X-ray signs of damage and diseases of the organ of vision

On the survey and sighting radiographs it is easy to determine the fractures of the walls and edges of the orbit. Fracture of the lower wall is accompanied by a darkening of the maxillary sinus due to hemorrhage into it. If a crack in the orbit penetrates into the paranasal sinus, air bubbles in the orbit (emphysema of the orbit) can be detected. In all the unclear cases, for example, with narrow cracks in the walls of the orbit, CT helps.

Trauma can be accompanied by the penetration of foreign bodies into the eye socket and eyeball. Metal bodies larger than 0.5 mm are easily recognized on radiographs. Very small and low-contrast foreign bodies are detected with the help of special equipment - the so-called disskeletal images of the eye. They are made on small films inserted after anesthesia in the conjunctival sac under the eyeball. In the image, the image of the anterior part of the eye is obtained without applying a shadow of the bone elements. In order to accurately localize the foreign body in the eye, the Comberga-Baltina prosthesis is applied to the surface of the eyeball. The shots with the prosthesis are performed in a straight and lateral projection from a distance of 60 cm. The obtained images are analyzed with the help of special schemes applied to a transparent celluloid film and determine the meridian of the eye on which the foreign body is located and its distance from the plane of the limb in millimeters.

Significantly facilitated the search for and precise localization of foreign bodies in the eye socket and eyeball, zhophtalmoskopiya and computed tomography. Ultrasound diagnosis of intraocular fragments is based on the detection of the so-called fragment echo - a short pulse on a one-dimensional echogram. At the site of this peak, isolines are judged for the localization of a foreign body - in the anterior chamber of the eye, inside the lens, in the vitreous body or on the fundus. An important sign of the echo signal, indicating its fragile nature, is the disappearance of the peak at the slightest change in the direction of the biolocation axis. Modern ultrasonic devices, under favorable conditions, can detect fragments with a diameter of 0.2-0.3 mm.

For planning the extraction of a foreign body, it is important to know its magnetic properties. During the ultrasound, an electromagnet is included. If the shape and size of the "fragmentation" echoes do not change, then the fragment's magnetization or the presence of pronounced scars around it, which prevent its displacement, is assumed.

Most diseases with eyeball damage are diagnosed with direct ophthalmoscopy and ultrasound. Computer or magnetic resonance imaging is used mainly to recognize lesions of the posterior orbit and to detect their intracranial spread. Very useful tomograms for establishing the volume of the eye mouse and optic nerve thickening in neuritis.

Ultrasound and MRI are widely used in opacities of the optic media of the eye in cases where direct ophthalmoscopy is ineffective. For example, with corneal leukemia, the echography allows you to determine its thickness, as well as the position and thickness of the lens, which is necessary when choosing surgical techniques for keratoplasty and keratoprosthetics. With a filmy cataract, i.e. Partial or complete clouding of the substance or capsule of the lens, a single "lens" echo is detected, indicating the presence of a filmy structure between the vitreous body and the cornea. Immature cataracts are accompanied by the appearance on the one-dimensional echogram of additional small echoes between two lens signals.

When the vitreous body is cloudy, one can establish the degree of its acoustic inhomogeneity. A typical picture is focal endophthalmitis, a serious eye disease accompanied by a loss of vitreous transparency.

With eye tumors, ultrasound examination makes it possible to determine the exact localization and area of the lesion, germination into adjacent membranes and retrobulbar space, the presence of small foci of necrosis, hemorrhage, calcification in the neoplasm. All this in a number of cases makes it possible to clarify the nature of the tumor.

Radiation studies are necessary in the pathological development of the eyeball from the orbit - exophthalmos. When analyzing the radiographs of the skull, the so-called false exophthalmos - the eyeball's stance at congenital asymmetry of the bones of the facial skull - is immediately excluded. The nature of the true exophthalmos is established by sonography, CT or MRI. These methods allow you to detect hematoma with a trauma, cyst or swelling in the tissues of the eye socket or sprouting from the neighboring area, brain hernia in the cavity of the orbit or spreading into the last inflammatory process from the cells of the trellis labyrinth.

In individual patients, pulsating exophthalmos are observed. It can be a manifestation of an aneurysm of the orbital artery, arterial hemangioma, lesions of carotid-venous anastomosis. If it is not possible to perform CT or MR angiography, then carotid angiography is performed (radiopaque examination of the carotid artery and its branches). Variant is the intermittent exophthalmus, which occurs when the varicose veins of the orbit are widened. And in this case, angiographic techniques - CT, MR angiography or oculary venography - are of crucial importance in diagnosis.

Exophthalmus sometimes develops as a result of endocrine disorders, in particular with thyrotoxicosis. In these cases, it is associated with an increase in ectopic muscles (especially the medial rectus muscle), which is clearly recorded on computer and magnetic resonance tomograms. They also make it possible to detect exophthalmos caused by the accumulation of fat in the cavity of the orbit. The diagram shows an exemplary survey tactics conducted to find out the causes of the ectophthalmus. For the investigation of lacrimal canals, two ray techniques have been developed: X-ray and radionuclide dacryocystography. In both cases, after an anesthetic of the conjunctiva 0.25% solution of dicaine with a 1-2 gram syringe, a solution of contrast medium is injected through the thin blunt needle into the upper or lower lacrimal point. With x-ray dacryocystography, an X-ray contrast preparation is poured (recently, digital x-ray is the method of choice, which makes it possible to obtain an image of lacrimal passages without the imposition of bone elements.