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"lead": "Нарушения зрения — снижение способности видеть до такой степени, что вызывает проблемы, не устраняемые обычными способами, такими как очки или лекарства.[1][2][3]\r\n\r\nЭто может быть из-за болезни, травмы, врождённых или дегенеративных заболеваний. Эта потеря зрения, как правило, определяется как:\r\n\r\nОстрота зрения с коррекцией менее 20/60, или значительный дефект центрального поля,\r\nЗначительный одноимённый или разноимённый двусторонний визуальный дефект периферического поля, включающий дефект поля или общее сжатия или сужение поля, или\r\nПониженный пик контрастной чувствительности с любым из указанных выше условий.[1][2][3][4]\r\nГлазные нарушения, которые могут привести к нарушениям зрения могут включать в себя дегенерацию сетчатки, альбинизм, катаракты, глаукомы, мышечные проблемы, которые приводят к нарушениям зрения, расстройства роговицы, диабетическую ретинопатию, врождённые пороки и инфекции. Нарушения зрения также могут быть вызваны расстройствами мозга и нервной системы, в этом случае их, как правило, называют кортикальными нарушениями зрения (CVI). Путеводитель оценки постоянного ухудшения американской медицинской ассоциации попытался представить «стандартизированный, объективный подход к оценке медицинских нарушений». Глава Визуальная система «устанавливает критерии для оценки постоянного ухудшения зрительной системы, как это влияет на способность человека выполнять действия в повседневной жизни».[5] Путеводитель оценил, что потеря одного глаза составляет 25 % нарушений зрительной системы и 24 % от полного обесценивания человека;[5][6]. Полная потеря зрения на оба глаза, как считается, является 100 % нарушением зрения и 85 % от полного обесценивания человека[5]\r\n\r\nВизуальные нарушения наносят значительный экономический удар даже в развитых странах.[7] Значительную часть глобального нарушения зрения можно предупредить.",
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"code": "H44.4",
"name": "Гипотония глаза",
"icd_name": "Гипотония глаза",
"gender": 0,
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"slug": "h44.4_gipotoniya_glaza",
"lead": "синдром, патогномоничным признаком которого является снижение внутриглазного давления",
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"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Формирование внутриглазного давления формируется за счет давления стекловидного тела и внутриглазной жидкости на оболочку изнутри. Патологическое снижение внутриглазного давления происходит в следующих случаях:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">негерметичность швов после операций на глазах</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">инъекции препаратов в позадибульбарную клетчатку (при лечении прочих заболеваний глаз)</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">прорыв склеры во время наложения швов на верхнюю прямую мышцу глаза</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">отслойка сетчатки</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">побочное действие некоторых лекарственных препаратов</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">общая гипотония организма и состояние комы</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">воспалительные процессы радужной оболочки</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">сбои в процессе формирования внутриглазной жидкости</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">патология сосудов глаз</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">пониженное внутричерепное давление</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">заболевания эндокринной системы</span></li>\r\n</ul>\r\n<p> </p>",
"pathogenesis": "<p><span style=\"font-family: Verdana; font-size: 9.33333px; white-space: pre-wrap;\">При гипотонии глазного яблока уменьшается интенсивность продукции ВГЖ. Это вызвано дефицитом кровоснабжения, который ведет к трофическим нарушениям и ишемии окружающих тканей. Впоследствии развиваются деструктивные изменения цилиарного тела с его дальнейшей дисфункцией. В патогенезе посттравматической гипотонии важная роль отводится гидродинамическим сдвигам. При прободном ранении стойкая офтальмогипертензия после повреждения оболочек глаза сменяется выраженной гипотонией. В ряде случаев тонус глазного блока низкий из-за повышенного оттока камерной влаги. Подобные патологические изменения наблюдаются при отрыве или плоской отслойке цилиарного тела.</span></p>",
"diagnostics": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Для диагностирования заболевания глаза проводятся такие методы исследований как:</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<ul>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">общий анализ крови и мочи</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">коагулограмма, анализ крови на сифилис, сахар, анализ на определение антигена гепатита В</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">визометрия – исследование для определения остроты зрения</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">периметрия – обследование, при котором определяют границы поля зрения и области выпадения части поля зрения</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">офтальмоскопия и измерение глазного давления (тонометрия)</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">гониоскопия – метод диагностики, используемый для изучения структур передней камеры глазного яблока</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">биомикроскопия – детальное исследование структур глаза с помощью специального оптического прибора</span></li>\r\n</ul>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Этиотропная терапия при сниженном офтальмотонусе направлена не только на повышение ВГД, но и на улучшение кровоснабжения оболочек глаз, что увеличивает активность метаболических процессов в его структурах. Для этого внутривенно вводятся плазмозаменители и ангиопротекторы. При гипотонии, вызванной нарушением продукции ВГЖ, целесообразно назначение циклоплегических мидриатиков и сосудорасширяющих средств. Рекомендовано попеременное применение антиоксидантов (метилэтилпиридинол) и синтетических глюкокортикостероидов (дексаметазона фосфат). Однако данные методы позволяют повысить внутриглазное давление лишь на короткий промежуток времени.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Эффективным способом воздействия на синтез ВГЖ принято считать лазерную стимуляцию цилиарного тела. Для восстановления офтальмотонуса у лиц с ранее проведенной антиглаукоматозной операцией показана пластика фильтрующей зоны. Для этого в полость фильтрационной подушки вводится раствор объемно-структурированного геля коллагена. Выполняется ревизия зоны хирургического вмешательства. Пластика тканей осуществляется путем наложения дополнительных швов на трепанационное отверстие и склеральный лоскут.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Для снижения оттока водянистой влаги используются такие методы физического воздействия, как диатермия, лазерная терапия и криоапликации. При проникающем ранении глаза необходимо свести края раны с целью достижения полной герметизации. В случае выраженного уменьшения размера стекловидного тела рекомендовано интравитреальное введение силикона, изотонического раствора хлорида натрия или гиалона.</span></p>\r\n<p> </p>",
"prevention": "<p><span style=\"font-family: Verdana; font-size: 9.33333px; white-space: pre-wrap;\">Специфические превентивные меры не разработаны. Неспецифическая профилактика направлена на предупреждение травмирования глаз. Для этого рекомендовано использовать средства индивидуальной защиты (очки, маски) при высоком риске травматизации.</span></p>",
"clinical_picture": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При незначительном уменьшение внутриглазного давления отмечается развитие плавающих помутнений и мушек перед глазами. При продолжительном течении заболевания у пациента могут возникать головные боли, которые локализируются в области затылка. Больные могут жаловаться на повышенную утомляемость при зрительных нагрузках. При тяжелой степени гипотонии может выявляться снижение остроты зрения. Также больные могут отмечать появление дискомфорта при движении глазных яблок и снижение периферического зрения. Интенсивные боли в глазном яблоке могут указывать на травматическую природу заболевания. При возникновении заболевания на фоне инфекции отмечается покраснение сосудов конъюнктивы и развитие усиленного слезотечения.</span></p>",
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{
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