RU2413455C1 - Preclinical and early clinical diagnostic technique for body system disorders - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to diagnosing by means of eye examination apparatuses. One-stage integrated study and correlation of eye functions and structures enable high-reliable preclinical and early clinical detection of body system disorders.

EFFECT: method provides preventive examination for well-timed referral to specialists.

3 ex

Description

The invention relates to medicine, in particular to diagnostics using devices for eye examination, and can be used to detect disorders of the body systems in the preclinical and / or early clinical stage.

A known method of iridodiagnostics of human diseases, in which when assessing the state of the body, only changes that occur on the iris of the eye are taken into account (RU No. 2253353). Without denying the significance of the known method, it should be noted that in the description of the invention there is no clear definition of the projection zones of individual organs on the iris. To diagnose disorders of the body systems in the preclinical and / or early clinical stage, it is advisable to compare the iridodiagnosis data with the functions of the eye, the state of ocular fundus microcirculation, oculomotor activity of the eyeball.

Also known is the monograph by E. A. Egorov, T. V. Stavitskaya, E. S. Tutaeva “Ophthalmic manifestations of common diseases” (“GEOTAR-Media”, Moscow, 2009), which describes the ocular manifestations of developed stages of the disease, however Neither the state of microcirculation nor the iridological signs were taken into account.

The claimed invention is directed to solving the problem of diagnosing disorders of the body systems in the preclinical and / or early clinical stages based on the analysis and assessment of the state of the structures and functions of the eyes.

The use of the proposed method in clinical practice makes it possible to determine the state of the organism as a whole, including disorders of a general somatic nature, as well as to identify the pathology of individual body systems in the preclinical and / or early clinical stages, without resorting to lengthy and expensive research methods.

These diagnostic results in the implementation of the invention are achieved due to the fact that violations of the systems of the body in the preclinical and / or early clinical stages are diagnosed by instrumental examination of the functions of the organ of vision and visual examination of its structures.

A feature of the claimed invention is that they carry out a simultaneous comprehensive assessment and comparison of the state of the following functions and structures of the organ of vision: measuring visual acuity, visual field boundaries, intraocular pressure, determining the position and volume of movement of the eyeballs, width of the palpebral fissure, condition of the edges of the eyelids, bulbar conjunctiva, limb capillaries, sclera, cornea, anterior chamber, iris, pupils, lens, vitreous, optic disc, retina, fundus vessels.

The invention consists in the following.

It was established that a simultaneous comprehensive study and comparison of the state of the above functions and structures of the eyes makes it possible to identify with great accuracy violations of the systems of the body in the preclinical and / or early clinical stage.

Namely:

Disorders of the cardiovascular system in the preclinical and / or early clinical stages are characterized by a combination of the following symptoms:

- field of view - the presence of peripheral absolute and relative cattle while maintaining high visual acuity,

- an equivalent increase in intraocular pressure in both eyes,

- limb capillaries - a violation of microcirculation, expressed in a decrease in the number of capillaries, the presence of ampoule-shaped extensions of the capillaries, microaneurysms, exudates, stasis and sludge of red blood cells, the presence of "silent zones", the effect of "fireworks",

- the iris - the presence of iridological pathological signs in the projection of the heart, organs of the nasopharynx, kidneys, liver, the presence of lymphoid rosary, smooth pattern of the iris,

- optic disc - decoloration, monotony,

- fundus vessels - violation in the ratio of the caliber of arteries and veins, the unevenness of their lumen, the tortuosity of the vessels, the presence of pathological reflexes,

- retina - redistribution of pigment, the presence of degenerative foci, exudates.

Disorders of the gastrointestinal tract in the preclinical and / or early clinical stages are characterized by a combination of the following symptoms:

- eyelids - hyperemia, swelling of the edges of the eyelids, a history of barley,

- bulbar conjunctiva - friability, edema, conjunctival injection of blood vessels,

- limb capillaries - violation of microcirculation (stasis, sludge of red blood cells, a decrease in the number of capillaries, the presence of "silent zones"),

- sclera - color change (ekterichnost),

- the iris - thinning of the mesoderm layer in the pupil girdle, thinning of the pigment border, the presence of cysts along the pupil edge, the presence of pathological iridological signs from 5-7 hours on the dentate line and in the projection of the stomach, liver and pancreas,

- fundus vessels - the presence of pathological reflexes from the walls of blood vessels,

- safety of eye functions.

Disorders of the central nervous system in the preclinical and / or early clinical stages are characterized by a combination of the following symptoms:

- violation of the functions of the organ of vision: an uncorrectable decrease in visual acuity, double vision when viewed with two eyes and its absence when viewed with one eye, the presence of absolute and relative livestock in the field of view, the presence of hemianopsia,

- eyelids - the presence of ptosis,

- eyeballs - restriction of the range of motion, the presence of nystagmus, impaired convergence,

- limb capillaries - violation of microcirculation (the presence of "silent zones", stasis, sludge of red blood cells),

- cornea - the presence of pathological signs in the form of annular opacities, inclusions on the periphery of the cornea, in the deep or outer layers of the cornea,

- pupil - asymmetry (difference) in the area and reaction to light of both pupils, violation of the shape of the pupils in the form of flattening of the upper segments,

- optic nerve disc - blurring of the borders, peripapillary deposits of the pigment, shift of the exit site of the vascular bundle, violation of the ratio of the caliber of arteries and veins on the disk, disc color change (decoloration and / or hyperemia), the presence and nature of stromal edema, exposure of the lattice plate in the form of honeycombs .

