Eyes are one of the important sensory organs with the help of which a person can see everything around him. The visual organ consists of the eyeball, visual system and auxiliary organs (eyelids, tear ducts, muscles of the eyeball, conjunctival sac, etc.)
The conjunctival sac of the eye is a cavity that is located between the upper or lower eyelids and the eye itself. It follows from this that the upper and lower conjunctival sac are different. The frontal wall is the eyelid, and the posterior wall is the conjunctiva of the eye.
If you close your eyes, the conjunctival sac forms a closed internal hollow space, hence the name of the sac. The average volume of this recess is approximately 1-2 drops.
What is the function of the conjunctival sac of the eye? Its direct purpose is the secretion of the composition of the tear fluid, due to which the eyeball is lubricated and softened. Also protects against dust, lint and other foreign bodies.
Many eye drops say that they must be instilled into the conjunctival sac. But many people don’t even know how to do it correctly.
To properly instill drops into the conjunctival sac, you need to tilt your head back a little. Then gently pull back the lower eyelid and drop as many drops into the conjunctival space as recommended by the doctor or the instructions for the medication.
It is worth paying attention to the fact that drugs used to treat the eyes (ointments or drops) are distributed very quickly and evenly throughout the organ of vision. This occurs due to reflexive frequent blinking and the release of tear fluid.
Basically, diseases that can occur in the conjunctival space are caused by poor eye hygiene. Often this problem occurs in children who do not wash their hands and begin to rub their eyes. As a result, a serious eye disease is conjunctivitis. In addition to infection, inflammation of the conjunctiva can be caused by an allergic reaction, disruption of the normal functioning of the glands, or exposure to poisonous and toxic substances.
Clinical picture of the disease:
It is usually difficult and painful to open your eyes in the morning, as the purulent contents stick together and dry out overnight.
A serious complication of conjunctival inflammation is vision loss caused by keratitis. Keratitis is an inflammation of the stratum corneum of the eye.
Trachoma is a chronic eye disease that is caused by chlamydia and is characterized by damage to the cornea and conjunctiva. In the absence of proper treatment, scarring of the mucous membrane, destruction of cartilage and complete loss of vision occurs.
Symptoms of trachoma are:
As a consequence of a recurrent disease, scarring of the conjunctiva occurs with the formation of adhesions between the eyeball and the inner surface of the eyelid. This process causes contraction of the conjunctival arches and or their complete disappearance. Scarring of the cartilage causes entropion, eyelash growth toward the eyeball, and drooping of the upper eyelid (ptosis).
Chemosis is significant swelling of the conjunctiva. Most often it reaches large sizes, covers the stratum corneum of the eye and then begins to protrude from the palpebral fissures. The causes of chemosis are varied: conjunctivitis, drug instillation, swelling of the eyelids, acute inflammatory diseases (hordeolum, orbital phlegmon, panophthalmitis), tumor in the retrobulbar space.
Symptoms of the disease:
The occurrence of the disease is possible both in a limited area and on the entire surface of the visual organ. During conjunctivitis, accumulation of purulent contents under the swollen layer is possible, which will begin to lead to the appearance of ulcers on the cornea. Treatment should be carried out by an ophthalmologist, since self-medication will only cause harm.
All kinds of eye injuries occur as a result of injury to the eyeball and its appendages (conjunctival sac, eyelids, lacrimal organs, and others). Due to the fact that the eyes are located on the surface of the face, they are very vulnerable to all kinds of mechanical damage: burns, injuries, wounds, foreign objects and others.
Superficial injuries often occur as a result of damage to the ocular apparatus by nails, lenses, tree branches, clothing, etc. Blunt injuries occur as a result of being hit with a fist, ball, sticks and are often accompanied by bleeding in the tissue of the eyelids and eyes. A frequent combination is observed with a concussion.
Penetrating injuries occur as a result of the use of sharp objects (knives, forks, wire, glass fragments and many others). Often, when injured by shrapnel, a foreign object penetrates inside the eye. Treatment depends on the severity of the injury and is carried out in a hospital setting.
An acute respiratory viral infection (rubella, measles, chickenpox) provokes inflammation of the conjunctiva and affects the conjunctival sac of the eye due to decreased immunity. To get rid of the disease, it is necessary to treat the underlying disease, then after a few days the swelling will go away and the eyes will return to their previous healthy appearance.
