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Slit lamp biomicroscopy - fmhs.auckland.ac.nz€¦ · Slit lamp biomicroscope. Microscope •...

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Slit lamp biomicroscopy Dr Alex Muntz PhD MSc Optom & Vision Science Postdoctoral Research Fellow Dept. of Ophthalmology
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Page 1: Slit lamp biomicroscopy - fmhs.auckland.ac.nz€¦ · Slit lamp biomicroscope. Microscope • Binocular - depth perception • Eyepiece adjustments ( PD, Rx) • Magnification •

Slit lamp biomicroscopyDr Alex Muntz

PhD MSc Optom & Vision Science Postdoctoral Research Fellow

Dept. of Ophthalmology

Page 2: Slit lamp biomicroscopy - fmhs.auckland.ac.nz€¦ · Slit lamp biomicroscope. Microscope • Binocular - depth perception • Eyepiece adjustments ( PD, Rx) • Magnification •

Patient's eye

Illumination system (lamp)

Observation system(microscope)

Slit lamp biomicroscope

Page 3: Slit lamp biomicroscopy - fmhs.auckland.ac.nz€¦ · Slit lamp biomicroscope. Microscope • Binocular - depth perception • Eyepiece adjustments ( PD, Rx) • Magnification •

Microscope

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

Page 4: Slit lamp biomicroscopy - fmhs.auckland.ac.nz€¦ · 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

Page 5: Slit lamp biomicroscopy - fmhs.auckland.ac.nz€¦ · Slit lamp biomicroscope. Microscope • Binocular - depth perception • Eyepiece adjustments ( PD, Rx) • Magnification •

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…

Page 6: Slit lamp biomicroscopy - fmhs.auckland.ac.nz€¦ · Slit lamp biomicroscope. Microscope • Binocular - depth perception • Eyepiece adjustments ( PD, Rx) • Magnification •

… this!

slit beam on iris

slit beam on cornea

slit beam on anterior lens

slit beam on posterior lens

Page 7: Slit lamp biomicroscopy - fmhs.auckland.ac.nz€¦ · Slit lamp biomicroscope. Microscope • Binocular - depth perception • Eyepiece adjustments ( PD, Rx) • Magnification •

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

Page 8: Slit lamp biomicroscopy - fmhs.auckland.ac.nz€¦ · Slit lamp biomicroscope. Microscope • Binocular - depth perception • Eyepiece adjustments ( PD, Rx) • Magnification •

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

Page 9: Slit lamp biomicroscopy - fmhs.auckland.ac.nz€¦ · Slit lamp biomicroscope. Microscope • Binocular - depth perception • Eyepiece adjustments ( PD, Rx) • Magnification •

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

Page 10: Slit lamp biomicroscopy - fmhs.auckland.ac.nz€¦ · Slit lamp biomicroscope. Microscope • Binocular - depth perception • Eyepiece adjustments ( PD, Rx) • Magnification •

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

Page 11: Slit lamp biomicroscopy - fmhs.auckland.ac.nz€¦ · Slit lamp biomicroscope. Microscope • Binocular - depth perception • Eyepiece adjustments ( PD, Rx) • Magnification •

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

Page 12: Slit lamp biomicroscopy - fmhs.auckland.ac.nz€¦ · Slit lamp biomicroscope. Microscope • Binocular - depth perception • Eyepiece adjustments ( PD, Rx) • Magnification •

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Page 13: Slit lamp biomicroscopy - fmhs.auckland.ac.nz€¦ · Slit lamp biomicroscope. Microscope • Binocular - depth perception • Eyepiece adjustments ( PD, Rx) • Magnification •

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

Page 14: Slit lamp biomicroscopy - fmhs.auckland.ac.nz€¦ · Slit lamp biomicroscope. Microscope • Binocular - depth perception • Eyepiece adjustments ( PD, Rx) • Magnification •

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Page 15: Slit lamp biomicroscopy - fmhs.auckland.ac.nz€¦ · Slit lamp biomicroscope. Microscope • Binocular - depth perception • Eyepiece adjustments ( PD, Rx) • Magnification •

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Page 16: Slit lamp biomicroscopy - fmhs.auckland.ac.nz€¦ · Slit lamp biomicroscope. Microscope • Binocular - depth perception • Eyepiece adjustments ( PD, Rx) • Magnification •

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!


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