Disorders of the thyroid gland in the preclinical and / or early clinical stage are characterized by a combination of the following symptoms:

- increased intraocular pressure symmetrically in both eyes (symptomatic hypertension),

- eyelids - expansion of the palpebral fissure, the presence of symptoms of Gref, Moebius,

- eyeballs - difficulty in movement and the occurrence of double vision when looking in extreme leads,

- bulbar conjunctiva - the presence of dry eye syndrome, vasodilation of the conjunctiva,

- limb capillaries - microcirculation disorders (sludge, red blood cell stasis),

- cornea - increased gloss of the eyes,

- iris - the presence of pathological iridological signs in the projection of the thyroid gland, the presence of lymphoid rosary, smoothness of the picture,

- pupil - flattening of the lower segments,

- the lens - clouding of the posterior capsule, signs of complicated cataract,

- optic disc - edema and hyperemia of the internal segments while maintaining the clarity of the boundaries of the disc, the shift of the vascular bundle in the nasal direction,

- fundus vessels - violation of the ratio of the caliber of arteries and veins, uneven lumen of the veins.

Pancreatic disorders (diabetes mellitus) in the preclinical and / or early clinical stages are characterized by a combination of the following symptoms:

- eyelids - the presence of recurrent barley, blepharoconjunctivitis,

- cornea - point keratopathy, recurrent erosion,

- limb capillaries - violation of microcirculation (stasis, sludge of red blood cells, a decrease in the number of capillaries, ampoule-shaped expansion, the presence of "silent zones" and newly formed vessels in the form of tangles),

- the iris - the presence of dilated and newly formed vessels, pathological signs in the projection of the liver, pancreas against the background of transillumination of the mesoderm of the iris in the pupil,

- lens - clouding of the posterior capsule, signs of complicated cataract, subcapsular vacuoles,

- pupil - flattening of the lower outer quadrants,

- optic nerve disk - edema and hyperemia of the internal segments while maintaining the boundaries of the disk, the shift of the vascular bundle to the nasal side,

- fundus vessels - violation of the ratio of the caliber of arteries and veins, uneven lumen of the veins, microaneurysms, hemorrhages and proliferates.

Disorders in the diencephalic region and pituitary gland in the preclinical and / or early clinical stages are characterized by a combination of the following symptoms:

- expansion of the space between the upper eyelids and eyebrows (brow arches),

- field of view - the presence of hemioanopsia,

- intraocular pressure - symptomatic intraocular hypertension,

- optic nerve disc - stromal edema, hyperemia, blurring of borders, stagnation phenomena,

- fundus vessels - violation of the ratio of the caliber of arteries and veins, uneven lumen of the veins, their expansion and tortuosity, straightness and narrowing of the arteries,

- retina - peripapillary edema.

Autoimmune disorders, including connective tissue diseases, in the preclinical and / or early clinical stages are characterized by a combination of the following symptoms:

- visual acuity - uncorrectable decrease,

- field of view - the presence of absolute and relative cattle,

- intraocular pressure - symptomatic hypertension,

- bulbar conjunctiva - dry eye syndrome,

- limb capillaries - violation of microcirculation (ampoule-shaped extensions, sludge, red blood cell stasis, symptom of “fireworks”, microaneurysms),

- sclera - the presence of recurrent episcleritis,

- cornea - spraying of pigment or precipitates in the form of a triangle,

- anterior chamber - the presence of signs of acute or transferred iridocyclitis, iritis (Tyndall phenomenon),

- iris - lymphoid rosary, smoothness of the picture, the presence of traces of the posterior synechia, pathological iridological signs in the nasopharynx,

- pupil - narrowing, decreased reaction to light,

- vitreous body - the presence of a suspension of exudate, turbidity of varying degrees,

- retina - the presence or traces of exudates and chorioretinal foci in the central and peripheral departments with the possibility of exudative detachment,

- optic disc - the clinical picture of optic neuritis,

- macular region - exudate, the presence of secondary foci.

Disorders of the musculoskeletal system in the preclinical and / or early clinical stages are characterized by a combination of the following symptoms:

- field of view - the presence of peripheral cattle,

- increased intraocular pressure (symptomatic hypertension),

- eyelids of the eyeballs - ptosis,

- the iris - the presence of lymphoid rosary, iridological pathological signs in the projection of the tonsils, the area of the spine, lower and upper extremities,

- optic nerve disc - decoloration of the temporal half of the optic nerve, exposure of the ethmoid plate, shift of the exit site of the vascular bundle to the nasal side.