The cavity located between the eye and the eyelid is called the conjunctival sac. The eyeball and eyelid form its posterior and anterior walls, and the areas where they adjoin each other are the conjunctival fornix.
The definition of a bag was not given by chance, but because when the eyelids are closed, it is a cavity tightly closed on all sides. A volume of liquid of no more than 1–2 drops is placed in it. The upper arch has an average depth of 10 mm, and the lower – 8 mm.
The surface of the conjunctival sac is covered with a smooth, pale pink membrane. At the outer and inner corners, the conjunctiva is loose and red, as it contains many vessels. The conjunctival sac is necessary for the secretion of tears and wetting the eye, removing dust particles and villi along with the mucous fluid.
Any ophthalmic medications are instilled directly into the conjunctival sac. And to be more precise, in its lower arch.
This is explained by the fact that after closing the eyelids, the product is evenly distributed and envelops the entire mucous membrane of the eye. This promotes rapid absorption of the drug and rapid manifestation of the pharmacological action.
When using eye drops, you must adhere to the following rules:
Pull back the lower eyelid and look up. Squeeze a thin strip of ointment from the tube into the lower conjunctival fornix along its entire length, moving from the inner corner to the outer.
After completion, it is useful to blink, so the drug will be distributed over the surface faster.
If it is necessary to introduce several types of drugs into the conjunctival sac, a certain order must be followed:
The interval between injections is at least 10 minutes. If pus is released, the eye is first washed with cool running water.
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All information is presented for educational purposes. Do not self-medicate, it is dangerous! Only a doctor can make an accurate diagnosis.
Along with general treatment, local therapy is also widely used in ophthalmology. The most commonly used method is the administration (instillation) of eye drops.
Injection of eye drops into the conjunctival sac is carried out as follows. The sister takes the pipette in her right hand (Fig. 58). Fix the glass part of the pipette between the II and III or between the III and IV fingers, and the pipette between the thumb and forefinger and draw a few drops of medicine into the pipette. With the fingers of her left hand, in which there is a damp ball of cotton wool, she pulls back the lower eyelid (the patient looks up) and quickly puts 1-2 drops into the inner corner of the eye. You cannot turn the pipette upside down; it is best to hold it with the tip down at an angle of 45°. The pipette should not touch the eyelashes. No more than 1-2 drops can fit in the conjunctival sac. Drops remaining in the pipette should not be poured back into the vial. After putting drops into the eyes or putting ointment behind the eyelids, you must ask the patient to look down.
Rinsing the conjunctival sac. The conjunctival sac can be washed in several ways (Fig. 59.).
1. They let in not 1-2 drops, but 5-6 drops. Excess fluid flows out.
2. The lower eyelid is pulled back and the conjunctival sac is washed using an undine or rubber balloon. The liquid flows into a kidney-shaped basin, which the patient holds against his cheek. The eyelids are spread apart, sometimes turned inside out.
3. Pour the required solution into a special eye bath to the brim and, pressing the edges of the glass to the bony walls of the orbit, force the patient to blink.
4. Esmarch’s mug is suspended at a height of up to 1 m (so that the liquid flows out under some pressure) and the cavity of the conjunctival sac is washed from a rubber tube in case of chemical burns, dust, etc. To irrigate and cauterize the conjunctiva, turn out the upper eyelid, then bring it closer with the conjunctiva of the retracted lower eyelid (to cover the cornea to avoid burns), irrigate the conjunctiva with the necessary solution. Its excess is neutralized and washed off from the undine with physiological solution.
To put ointment into the conjunctival sac, take it on the spatula of a glass rod, pull back the lower eyelid and place a stick with ointment in the area of the lower fornix (Fig. 60). Then the eyelids are closed, the glass rod is slowly removed to the side, and the eyeball through the eyelid is lightly massaged so that the ointment is distributed evenly.
Eye ointments are prepared with sterile Vaseline. To make the ointment more gentle, lanolin is added to Vaseline in equal parts. Ointments remain in the conjunctival sac longer than drops, and the fatty base of the ointment itself sometimes has a beneficial effect on the conjunctiva. Medicines used for ointments must be thoroughly ground. Emulsions are laid in the same way.
