slit-lamp-examination
March 25, 2019
For further examination, you can add a few drops to dilate the patient’s pupil. Before you can observe the back of the eye, wait 15 to 20 minutes for the drops to dilate the pupils.


Types of Illumination Techniques

The slit lamp is mounted on a moveable stand. The joystick is used to move the slit lamp left, right, backwards and forwards, as well as raising or lowering it. It has a slit projector which can pivot 180 degrees. The instrument also consists of a beam that can be projected tangential, perpendicular or adjusted to an angle of preference. Ensure you move the light source frequently at different angles while performing the examination - it makes it easier to identify abnormalities.

There are several slit lamp lighting techniques which are used during an examination:

Direct Focal Illumination
The direct focal illumination is the most frequently used method for closer inspection of the eye. The optic section, parallelepiped and conical beam are types of direct focal illumination.

The optical section is used to evaluate the severity of the patient’s cornea or finding out the opacity and depth within the lens. Direct the biomicroscope into the patient’s eye. The angle between illuminating and viewing path should be as big as possible but not extended beyond 90 degrees. Keep the slit length small, the most commonly used magnification is between 7 – 10 X.

The parallelepiped is used to assess corneal scars, abrasions, nerves and blood vessels. Focus the biomicroscope into the patient’s eye parallelepiped slit should be around 1 mm wide and 2 mm long. The light beam should be directed to the pupil at a 45 – 60 degrees angle. The examination should be done in a dark room and make sure to allow time to adapt to the change.

The conical beam is used to observe floating debris in the anterior chamber. It is recommended to use high magnification and dim the lights to a minimum or total darkness for this technique. At approximately 45 degrees, the beam is focused between the cornea and the surface of the anterior lens.

Diffuse Illumination
Diffuse illumination is used to provide light to the eye for general survey and observation. This method is useful if the patient’s cornea is opaque, and if you can’t obtain any optical section images. A wide beam of light with the slit fully opened is directed to the cornea or area of interest at 30 – 50 degrees angle. A low to medium magnification (5 – 12 X) is used to display a view of the eye and visualise the structures. Also, with particular dyes, cobalt blue filter or green (red-free) filter can be used together with diffuse illumination to determine various eye conditions.

Retroillumination
Retroillumination is the best method to study the cornea. It uses parallelepiped light to reflect unfocussed light of structures such as the iris, crystalline lens or the retina and observes the back-lighting. Firstly, you should dilate the patient’s pupils and adjust the slit width to 1-2 mm wide and 4-5 mm high. Use a low magnification (7-10 X) before reflecting light from the edge of the iris to illuminate the cornea. The iris is defective if you see an orange glow within the eye.
 
Sclerotic Scatter Illumination
Maximise the light source and focus a wide beam on the limbal region of the cornea. A low magnification (6 – 10 X) and a low angle should be selected so you can see the entire cornea at first glance. The cornea will appear transparent and clear if the eye is normal. However, an illumination or shadow suggests scars, deposits and opacities.

Specular Reflection Illumination
The specular reflection illumination is used to observe the endothelial cells of the cornea. Firstly, focus the biomicroscope in front of the patient’s eye. You should use high magnification and parallelepiped illumination at 45 – 60 degrees for this method.


Indirect Illumination
The indirect illumination is useful to determine irregularities of the corneal epithelium or foreign particles embedded in the cornea. A biomicroscope is directed to the area of interest, and immediately the light beam is positioned next to the focus area at approximately 45 degrees. The beam passes through the cornea but not the iris. As a result, the reflected, indirect light illuminates the cornea and allows close inspection.

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Meta Title
How to Conduct Slit Lamp Examinations | Brawn Medical
Meta Description
Read our article to learn various techniques you can use when conducting a slit lamp examination on a patient.

How to Conduct Slit Lamp Examinations

A slit lamp is an instrument which consists of a high-intensity light source. An eye doctor can shine a light from the instrument into the patient’s eye. This allows different structures of their eye to be observed in more detail as the slit lamp provides a magnified view. Also, a biomicroscope is used in combination with the slit lamp to allow the eye doctor (ophthalmologist) to see the structure of the back of the patient's eye. The slit lamp is used to determine the health of the patient’s eyes and diagnose whether they may have an eye disease.

If you’re starting optometry school or are an experienced eye doctor, it is important to learn or review slit lamp lighting techniques to refresh your memory. Continue reading to learn various techniques you can use when conducting a slit lamp examination on a patient.

The General Procedure

Once the patient is seated in the examination chair, Instruct them to rest their chin and forehead as direct by the ophthalmologist to steady their head, and then begin to examine the patient’s eye with a biomicroscope.

