Slit Lamp - 2

SLIT LAMP Biomicroscopy
Vijay Kumar.Y
SLIT-LAMP BIOMICROSCOPY
?
IT IS IMPORTANT BECAUSE …...
Baseline findings
Indicates patient’s susceptibility
Diagnosis of problems
Accessories- Tonometer
Possibility of Electronic capturing
BASELINE FLOWCHART
LIDS
BULBAR
CONJUNCTIVA
LIMBUS PALPEBRAL
CORNEA
TEARS
ANTERIOR CHAMBER
IRIS
LENS
Parts of slit lamp
1.Observation system
2. Mechanical support
3. Illumination system
Magnification
• Low - 7X-10X general eye

• Medium - 20X-25X structure layers
• High - 30X-40X detail
Low-magnification(7x-10x)
General eye
• lids
• bulbar conjunctiva
• cornea/limbus
• tears
• AC/iris/lens
Medium- magnification 20x-25x
Structures:
• Eepithelium
• stroma
• endothelium
• lens fit/surface
High magnification 30x-40x
• Details
Epithelial changes
Stromal striae,folds
endothelial folds,polymegathism
Microcysts Vogt’s striae

ILLUMINATION TECHNIQUES
DIFFUSE
DIRECT
INDIRECT
RETRO-ILLUMINATION
SPECULAR REFLECTION
SCLEROTIC SCATTER
TANGENTIAL
Diffuse illumination
• 45 degree angle
• Fully open slit
• Diffusing filter
• Variable magnification
• Low magnification preferred
Overall view of;

• lids/lashes
• conjunctiva
• cornea
• sclera
• iris
• pupil
Blepharitis Meibomitis
UTC Evaluation
Bulbar congestion Bulbar congestion
Eye make-up Corneal scar

Soft contact lens fit RGP fit
Iris Naevi( freckles)
Test Slide
 Broad area of inspection at once

 Ideal for color/localization assessment
 If patients are not tolerate the brightness of a wide beam
Direct illumination
• Illumination & Observation system focused at same point
• Vary angle of illumination
• Low to high magnification
• Vary width and height of light source
Point of Interest
• Cornea
• AC
• Lens
• Flare and cells
Direct illumination
 Optic section
- narrow,focused light
 Parallelepiped
- wider,focused light
 Conical beam
- small,circular light
Optic section
Thinnest possible( < 1mm)/High illumination &
variable magnification
•Indicates depth/thickness
•Localize: - nerve fibers
- blood vessels
- infiltrates
-cataract
•Anterior chamber angle
Optic section
Nebular scar
Heights and widths
Monitoring the diseases
• Epithelial Defect and Infiltrate

Localization
Cornea/AC/Lens
Parallelepiped
• Broader view of the cornea – 2mm width
• Illuminated block of the cornea: 3-D view of the cornea
• More extensive examination
•Moderate to high magnification
Examination of the cornea & pupillary
margin
•
Parallelepiped
Striae Folds
5% or more
Parallelepiped
Epithelial defect Corneal scar

Parallelepiped
Corneal nerves Corneal pigmentation

Test slides
Test Slides
Conical beam
•Dark room
•High magnification
•High illumination
0
•0.2mm width slit and angle - 45 -50
• Inflammatory cells/flare in AC
Flare and cells
Tyndall phenomenon
Slit width for direct illumination
Angle of Illumination
 Higher the angle between Illumination & Observation
 Deeper layers are seen clearly
 For a wider beams higher the angles – depth of view
Indirect illumination
 Vary angle of illumination

 Slit beam is off set
 Vary beam width
 Low to high magnification
• Epithelial vesicles
• Epithelial erosions
• Iris pathology
• Iris sphincter
• Infiltrates /scars
Corneal neovascularization
Direct and Indirect illumination techniques

Indirect view of Fresh KPS
Epithelial vesicle
Retro-illumination
• Vary angle of illumination
• Moderately wide beam
• Slit beam is off set
• Medium to high magnification
• Reflected light from iris or fundus
Retro Illumination
• Light reflects from Iris and Retina

• For Cornea- Iris retro
• For lens/cornea – fundus retro
• Lesions appears as dark
Retro Illumination Types
Direct Retro – Iris and Fundus

Indirect – Iris retro
Marginal
Retro illumination
• Vascularization
• Epithelial edema
• Microcysts
• Vacuoles
• Dystrophies
• Crystalline lens opacities
• Contact lens deposits
Direct/Indirect/Retro
Retro illumination
Vascularization Jelly bumps
Retro illumination
Epithelial edema Microcyts
Fundus retro
IOL
Fundus Retro
KPS on direct and retro
Specular reflection
Angle of incident equals to

angle of reflection
Specular reflection
• Endothelial cell layer

• Tear film debris
• Tear film lipid layer
Specular reflection
Specular reflection
Tear debris Color fringes

Sclerotic scatter
•Localized epithelial edema

•Corneal scars
•Foreign bodies in cornea
Sclerotic scatter
Central Corneal clouding
• Creates a glow halo

Tangential illumination
Large angle of 70- 80 - illumination

iris freckles
•tumors
•integrity of cornea and iris
Iris pattern
Examination with filters
Blue and yellow filter
Red free… green filter
• Hemorrhages will become more black

• Pigmented lesions remains… same dark color
Thank you

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SLIT LAMP Biomicroscopy

• Low - 7X-10X general eye

Microcysts Vogt’s striae

Overall view of;

Eye make-up Corneal scar

 Broad area of inspection at once

Monitoring the diseases

• Epithelial Defect and Infiltrate

Epithelial defect Corneal scar

Corneal nerves Corneal pigmentation

 Vary angle of illumination

Direct and Indirect illumination techniques

• Light reflects from Iris and Retina

Direct Retro – Iris and Fundus

Angle of incident equals to

• Endothelial cell layer

Tear debris Color fringes

•Localized epithelial edema

• Creates a glow halo

Large angle of 70- 80 - illumination

• Hemorrhages will become more black

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