Why is it important to dilate the pupils during an ophthalmological examination?

A detailed ophthalmological examination includes, in addition to testing visual acuity, measurement of intraocular pressure, examination of the anterior segment of the eye on a biomicroscope and dilation of the pupils to examine the posterior segment of the eye – the fundus.

Dilation of the pupils is achieved by instilling so-called mydriatic drops into the eye, which makes the entire fundus accessible to the ophthalmologist, both the central and peripheral parts of the retina. The most detailed examination is performed by the contact method through the Panfundoscope or Goldman’s glass with three mirrors that are placed directly on the eye using contact gel with prior instillation of local anesthetic.

We can see the peripheral part of the retina only with a completely wide pupil – mydriasis, that part is important because it often contains a wide variety of changes that, if not noticed in time, can lead to complications, and one of the most serious is certainly a rupture – tearing of the retina with the consequent detachment of the retina from its base ie retinal ablation.

Changes can be:

degeneration of the retinal periphery, which can be risky or non-risky
ruptures that can be horseshoe-shaped – tractional (risky) and circular (less risky)

Vitreoretinal degenerations are highly risky, they can predispose to the occurrence of rupture and ablation, especially when symptomatic vitreous detachment occurs and when it comes to risk categories (myopic people, condition after cataract surgery – pseudophakia, after YAG laser capulotomy, after severe injuries, inflammation… )

1. Palisade / reticular or equatorial degeneration, which occurs acquired, is more common with the aging process, more often in myopic persons, often bilaterally and in the upper-temporal parts of the retina. There may also be radials along the blood vessels of the peripheral retina. It occurs in 6-8% of patients and is associated with retinal detachment in 14-35% of cases. Due to the pathological relationship between the vitreous and the retina at the point of degeneration and the possibility of retinal rupture, this degeneration is an indication for LFC treatment.
   

   Lattice degeneration – palisade degeneration of the retina, belongs to the high-risk degenerations

   

   Traction rupture formed at the back edge of the palisade degeneration – traction caused by the separation of the vitreous body

   

   Retinal ablation can occur asymptomatically, without prior vitreous detachment due to the presence of quiet circular ruptures within the palisade degeneration.

2. Degeneration in the form of frost, Farinata-flourish, according to the “snail track”-“snail track” type, has a very specific appearance due to its shimmering, occurs in 10% of the population, in 40% of myopic people. Like palisade degeneration, it develops parallel to the equator in the pre-equatorial part in the region of the base of the vitreous body. It presents a risk for rupture and subsequent ablation and is an indication for LFC treatment. Even in 54% of cases it is associated with the occurrence of retinal rupture.
   

   Snail track degeneration – has a “snail track” appearance

3. Retinal tufts – sites of focal adhesion of the retina and vitreous body and are a risk for rupture and an indication for laser treatment
   

   Retinal ruptures occurred at the site of focal VR traction

4. Intraretinal degeneration carries a lower risk of rupture, among them the phenomenon of “white without pressure” is of particular importance due to the possibility of giant rupture and dialysis. It occurs in 30% of the population and is more common in myopic people.
   

   “White without pressure” – WWP

   

   Two horseshoe retinal tears with initial local retinal detachment

   

   Retinal ablation as a consequence of a horseshoe rupture – the passage of aqueous humor through the rupture leads to detachment of the retina – a condition that can only be solved surgically

Non-risky degenerations include:

• chorioretinal degeneration – paving stone degeneration (degeneratio annularis / ovalis),
• retinal drusen
• microcystoid degeneration
• pigment clumping
• diffuse zones of atrophy
  

  Paving stone degeneration, contrary to what was previously mentioned, it creates an even stronger adhesion to the chorioretina, thus imitating laser seals, and we call it protective degeneration

The aforementioned risky changes in the peripheral part of the retina, detected in time, are treated with a laser (laser photocoagulation), which “solidifies” the layers of the retina and choroid and prevents the occurrence of ablation. The intervention itself lasts a few minutes, it is not painful, it feels like a burning sensation, it is done under local/drip anesthesia, there is no recovery after the intervention, the patient is able to function from the next day, with instillation of drops – local non-steroidal anti-inflammatory drugs (Nevanac, Indocollyre, Uniclofen).

Retinal ruptures limited by laser stamps in several rows

Round retinal tears – “round holes” carry a lower risk of retinal detachment, but if the edges are raised and if it is a risk category, then LFC treatment is indicated

It is important to come to the ophthalmological examination with an escort and not to drive a vehicle, due to reduced visual acuity. Blurred vision is transient and lasts for several hours. An ophthalmological examination with dilation of the pupils and an examination of the fundus is a complete ophthalmological examination!

Schedule a complete ophthalmological examination on time!
See you at the well-known address Bulevar Patrijarha Pavla 1a in Novi Sad.
Schedule your appointment at 066/403 174 or 021/403174 or via the appointment form on our website.

See you!