You may need to carry out a fluorescein eye stain test if you suspect their cornea is damaged or you have detected foreign objects in their eye. Touch the piece of paper stain with fluorescein on the side of the patient’s eye and ask them to blink. The dye will spread and coat the tear film that covers the surface of their cornea after blinking. You can shine cobalt blue light in the patient’s eye to highlight any abnormalities or abrasion on their
cornea. If the dye appears smooth across the patient’s eye, their cornea is not damaged. However if the dye appears green under cobalt blue light, this suggests that the patient has an eye abnormality.

For further examination, you can add a few drops to dilate the patient’s pupil. Before you can observe the back of the eye, wait 15 to 20 minutes for the drops to dilate the pupils.


Types of Illumination Techniques

The slit lamp is mounted on a moveable stand. The joystick is used to move the slit lamp left, right, backwards and forwards, as well as raising or lowering it. It has a slit projector which can pivot 180 degrees. The instrument also consists of a beam that can be projected tangential, perpendicular or adjusted to an angle of preference. Ensure you move the light source frequently at different angles while performing the examination - it makes it easier to identify abnormalities.

There are several slit lamp lighting techniques which are used during an examination:

Direct Focal Illumination
The direct focal illumination is the most frequently used method for closer inspection of the eye. The optic section, parallelepiped and conical beam are types of direct focal illumination.

The optical section is used to evaluate the severity of the patient’s cornea or finding out the opacity and depth within the lens. Direct the biomicroscope into the patient’s eye. The angle between illuminating and viewing path should be as big as possible but not extended beyond 90 degrees. Keep the slit length small, the most commonly used magnification is between 7 – 10 X.

The parallelepiped is used to assess corneal scars, abrasions, nerves and blood vessels. Focus the biomicroscope into the patient’s eye parallelepiped slit should be around 1 mm wide and 2 mm long. The light beam should be directed to the pupil at a 45 – 60 degrees angle. The examination should be done in a dark room and make sure to allow time to adapt to the change.

The conical beam is used to observe floating debris in the anterior chamber. It is recommended to use high magnification and dim the lights to a minimum or total darkness for this technique. At approximately 45 degrees, the beam is focused between the cornea and the surface of the anterior lens.

Diffuse Illumination
Diffuse illumination is used to provide light to the eye for general survey and observation. This method is useful if the patient’s cornea is opaque, and if you can’t obtain any optical section images. A wide beam of light with the slit fully opened is directed to the cornea or area of interest at 30 – 50 degrees angle. A low to medium magnification (5 – 12 X) is used to display a view of the eye and visualise the structures. Also, with particular dyes, cobalt blue filter or green (red-free) filter can be used together with diffuse illumination to determine various eye conditions.

Retroillumination
Retroillumination is the best method to study the cornea. It uses parallelepiped light to reflect unfocussed light of structures such as the iris, crystalline lens or the retina and observes the back-lighting. Firstly, you should dilate the patient’s pupils and adjust the slit width to 1-2 mm wide and 4-5 mm high. Use a low magnification (7-10 X) before reflecting light from the edge of the iris to illuminate the cornea. The iris is defective if you see an orange glow within the eye.
 
Sclerotic Scatter Illumination
Maximise the light source and focus a wide beam on the limbal region of the cornea. A low magnification (6 – 10 X) and a low angle should be selected so you can see the entire cornea at first glance. The cornea will appear transparent and clear if the eye is normal. However, an illumination or shadow suggests scars, deposits and opacities.

Specular Reflection Illumination
The specular reflection illumination is used to observe the endothelial cells of the cornea. Firstly, focus the biomicroscope in front of the patient’s eye. You should use high magnification and parallelepiped illumination at 45 – 60 degrees for this method.


Indirect Illumination
The indirect illumination is useful to determine irregularities of the corneal epithelium or foreign particles embedded in the cornea. A biomicroscope is directed to the area of interest, and immediately the light beam is positioned next to the focus area at approximately 45 degrees. The beam passes through the cornea but not the iris. As a result, the reflected, indirect light illuminates the cornea and allows close inspection.

Hi there mates, how is all, and what you want to say
concerning this paragraph, in my view its in fact remarkable designed for me.

Shelley

Also visit my web page :: Shelley

I have been browsing online more than three hours lately, but I never found any attention-grabbing article like yours.

It's beautiful value enough for me. In my opinion, if all webmasters and bloggers made good content material as you probably did,
the web might be a lot more helpful than ever before.

Also visit my blog - More hints

Hi, i think that i saw you visited my site so i came to “return the favor”.I'm attempting to find things to enhance my website!I suppose its ok to use a few
of your ideas!!

My homepage get redirected here

Hi there great blog! Does running a blog like
this require a great deal of work? I've very little expertise
in programming however I had been hoping to start my own blog soon. Anyways, if you have any recommendations or techniques for new blog owners please share.
I understand this is off topic however I just needed to ask.