Disorders of the reproductive organs in the preclinical and / or early clinical stage are characterized by a combination of the following symptoms:

- functions - symptomatic intraocular hypertension,

- pupil - flattening in the lower segments,

- the iris - disruption of the stroma, pathological signs in the "sex triangle" and projections of the thyroid gland, mammary glands, lymphoid rosary,

- optic nerve disc - edema and hyperemia of the internal segments of the stroma while maintaining the clarity of boundaries, the tendency to shift the vascular bundle in the nasal direction,

- fundus vessels - hypertensive angiopathy.

Disorders of kidney activity in the preclinical and / or early clinical stages are characterized by a combination of the following symptoms:

- bulbar conjunctiva - the presence of straightened and narrowed vessels,

- limb capillaries - violation of microcirculation (reduction in the number of capillaries, their sharp rectification, stasis, sludge of red blood cells),

- iris - the presence of pathological iridological signs in the projection of the pelvic organs, kidneys, tonsils, lymphoid rosary,

- pupil - flattening of the lower segments,

- fundus vessels - straightening and narrowing of the arteries,

- retina - the presence of exudates,

- optic nerve disc - monotonous decoration.

The method is as follows.

Using a sign projector, visual acuity is determined. Using the computer perimeter "Perikon" determine the boundaries of the field of view. Maklakov tonometer measure the value of intraocular pressure. Next, using a slit lamp (magnification 40) and a direct ophthalmoscope, a visual examination of the state of the anatomical structures of the eyes is carried out, observing the following sequence: position and volume of movement of the eyeballs, width of the palpebral fissure, condition of the appendages of the eye, condition of the bulbar conjunctiva, capillaries of the limb, cornea, anterior chamber , iris, pupils, crystalline lens, vitreous, optic disc, retina, fundus vessels, macula.

When examining the eyelids, their puffiness, hyperemia, thickening, the presence of scales, barley, holazion, patency of the lacrimal passages are recorded.

When examining the bulbar conjunctiva, its density, vascular injection, the nature of the discharge are recorded.

When examining the limb capillaries, the number of capillaries is determined, blood flow velocity, sludge, pendulum movements, erythrocyte stasis, erythropedesis, ampoule-shaped expansion, the presence of "silent zones", microaneurysms are recorded.

When examining the cornea, its shape, degree of gloss, transparency or clouding are determined, the state of the epithelium, stroma and endothelium of the cornea, pigment spraying, the presence of precipitates are noted.

When examining the anterior chamber, its depth, degree of moisture transparency, the presence of exudates, signs of inflammation are recorded.

When examining the iris, its structure is recorded, the presence of subatrophy of the stroma, pigment spraying, the presence of iridological signs.

When examining the pupils, their area, shape, reaction rate to light, the presence of posterior synechia, and the condition of the pigment border are recorded.

When examining the lenses, their transparency, the presence of clouding of the nucleus, cortical layers, posterior capsule, the presence of subcapsular vacuoles are recorded.

When examining the vitreous body, its transparency is determined, the presence of filamentous destruction, proliferates, exudates, hemophthalmos, cell suspension is recorded.

When examining the optic nerve disk, the state of the borders (clear or shaded in certain segments), the state of the internal segments, the presence of temporal halves are detected, the exposure of the ethmoid plate, glaucomatous, physiological excavation, the exit site of the vascular bundle, the presence of myopic cone, peripapillary pigment are recorded.

When examining the retina, the degree of sparseness, the presence of exudates, newly formed vessels, areas of pigmentation, degenerative foci are determined.

When examining the fundus vessels, the ratio of the caliber of the arteries and veins, the degree of their tortuosity and density, the presence of pathological symptoms, microaneurysms, hemorrhages are determined.

The nature and degree of deviations from the norm of each of the above anatomical structures of the eyes is revealed. Compared with the results of a study of eye function. The set of characteristic features allows us to make an assumption about existing violations of the activity of body systems in the preclinical and / or early clinical stage.

Clinical examples

1. Patient K., born in 1955 He complained of rapid eye fatigue, hyperemia of the mucous membrane, double vision after a small visual load. When examining the functions and structures of the eyes in accordance with the claimed methodology, the following pathological signs were identified.

Status oculorum:

- VISUS - OD - 0.9, OS - 0.4

- IOP - OD - 23 mm, OS - 25 mm

- Field of view - peripheral relative and absolute scotomas, field boundaries are normal.

