaldiagnosis,magneticresonancetechnologyandultrasonicdiagnosis.6.光相干斷層掃描血管成像技術(shù)(OCTA)

是一種快速、無創(chuàng)的新型血管成像技術(shù)，可實(shí)現(xiàn)視網(wǎng)膜脈絡(luò)膜血管分層成像，量化病灶血流面積和指定區(qū)域血流指數(shù)；同時(shí)避免了眼底血管造影等有創(chuàng)檢査的潛在風(fēng)險(xiǎn)。應(yīng)用于視網(wǎng)膜血管性疾病、脈絡(luò)膜新生血管、特發(fā)性黃斑中心凹旁毛細(xì)血管擴(kuò)張癥及視神經(jīng)炎等眼底疾病的診斷和治療隨訪，在分層顯示視網(wǎng)膜各層血管及其血流狀態(tài)方面表現(xiàn)出獨(dú)具特色的優(yōu)勢(shì)。6.Opticalcoherencetomographyangiography(OCTA):Itisanovel,rapid,non-invasivevascularimagingtechnologythatcanrealizestratifiedimagingoftheretinalandchoroidalvesselsandquantificationoftheflowareaofthediseaseandtheflowindexofagivenregion;whileitavoidsthepotentialrisksofinvasiveexaminationssuchasfundusangiography.Itisappliedtothediagnosisandtreatmentfollow-upofretinalvasculardiseases,choroidalneovascularization,idiopathicparafovealtelangiectasia,opticneuritis,andotherfundusdiseases,showinguniqueadvantagesintheaspectofstratifiedimagingoftheretinalandchoroidalvesselsandflowstatus.7.廣角數(shù)碼兒童視網(wǎng)膜成像系統(tǒng)(RetCam)