Cheers!
Aliza

my webpage; Aliza

I blog frequently and I really appreciate your content.

This great article has really peaked my interest. I'm going to bookmark your
website and keep checking for new information about once per week.
I subscribed to your RSS feed too.
Jorge

Feel free to visit my blog post Jorge

I was excited to discover this great site. I want to to thank you for ones time due to this fantastic read!!
I definitely savored every little bit of it and i also have you bookmarked to check out new stuff in your web site.

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I like the helpful inbfo you provide in your articles.
I'll bookmark yor blog and check again here frequently.
I am quite certain I will learn plenty of new stuff right here!
Best of luck for the next!

my site the soundcloud manager

Undeniably believe that which you stated. Your favorite justification appeared to be on the internet the easiest factor to remember of.

I say to you, I certainly get annoyed while people think
about issues that they plainly do not know about.
You managed to hit the nail upon the highest as
smartly as defined out the entire thing without having side-effects ,
people can take a signal. Will likely be back to get more.
Thanks
Azucena

My page :: Azucena

I am no longer positive the place you're getting
your info, but great topic. I needs to spend some time learning much
more or working out more. Thanks for wonderful information I used to be on the lookout for this info for my mission.
Darren

my blog post: Darren

Admiring the persistence you put into your blog and in depth information you provide.

It's great to come across a blog every once in a while that isn't the same
outdated rehashed material. Great read! I've
saved your site and I'm adding your RSS feeds to
my Google account.
Eric

Here is my page: Eric

Quality posts is the important to be a focus for
the viewers to pay a quick visit the site, that's
what this web site is providing.
Modesto

Also visit my blog post: Modesto

Hi mates, its wonderful piece of writing concerning educationand completely defined, keep it up all the time.

Cyril

Review my page ... Cyril

Hi there everybody, here every person is sharing these experience, so it's pleasant to read this web site, and I
used to pay a quick visit this web site every day.

Here is my website ... look at this site

First of all I want to say great blog! I had a quick question which I'd like to ask if you do
not mind. I was interested to find out how you center yourself and clear your head before writing.

I have had a difficult time clearing my thoughts in getting my thoughts out there.

I truly do enjoy writing however it just seems like the first 10 to 15 minutes are usually
lost just trying to figure out how to begin. Any suggestions or hints?
Thank you!
Elsie

Also visit my website: Elsie

I'm really loving the theme/design of your website.
Do you ever run into any internet browser compatibility issues?

A few of my blog readers have complained about my blog
not operating correctly in Explorer but looks great in Firefox.
Do you have any ideas to help fix this issue?

Addie

My page - Addie

hi!,I like your writing so so much! share we keep in touch extra
about your article on AOL? I need a specialist in this space to resolve my problem.
May be that's you! Having a look forward to see you.
Avis

Have a look at my page; Avis

Hi there, just wanted to tell you, I loved this
blog post. It was helpful. Keep on posting!
Thad

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An intriguing discussion is worth comment. I think that you need to publish
more on this issue, it may not be a taboo subject but typically people do not discuss
these topics. To the next! Best wishes!!
Corey

My web-site: Corey

Quality content is the main to invite the people to pay a visit the website,
that's what this website is providing.
Hugh

Feel free to visit my homepage ... Hugh

After I initially commented I appear to have
clicked on the -Notify me when new comments are added- checkbox and from now on whenever a comment is added I receive four
emails with the same comment. Perhaps there is a way you can remove me from that service?
Kudos!
Lyle

my webpage; Lyle

Hi, i read your blog from time to time and i own a similar one and i was just curious if
you get a lot of spam comments? If so how do you prevent it, any plugin or anything you can advise?
I get so much lately it's driving me crazy so any help is very much appreciated.

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Pretty nice post. I just stumbled upon your blog and wanted
to say that I've really enjoyed surfing around your blog posts.
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I like what you guys tend to be up too. This kind of clever work
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Really no matter if someone doesn't understand then its up to other users
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If you desire to grow your know-how just keep visiting this
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Hi it's me, I am also visiting this site daily, this web page is in fact pleasant and the viewers are truly sharing fastidious thoughts.

Stop by my blog - advice

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Hmm is anyone else having problems with the images on this blog loading?
I'm trying to find out if its a problem on my end or
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Iona

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Also visit my web page ... see page

What's up friends, how is the whole thing, and what
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Valarie

Here is my page; Valarie

It is in point of fact a nice and useful piece of info. I am glad that you shared this helpful
information with us. Please stay us informed like this.
Thank you for sharing.
Tawanna

Have a look at my web-site Tawanna

Add new comment

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