Objectively:

- eyelids - hyperemia and thickening of the edges of the eyelids;

- palpebral fissure expanded, symptom of Greff,

- eyeball - restriction of movements, in extreme leads double vision,

- the orbit - OU during palpation of the upper sections is determined by the compaction of rounded fiber, movable, not fused with the surrounding tissue, 1.5-1.0 cm in size,

- conjunctiva - loose, straightened vessels, dilatation of the veins of the conjunctiva,

- limb capillaries - violation of microcirculation:

ampoule-like expansion, tortuosity,

the number of capillaries is reduced,

flow fractionation

sludge, red blood cell stasis in defined capillaries,

"Silent zones";

- cornea - the initial arcus senilis,

- front camera - 3 mm, moisture is transparent,

- Iris:

pupil 3 mm

OD = OS,

light response is reduced

subatrophy of the stroma in the pupil zone,

deformation of the gear line at 12 hours,

pathological signs OS - 9.30, OD - 2.30,

at 8 hours OD and at 4 hours OS outside of the gear line,

the release of stroma and crypts,

lymphoid rosary;

- the lens - the initial clouding of the posterior capsule and posterior cortical layers,

- vitreous body - trellised destruction,

- DZN:

the boundaries are clear

swelling and hyperemia of the stroma in the inner segments,

decoloration of the temporal half, exposure of the ethmoid plate,

a tendency to shift the vascular bundle to the nasal side,

arteries are narrowed, straightened,

veins dilated, uneven caliber;

- retina - without features, arteries are narrowed, straightened, veins of uneven caliber, tortuous.

Discussion:

The patient’s complaints of double vision, as well as the revealed pathological signs: Greff’s symptom, retrobulbar fiber compaction, microcirculatory disturbances on the limb, presence of lymphoid rosary on the iris, dentate line deformities at 12 o’clock, iris stroma in the region of OS - 9.30, OD - 2.30, signs of initial opacification of the posterior capsule in the lens, edema and hyperemia of the inner segments of the optic nerve, hypertonic type of angiopathy suggest impaired immune system activity with the development of autoimm unary reactions (thyroid gland, endocrine ophthalmopathy). Decolorization of the temporal halves of the optic nerve disc with exposure of the ethmoid plate, iridological signs in the cervical spine suggest a lack of blood supply to the visual analyzer associated with the cervicothoracic spine.

The patient was assigned examination:

- general analysis of blood, general analysis of urine,

- biochemical blood examination,

- Ultrasound of the abdominal cavity, kidneys, prostate, thyroid gland,

- ophthalmoscanning of the eye muscles and retrobulbar fiber,

- duplex examination of intracranial and brachiocephalic vessels, vessels of the lower extremities,

- MRI of the brain,

- X-ray of the lungs,

- consultation of a therapist, neurologist, endocrinologist, urologist, pulmonologist. Survey results

Ultrasound of the abdominal cavity - no pathology revealed.

Ultrasound of the prostate gland: nodular hyperplasia with a homogeneous structure of transition zones up to 9-10 mm in size. The capsule and the symmetry of the gland are preserved. Volume 32 sq.cm. The vesicles are not expanded, the walls are thin, the contents are transparent.

Ultrasound of the thyroid gland - echoes of multinodular goiter, nodes of both lobes of the thyroid gland.

Ultrasound ophthalmoscanning: OU - in the retrobulbar cellulose, 2 formations with clear contours are hypoechoic with a pronounced cystic structure, compaction and swelling of the rectus muscles of the eye.

MRI of the brain - no structural changes in the substance of the brain were detected; MRI is a picture of half-sinusitis with a marked decrease in pneumatization of all PPN.

CT of the paranasal sinuses in two projections: signs of exacerbation of chronic bilateral maxillary sinusitis, more pronounced on the right, pronounced ethmoiditis and sphenoiditis. Cyst of the left maxillary sinus. Curvature of the nasal septum.

X-ray of the lungs: lung tissue infiltration in the root zone of both lungs.

Doppler ultrasound of brachiocephalic and intracranial vessels: Y3-signs of difficulty in venous outflow along the vertebral plexuses (D> S) are moderate. When TKD - the arteries of the Wiliziev circle are passable, the laminar blood flow, LSC - in the MCA, PMA and ZMA - the norm, in vertebrates - on the right - is reduced. When conducting a rotary test - a decrease in BFV in the left PA is 40%, on the right - up to 60% + changes in blood flow with signs of collaterization.

MRI of the cervical spine: signs of osteochondrosis of all parts of the spine, deforming spondylosis of the cervical spine. Hernia of discs C5-C7, Th7-Th8, L5-S1. Rear protrusion of discs C2-C5, Th8-Thl0, L3-L5. Schmorl's hernia at levels Th6-Th7, Th8-Th9.

MR imaging of the cervical spine: signs of osteochondrosis and deforming spondylosis of the cervical spine. Herniated discs C5-C7, Rear protrusion of the intervertebral discs C2-C5.

MRI of the thoracic spine: signs of osteochondrosis of the thoracic spine. Protrusion of Th8-Th10 discs. Disc herniation Th7- Th8. Schmorl's hernia at the levels of Th6-Th7, Th8-Th9.

MRI of the lumbosacral spine: signs of osteochondrosis. Hernia of the disc L5-S1. L3-L5 disc protrusion.

Laboratory study: in a general blood test, an increase in the number of basophils is 2.1 (N up to 1.5%), eosinophils - 9.3 (N - 5.0%), acceleration of ESR - 85 mm / hour (N 2-20 mm /hour); hypoglycemia - 3.64 mmol / l; hypercholesterolemia (total cholesterol - 5.86 mmol / L (N - 5.7 mmol / L), LDL - 3.84 mmol / L, VLDL - 5.8 mmol / L), atherogenic index 4.23 (N up to 3 ,5); hyperkalemia - 5.8 mmol / L (N 3.5 - 5.1 mmol / L); a decrease in cellular immunity: a decrease in T-helpers - 30.7 (N 31.0-51.0), a decrease in the immunoregulatory index CD4 / CD8 = 0.84 (N1.5-2.5), an increase in the number of NK cells - 29.4 (N 6.0-20.0), an increase in killer T cells of 16.90 (N 1.00-10.00).