Some medications in the form of carefully crushed powders are injected into the conjunctival cavity. To do this, pull back the lower eyelid and powder the conjunctiva with a glass rod or cotton wool (sulfonamides, calomel, etc.).
Often the medicinal substance is injected directly under the conjunctiva of the eye or fornix, where a depot of these substances is created. After one or two instillations of a 0.5% dicaine solution, an injection of corticosteroids, novocaine, streptomycin, and penicillin is made under the conjunctiva. Autologous blood and oxygen are administered in the same way (oxygen therapy).
Sometimes the conjunctivae of the eyelids are lubricated with copper sulfate or alum in the form of eye pencils. In this case, you need to carefully check whether the eye pencil has any sharp edges. Before use, the pencil must be wiped with a damp cotton swab and a disinfectant solution.
Lubrication is used for trachoma and follicular conjunctivitis.
Rice. 58. Letting in drops. 
Rice. 59. Rinsing the conjunctival sac. 
Rice. 60. Laying ointment.
Indications. Treatment, diagnosis, pain relief during various manipulations.
Contraindications. Drug intolerance.
Equipment. Pipette, cotton ball.
Instructions for the patient before the procedure.
Raise your chin and fix your gaze upward and inward.
Technique. Typically, eye drops are instilled into the lower conjunctival fornix when the lower eyelid is pulled back with a cotton ball and the eyeball is deviated upward and inward. It is preferable to instill drops into the outer canthus. It is necessary to ensure that the drops do not fall on the cornea - the most sensitive part of the eye. The cotton ball absorbs excess medication, preventing it from running down the patient's face. You can also instill drops into the upper half of the eyeball - when the upper eyelid is retracted and when the patient is looking down. When instilling potent drugs (for example, atropine) into the eyes, in order to avoid getting them into the nasal cavity and in order to reduce the overall effect, you should press the area of the lacrimal canaliculi with your index finger for one minute.
Possible complications. Allergic reaction to the drug. If the manipulation is carried out carelessly, damage to the conjunctiva or cornea may occur.
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19. Approximate assessment of the binocular state using:
· "hole in the palm" tests
· tests with knitting needles
Binocular vision is a complex mechanism that combines the activity of the sensory and motor systems of both eyes, ensuring the simultaneous direction of the visual axes to the object of fixation, the fusion (fusion) of monocular images of this object into a single cortical image and its localization to the appropriate place in space. Binocular vision allows you to more accurately assess the third spatial dimension, i.e. the volume of an object, the degree of its absolute and relative distance.
The stimulus for binocular fixation of an object is the constant tendency of the visual system to overcome diplopia, to single vision.
Binocular vision is a visual function that was formed last in the process of phylogenesis.
Clinical significance.
The study is carried out for an approximate assessment of the state of binocular vision.
Research algorithm.
Test with a “hole in the palm”.
1. The patient needs to look into the distance with both eyes at some object (table, picture, etc.)
2. Place a tube with a diameter of 1.5 - 2 cm and a length of 10 - 12 cm in front of the right eye, close to it.
3. In front of your left eye, place the palm of your left hand at the level of the far end of the tube, close to its edge.
4. Evaluate the resulting image.
Criteria for evaluation.
1. If you get the impression of a “hole in the center of the palm” through which the object in question is visible, your vision is binocular.
2. The “hole in the palm” is shifted to the edge of the palm or partially extends beyond its limits - the nature of vision is unstable binocular or simultaneous.
3. The “hole in the palm” does not appear; the area of the visual field limited by the tube and the palm are visible separately - the nature of vision is monocular or simultaneous.
Test with knitting needles.
1. The patient needs to look straight ahead with both eyes, taking a rod or knitting needle in his hand in a vertical position with the sharp end down.
2. The doctor should stand in front of the patient at a distance of 50-100 cm and, holding the same knitting needle or rod vertically in his hand with the point up, ask the patient to align the sharp ends of the knitting needles along the axis with a strictly vertical movement of the hand from top to bottom.
3. Repeat the study several times, changing the position of your needle in height and degree of distance from the test subject, recording the number of misses.
