Slit lamp biomicroscopyDr Alex Muntz

PhD MSc Optom & Vision Science Postdoctoral Research Fellow

Dept. of Ophthalmology

Patient's eye

Illumination system (lamp)

Observation system(microscope)

Slit lamp biomicroscope

Microscope

• Binocular - depth perception• Eyepiece adjustments (PD, Rx)• Magnification

Slit beam• ON / OFF• Slit height• Slit width• Focus/movement• Magnification

Important Controls

Viewing the cornea

• Turn SL on• Select low magnification level • Adjust slit to medium width• Move the SL to focus light on the eye while

watching from the side• Look through the SL and fine-tune focus• Now you should see something like…

… this!

slit beam on iris

slit beam on cornea

slit beam on anterior lens

slit beam on posterior lens

Narrow slit, high magnification

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corneal epithelium

Bowman’s layer

corneal stroma

corneal endothelium

anterior chamber overlying pupil

anterior chamber overlying iris

iris

A Suggested Examination

• Start anteriorly and work back

• Begin with low magnification and wide beam

• Examine external eye (eyelids / tears)

• Gross examination of corneal surface

• Gross examination of iris

A Suggested Examination• View red reflex to highlight media opacities

• Narrow slit beam width and increase magnification to more closely observe the cornea and anterior chamber

• Adjust focus posteriorly (move slit lamp towards patient) to examine crystalline lens

If Warranted• Examination with fluorescein• Pressure check (Goldmann)• Evert Lids• Fundal examination (Volk lens)• Gonioscopy

A Suggested Examination• View red reflex to highlight media opacities

• Narrow slit beam width and increase magnification to more closely observe the cornea and anterior chamber

• Adjust focus posteriorly (move slit lamp towards patient) to examine crystalline lens

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If Warranted• Examination with fluorescein• Pressure check (Goldmann)• Evert Lids• Fundal examination (Volk lens)• Gonioscopy

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Remember:

From... ToMagnification Low HighBeam width Wide NarrowBeam angle Straight Angled

Location Anterior/external Posterior

Inspection level General Detailed

Appropriate positioning of patient and examiner!