Thus, the signs of disturbances in the activity of internal organs revealed in the structures of the eyes: endocrine ophthalmopathy, multinodular autoimmune goiter of the thyroid gland, disorders of the immune system, chronic infection in the paranasal sinuses, bilateral pneumonia without clinical manifestations, pathological mobility of the spine with the development of Schmorl's hernias, muscle tonic syndrome and circulatory disorders in the occipital regions of the brain, prostatic hyperplasia with a uniform structure were confirmed by clinical examination. The patient was referred for further management to specialists.

2. Patient Sh., B.1949 Turned to test vision. No complaints at the time of inspection. Considers himself healthy. When examining the functions and structures of the eyes in accordance with the claimed methodology, the following pathological signs were identified.

Status oculorum:

- VISUS OU - 1.0,

- IOP OD - 25 mm, OS - 26 mm,

- field of view: peripheral relative and absolute scotomas, field boundaries are normal.

Objectively:

- eyelids - hyperemia and thickening of the edges of the eyelids,

- bulbar conjunctiva - loose, straightened vessels,

- limb capillaries:

microcirculation disturbance:

the number of capillaries is reduced,

sludge, red blood cell stasis,

shunting (robbery syndrome);

- cornea - the initial arcus senilis,

- front camera - 3 mm, moisture is transparent,

- Iris:

smoothness of the picture,

pupil 3 mm

OD = OS,

light response is reduced

subatrophy of the stroma in the pupil zone,

deformation of the gear line at 6 and 12 hours,

flattening of the lower external segments of the pupil,

6 hours below the dentate line, stroma and crypt

OD 6.30, OS 5.30 - pigment spots are adjacent directly to the ring,

OD in the lower outer quadrant is a stromal structure unrestricted;

- lens - initial changes in the posterior capsule,

- vitreous body without features,

- DZN:

the boundaries are clear

monotonous decoration,

a tendency to shift the vascular bundle to the nasal side,

arteries are sharply narrowed, straightened,

veins moderately dilated, uneven gauge;

- retina - vessels are narrowed, straightened, a symptom of "silver wire".

Discussion

Violation of microcirculation on the limb in combination with pathological signs on the iris in the liver zone, with a symptom of a silver wire in the vessels of the retina indicates possible lipid metabolism disorders. The rectification of the vessels of the conjunctiva and retina in combination with pathological signs in the area of the kidneys on the iris indicates a possible increase in blood pressure with the renal component and impaired lipid metabolism. Flattening of the lower external segments of the pupils, the presence of initial opacities of the posterior capsule (initial complicated cataract) in combination with pathological signs in the pancreas indicates a possible violation of carbohydrate metabolism. Pathological signs on the iris in the cervical spine, decoloration of the optic disc, the presence of relative cattle in the field of view, impaired microcirculation on the limb suggest chronic cerebral ischemia against the background of changes in the cervical spine and high blood pressure. The relaxation of the stroma in the genital triangle in the projection of the prostate gland suggests the presence of a pathological process in it. The abrasion of the iris pattern indicates a decrease in adaptive reserves and suggests that the process is in the nature of a neoplasm.

The patient was offered a preventive examination:

- ECG,

- blood pressure control,

- biochemical blood examination,

- Ultrasound of the abdominal cavity, pelvis,

- duplex examination of intracranial and brachiocephalic vessels,

- radiography of the cervicothoracic spine,

- consultation of a therapist, endocrinologist, urologist.

Survey results

Ultrasound of the abdominal organs: diffuse changes in liver tissue by type of fatty infiltration, small cysts in both lobes of the liver, deformation of the neck of the gallbladder, diffuse changes in pancreatic tissue.

Ultrasound of the kidneys: signs of pronounced diffuse changes in kidney tissue at the level of the parenchyma. At the sinus level, multiple calcifications, salt deposits, areas of dense fibrosis. Symmetric parenchymal cysts of both kidneys.

Ultrasound of the prostate gland: medium echogenicity. In the central zone, the knot is up to 3.3 cm.

Doppler ultrasound of brachiocephalic and intracranial vessels: OCA stenosis on the right - 30%, on the left - 45%. ICA on the left - 40% stenosis, on the right - an S-shaped bend with rotation in the distal section, PA - signs of extravasal compression during a rotary test, a decrease in blood flow on the right - 24%, on the left - 30%.

X-ray of the cervicothoracic spine: osteochondrosis and deforming spondylosis of the cervicothoracic spine. Disc herniation. Rear protrusion of the intervertebral discs C4-C5.