4. Invite the patient to close one eye with his palm or an opaque shield and repeat the study (step 3).
Criteria for evaluation.
1. When the patient sees with two eyes, there are no errors when combining the needles, but when the patient sees with one eye, the patient makes mistakes in all or most cases - the nature of vision is binocular.
2. If there are approximately the same number of errors both when the patient sees with two eyes and with one, binocular vision is absent.
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20. Definition of ciliary tenderness
The ciliary (ciliary) body is a part of the choroid (vascular tract) of the eye. It is a ring 6 – 7 mm wide. The ciliary body is inaccessible for inspection, since the opaque sclera covers it from the outside. The projection of the ciliary body onto the sclera is represented by a zone around the limbus 6–7 mm wide. Innervation of the iris and ciliary body is provided by short ciliary nerves, which include sensory fibers from the nasociliary nerve (branch of the ophthalmic nerve - 1 branch of the trigeminal nerve), autonomic parasympathetic fibers from the oculomotor nerve (postganglionic fibers after switching in the ciliary node) and autonomic sympathetic fibers from the plexus of the carotid artery. Long ciliary nerves also take part in the sensory innervation of the anterior part of the choroid.
Pain is one of the main symptoms of acute iridocyclitis (anterior uveitis. As a result of irritation of the ciliary nerves, sharp pain occurs in the eyeball and the corresponding half of the head. Increased pain at night can be explained by the predominance of the tone of the parasympathetic nervous system, increased passive hyperemia of the ciliary body. Increased pain intensity occurs when the eye is palpated through the eyelids in the area of projection of the ciliary body (ciliary tenderness) . A painful reaction is also typical during accommodation. Ciliary tenderness, in addition to other signs, is important when carrying out differential diagnosis with other diseases manifested by redness of the eye.
Clinical significance.
The test allows you to determine one of the clinical signs of iridocyclitis.
Research algorithm.
1.Ask the patient to look up or down.
2. Using two index fingers, alternately, lightly press through the eyelids on the eyeball in the projection area of the ciliary body (approximately 6-7 mm from the limbus).
Criteria for evaluation:
If pain appears or intensifies during the test, the symptom of ciliary pain is considered positive.
In the absence of this symptom, the sample is considered negative.
Section 2. MANIPULATIONS FOR DEVELOPMENT.
1. Instillation of eye drops into the conjunctival sac
Clinical significance .
Instillation (instillation) of drops is one of the main methods of administering drugs for the local treatment of most diseases of the organ of vision, as well as for a number of diagnostic studies. To instill eye drops, use a dropper bottle or a traditional pipette.
Manipulation algorithm.
1. Position the patient facing a window or next to a source of artificial light.
3. Place a dropper or pipette in front of the eyeball in an inclined position at a distance of 3-5 mm from the conjunctiva, without touching the eyelashes. For convenience, you can fix the palm with the pipette on the patient’s face using your little finger .
4. Place 2-3 drops of the drug into the area of the lower fornix of the conjunctiva.
5. Remove excess drops with a sterile cotton ball from the lower eyelid.
Criteria for evaluation.
Visual control of the “hit” of the drug in the conjunctival sac.
2. Placing eye ointment behind eyelids
Clinical significance .
Applying ointment is one of the main methods of administering drugs for local treatment of diseases of the organ of vision. For laying, use special tubes with ointment or a glass rod.
Manipulation algorithm.
1. Position the patient facing a window or next to a source of artificial
2. Pull back the lower eyelid using a sterile cotton ball with the left hand and ask the patient to look up.
4. Place the ointment behind the lower eyelid from the tube (its tip should not touch the conjunctiva). When using a glass rod, first apply a small amount of ointment to it.
5. Ask the patient to close his eyelids and make several circular movements with his eyeballs (to distribute the ointment evenly).
6. Remove excess ointment with a sterile cotton ball from the surface of the eyelids.
Criteria for evaluation.
Visual inspection of the presence of ointment in the conjunctival sac.
3. Application of a binocular bandage
Clinical significance.
The application of a binocular bandage is necessary for temporary immobilization of the eye in case of a penetrating injury.
Manipulation algorithm.
1. Ask the patient to close both eyes and place sterile wipes on the orbital area of each eye.
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