Laboratory research:

- hypercholesterolemia due to LDL and VLDL (total cholesterol - 7.4 mmol / L (N - 5.7), LDL - 4.7, VLDL -1.7,

- atherogenic index 6.4 (N up to 3.5),

- coagulogram - tendency to hypercoagulation,

- carbohydrate metabolism - an increase in glycosylated hemoglobin, a decrease in the level of insulin, C-peptide,

- PSA - increase in total (7.27 at a rate of 0-4 ng / ml) and free (1.547 ng / ml),

- increase in the FRSA / TRSA index to 21.3,

- reduction in cellular immunity: CD4 / CD8 = 4.5 (norm 2.5),

- decreased phagocytosis - phagocytic number 4.6 (normal 5-10), phagocytic indicator 47% (normal 60-95%).

Consultation of a therapist: hypertension II stage, II degree, risk 3. IHD: atherosclerotic cardiosclerosis. Dyslipidemia type II. Fatty hepatosis.

Endocrinologist's consultation: diabetes mellitus first detected (hyperinsulinism with insulin resistance).

Given the increased PSA, ultrasound of the prostate gland (the presence of a node in the parenchyma and multiple calcifications and cysts in the kidneys), the patient is referred for treatment to a urologist.

Thus, signs of disorders of the internal organs revealed in the structures of the eyes were confirmed by clinical examination. The patient was referred for further management to specialists.

3. Patient K (C)., B. 1946 Turned to test vision.

Status oculorum:

- VISUS - OD - 0.8, Sph + 0.5 = 0.9, OS - 0.6, Sph + 1.0 = 1.0

- VGD - OD - 18, OS - 18

- field of view: peripheral relative and absolute scotomas.

Objectively:

- eyelids - hyperemia and thickening of the edges of the eyelids,

- conjunctiva - loose, straightened vessels,

- limb capillaries - violation of microcirculation:

the number of capillaries is reduced,

sludge, red blood cell stasis,

shunting (robbery syndrome);

- cornea - the initial arcus senilis,

- front camera - 3 mm, moisture is transparent,

- Iris:

pupil 3 mm

OD = OS,

light response is reduced

pupil stroma subatrophy,

deformation of the gear line at 4 to 7 hours,

flattening of the lower external segments of the pupil,

6 hours below the dentate line, stroma and crypt

smoothness of the picture,

OD in the lower outer quadrant is an unfolding of the stromal structure;

- lens - initial changes in the posterior capsule,

- vitreous body - without features,

- DZN:

the boundaries are clear

monotonous decoration,

shift of the vascular bundle to the nasal side,

arteries are sharply narrowed, straightened,

veins moderately dilated, uneven gauge;

- retina - narrowed, straightened vessels, a symptom of "silver wire".

The discussion of the results

Violation of microcirculation on the limb (the number of capillaries is reduced, erythrocyte stasis, robbery syndrome, sludge) in combination with narrowing and straightening of the conjunctival vessels, condition of the vessels of the fundus (narrowing, straightening of arteries, a symptom of the “silver wire”, monotonous non-uniform calibration of optic arrhythmias, vein expansion, iris stroma relaxation at 4-6 hours in the extreme periphery indicates a possible increase in blood pressure (possibly of renal origin), a tendency to varicose disease of the lower extremities, onotonic decoloration of the optic nerve disc in combination with high visual acuity and the presence of peripheral absolute and relative livestock in the field of vision indicates the possibility of chronic cerebral ischemia with hypercholesterolemia and a tendency toward hypercoagulation. Hyperemia and edema of the edges of the eyelids (blepharoconjunctivitis), initial opacification of the posterior capsule , stromal subatrophy in the pupil border of the iris (tendency to enzymatic failure) in combination with flattening of the lower outer segments of the pupil, the presence of deformation of the tooth bacillus line from 4 to 7 hours suggests a violation of carbohydrate metabolism and duodenal pathology.

Survey appointed:

- ECG,

- blood pressure control,

- biochemical blood test,

- Ultrasound of the abdominal cavity, pelvis, thyroid gland,

- esophagogastroduodenoscopy,

- duplex examination of intracranial and brachiocephalic vessels, vessels (veins) of the lower extremities,

- radiography of the cervicothoracic spine,

- consultation of a therapist, endocrinologist, urologist.

Survey results

Duplex scanning of the branches of the aortic arch: ICA on the right - bifurcation stenosis - 45%, ICA - 30%; ICA on the left - bifurcation stenosis up to 50-55%, ICA - 30-35%.

Duplex scanning of veins of the lower extremities: varicose disease on both sides.

Ultrasound of the abdominal organs: diffuse changes in the liver, pancreas, gallbladder dysformia, cyst of the right kidney.

Ultrasound of the thyroid gland: usually located, normal size - isthmus 4 mm, left lobe 49 × 17 × 17 mm, right lobe 50 × 18 × 17 mm, smooth contours, diffuse heterogeneous structure, low echogenicity. The volume of the gland is 14.1 cc (the norm is up to 25 cc for men). In the right lobe closer to the upper pole, a hypoechoic nodular formation of up to 7-8 mm with perinodular blood flow is determined. In the central part along the front surface, a rounded section of reduced echogenicity up to 4 × 3 mm and a cyst up to 7 mm. In the left lobe are several small cystic formations from 3 to 6 mm. When studying in the CDK regimen, the vascularization of the gland is not changed. In the course of the vascular bundle of the neck on the left side, a hyperplastic l / node up to 14 × 8 mm of normal structure and vascularization.

Esophagogastroduodenoscopy: ulcer of the bulb of the duodenum 12 in the acute phase. Cicatricial deformity of the bulb. Active bulbitis. Focal gastritis. Duodenitis. Reflux of bile. Increased acidity.

Laboratory research

A laboratory study revealed hypercholesterolemia (cholesterol - 6.27 mmol / L, atherogenicity index - 4.14), impaired carbohydrate metabolism (glycosylated hemoglobin - 6.0, C-peptide after exercise - 5.97 ng / ml), hypercoagulation ( thrombin time - 21.6 seconds). Serological examination revealed AT to herpes simplex virus type 1 and type 2 Ig - 20.7.

Therapist consultation: hypertension, II tbsp. IHD - atherosclerotic cardiosclerosis, CH I.

Angiosurgeon consultation: atherosclerosis, stenosis of the internal carotid arteries on both sides (hemodynamically insignificant).

Therapist consultation. DS: Hypertension, II stage, II degree, risk 3. IHD - atherosclerotic cardiosclerosis, atherosclerotic stenosis of the carotid arteries on both sides (hemodynamically insignificant). Peptic ulcer of the duodenum in the acute stage. Active bulbitis. Fatty hepatosis. Hyperlipidemia. Cyst of the right kidney. Cyst of the left lobe of the thyroid gland.

The patient was prescribed treatment for newly diagnosed diseases and a rehabilitation therapy program was developed.

In total, the authors of the invention examined in accordance with the claimed methodology more than a hundred patients, most of whom contacted as part of the medical examination, considered themselves healthy, or limited themselves to complaints of decreased visual acuity. When conducting research according to the claimed methodology in the vast majority of patients, certain violations of the activity of body systems were revealed at the preclinical stage or the stage of hidden pathology.

The inventive method can be used by ophthalmologists in a routine examination of patients timely referral of patients to specialists. The inventive method has significant advantages and meets the criteria of patentability.

Claims (1)

A method for diagnosing disorders of the activity of body systems in the preclinical and / or early clinical stage by instrumental investigation of the functions and visual studies of the structures of the organ of vision, characterized in that they carry out a simultaneous comprehensive assessment of the structures and functions of the organ of vision and diagnose disorders of the cardiovascular system in the preclinical and / or early clinical stage in the presence of a combination of the following signs: peripheral absolute and relative cattle while maintaining high eye of visual acuity, increased intraocular pressure in both eyes, impaired microcirculation in the capillaries of the limbus, expressed in a decrease in the number of capillaries, the presence of ampoule-shaped extensions of capillaries, microaneurysms, exudates, stasis and sludge of red blood cells, the presence of "silent zones", the effect of "fireworks"; the presence of iridological pathological signs in the projection of the heart, organs of the nasopharynx, kidneys, liver, the presence of lymphoid rosary, the smoothness of the iris pattern; decoloration and monotony of the optic disc; violation in the ratio of the caliber of arteries and veins of the fundus, uneven lumen, tortuosity of the vessels in the fundus, the presence of pathological reflexes on the fundus; redistribution of pigment, the presence of degenerative foci, exudates in the retina; disorders of the gastrointestinal tract in the preclinical and / or early clinical stage in the presence of a combination of the following signs: hyperemia, edema of the edges of the eyelids, the presence of a history of barley; friability and edema of the bulbar conjunctiva, conjunctival injection of blood vessels; violation of microcirculation - stasis, sludge of red blood cells, a decrease in the number of capillaries, the presence of "silent zones" - in the capillaries of the limb; ekterichnost sclera; thinning of the mesodermal layer of the iris in the pupil girdle, thinning of the pigment border, the presence of cysts along the pupil edge of the iris, the presence of pathological iridological signs from 5-7 hours on the dentate line and in the projection of the stomach, liver and pancreas; the presence of pathological reflexes from the walls of the vessels of the fundus; disturbances in the activity of the central nervous system in the preclinical and / or early clinical stage in the presence of a combination of the following signs: an uncorrectable decrease in visual acuity, double vision when looking with two eyes and no one when looking with one eye, the presence of absolute and relative livestock in the field of view, the presence of hemianopsia, the presence of ptosis, limitation of the range of motion of the eyeballs, the presence of nystagmus, impaired convergence, impaired microcirculation - the presence of "silent zones", stasis, sludge of red blood cells - in the limb capillaries; the presence of pathological signs in the form of annular opacities of the cornea, inclusions on the periphery of the cornea, in the deep or outer layers of the cornea; the asymmetry of the area and the reaction to light of both pupils, violation of the shape of the pupils in the form of flattenings of the upper segments; blurring of the borders of the optic nerve disk, peripapillary deposits of the pigment, shift of the exit site of the vascular bundle, violation of the ratio of the caliber of arteries and veins on the disk, a change in decoloration and / or hyperemia - the color of the disk, the presence and nature of edema of the stroma, exposure of the ethmoid plate in the form of honeycombs; disorders of the thyroid gland in the preclinical and / or early clinical stage in the presence of a combination of the following signs: increased intraocular pressure symmetrically in both eyes, widening of the palpebral fissure, presence of Gref and Moebius symptoms, difficulty in moving the eyeballs and double vision when looking at the extreme leads, presence dry eye syndrome, conjunctival vasodilation, microcirculation disorders - sludge, red blood cell stasis - in limb capillaries, increased eye gloss, pathological iris biological signs in the projection of the thyroid gland, the presence of the lymphoid rosary, the smoothness of the iris pattern, flattening of the lower segments of the pupils, clouding of the posterior lens capsule, signs of complicated cataracts, edema and hyperemia of the inner segments while maintaining the sharpness of the boundaries of the optic nerve head, shift of the vascular bundle to the nasal side, impaired the ratio of the caliber of arteries and veins of the fundus, uneven clearance of the veins of the fundus; pancreatic disorders that indicate diabetes in the preclinical and / or early clinical stages are diagnosed in the presence of a combination of the following symptoms: the presence of recurring barley, blepharoconjunctivitis, point keratopathy, recurrent corneal erosion, microcirculation disturbance - stasis, red blood cell count reduction - capillaries of the limb, ampoule-shaped expansion, the presence of "silent zones" and newly formed limb vessels in the form of tangles, the presence of dilated and neo of the iris vessels, pathological iridological signs in the projection of the liver, pancreas against the background of the translucent mesoderm of the iris in the pupil girdle, clouding of the posterior lens capsule, signs of complicated cataracts, subcapsular vacuoles, flattening of the lower external quadrants of the pupil, edema and hyperemia optic nerve, shift of the vascular bundle to the nasal side, violation of the ratio of the caliber of arteries and veins of the fundus, uneven lumen of the veins, mi croaneurysms, hemorrhages and proliferation in the fundus; disturbances of activity in the diencephalic region and pituitary gland in the preclinical and / or early clinical stage are diagnosed in the presence of a combination of the following signs: the presence of hemioanopsia, symptomatic intraocular hypertension, edema of the stroma, hyperemia, blurring of the borders of the optic disc, stagnation, violation of the ratio of the caliber of arteries and ocular veins fundus, uneven lumen of the veins, their expansion and tortuosity, straightness and narrowing of the arteries of the fundus, peripapillary edema; autoimmune disorders in the preclinical and / or early clinical stage are diagnosed in the presence of a combination of the following symptoms: uncorrectable decrease in visual acuity, the presence of absolute and relative scotomas, symptomatic hypertension, dry eye syndrome, microcirculatory disorders - ampoule-shaped enlargements, sludge, red blood cell stasis, symptom " fireworks ”, microaneurysms - limb capillaries, the presence of recurrent episcleritis, the spraying of pigment or precipitates on the cornea in the form of a triangle, the presence of signs of iridocyclitis, iritis, lymphoid rosary, smooth pattern of the iris, presence of traces of the posterior synechia, pathological iridological signs in the nasopharynx, narrowing of the pupil and a decrease in its response to light, suspension of exudate in the vitreous body, opacification of the vitreous body or traces of exudates and chorioretinal foci in the central and peripheral parts of the retina with the possibility of exudative detachment, the clinical picture of optic neuritis, the presence of ex udata in the macular region; disorders of the musculoskeletal system in the preclinical and / or early clinical stage are diagnosed in the presence of a combination of the following symptoms: the presence of peripheral cattle, symptomatic hypertension, ptosis, the presence of lymphoid rosary on the iris, iridological pathological signs in the projection of the tonsils, spine, lower and upper extremities, decoloration of the temporal half of the optic nerve, exposure of the ethmoid plate, shift of the exit site of the vascular bundle to the nasal side; disorders of the reproductive organs in the preclinical and / or early clinical stage are diagnosed with a combination of the following symptoms: symptomatic intraocular hypertension, flattening of the pupil in the lower segments, iris stroma, pathological iridological signs in the “sex triangle” and projections of the thyroid gland, mammary glands, lymphoid the rosary of the iris, edema and hyperemia of the internal segments of the stroma of the optic disc with preserving the clarity of the boundaries, a tendency to shift the vascular uterus in the nasal side, hypertensive-type angiopathy in the fundus; impaired renal activity in the preclinical and / or early clinical stage is diagnosed if there are a combination of the following symptoms: the presence of straightened and narrowed vessels of the bulbar conjunctiva, microcirculatory disorders - a decrease in the number of capillaries, their sharp straightening, stasis, sludge of red blood cells - limb capillaries, the presence of pathological iridological signs in projections of the pelvic organs, kidneys, tonsils, lymphoid rosary, flattening of the lower segments of the pupil, straightness and narrowing of the fundus arteries, the presence of exudates on the retina, monotonous decoloration of the optic disc.