3.1.2: Use SL to examine external eye & related structures Flashcards

1
Q

What are the uses for low mag, medium mag and high mag?

A

o Low magnification (6x – 10x)
➢ General: Lids, Bulbar conjunctiva, Cornea, Limbus, Tears, Anterior chamber, Iris, Lens
o Medium magnification (16x – 25x)
➢ Structures: Epithelium, Stroma, Endothelium, Lens fit and surface
o High magnification (30x – 40x)
➢ Details: Epithelium (Vacuole, Microcyst), Stroma (Straie, Folds), Endothelium (Polymegathism, Dystrophy)

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2
Q

Describe the slit lamp beam/light filters?

A

Cobalt blue: Used with fluorescein dye during assessment of dry eyes, contact lenses, and Goldmann applanation tonometry
Neutral density: Reduces the brightness of the illumination and is complemented by the rheostat on the instrument.
Yellow/Wratten 12: Can be used in addition to the Cobalt blue filter to enhance contrast.
Red free (green): Enhances the contrast of blood vessels on the corneas of contact lens wearers and
haemorrhages seen under the conjunctiva
Diffuser: Generally used with a wide beam and low magnification with non-directional illumination for gross assessment of the eye.

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3
Q

Describe diffuse illumination?

A
  • Angle: 45°.
  • Widest beam.
  • Diffusing filter.
  • Magnification: 10-16x
  • Illumination: medium to high.
    Uses: eyelids, lashes, conjunctiva, sclera, pattern of redness, iris, pupil, gross pathology, and media opacities
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4
Q

Describe parallelepiped?

A
  • Angle: 45 °
  • Slit: 1-2mm in width
  • Filter: None
  • Magnification: 16-25x
  • Illumination: medium
    Uses: * Detect and examine corneal structures and defects
  • Higher magnification preferred to evaluate both depth and extent of corneal scarring or foreign bodies.
  • View corneal nerve fibres, punctate keratitis
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5
Q

Describe optic section?

A
  • Angle: 45 °
  • Slit: width minimum 0.01mm
  • Filter: no filter
  • Magnification: 25-40x
  • Illumination: medium
    Uses:
  • Used to localise: Nerve fibres, Blood vessels, Infiltrates, Cataracts, AC depth.
  • To discover thickening, thinning, and distortions in the corneal contour.
  • To determine the depth of foreign bodies or opacities in the corneal substance. (a % of the total corneal thickness)
  • To see a wide slice of stroma. (The angle between the microscope and illuminating arm can be increased.)
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6
Q

Describe conical beam?

A

➢ Narrow and short beam
➢ Medium magnification
➢ 45-60 degree angle
➢ Must be in darkened room pupil acts as a dark background
➢ Use – inflammatory cells and flare in anterior chamber

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7
Q

Describe specular reflection?

A

➢ Angle of incidence of illumination is equal to angle of observation
➢ Bright reflection (Purkinje images) seen from corneal surface (tears) acting as a mirror
➢ Medium to high magnification (16-40x)
➢ Illumination: med to max
➢ Slit width 4mm
➢ Only visible through one eye piece at a time
➢ Swing illumination arm till reflection achieved reduce angle for deeper structures
Uses:
* Tear film debris and flow, Endothelium, Crystalline lens (orange peel)
* To visualize the integrity of the tear film (lipid layer), corneal and lens surfaces
* To visualize the endothelium
1. Start with lower magnification (10X to 16X).
2. Direct a relatively narrow beam onto the cornea
3. Switch to the highest magnification available
-> Endothelium is best viewed using only one ocular.
* Under specular reflection anterior corneal surface appears as white uniform surface and corneal endothelium takes on a mosaic pattern.

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8
Q

Describe indirect illumination?

A

➢ Same as direct, but looking to the side of the light beam
➢ Direct beam may bleach defects from view
➢ Should decouple to focus observation system to side of the direct beam
➢ Uses – Epithelial vesicles, erosions, Iris pathology, Iris sphincter, Limbal vessels

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9
Q

Describe retro illumination?

A

➢ Use the iris or fundus to back illuminate the cornea
➢ Moderate wide beam
➢ Decoupled
➢ Medium to high magnification ( 10-16x)
➢ Use – Microcysts, Vacuoles, Lens opacities (PSCC, water cleft), CL deposits, Vascularisation

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10
Q

Describe sclerotic scatter?

A

➢ Illumination slit located on limbus, observation decoupled and focused on cornea
➢ Low magnification
➢ Total internal reflection, Halo of light in darkened room if cornea healthy
➢ Use – Corneal opacities, swelling or foreign body in cornea

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11
Q

Describe Van Herick’s?

A
  • Angle: 60°
  • Slit: Optic section
  • Filter: No filter
  • Magnification: Medium (10 or 16x)
  • Illumination: Medium to maximum
  • Comparing width of cornea to anterior chamber
    Grading:
    Grade 4 open ACA 1:1 ratio
    Grade 3 open ACA 1:0.5 ratio
    Grade 2 narrow ACA 1:0.25 ratio
    Grade 1 risky narrow ACA less than 1:0.25
    Grade 0 closed ACA cornea “sits” on iris
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12
Q

What is involved in a slit lamp examination?

A

o Fluorescein assessment
➢ Assess staining of cornea and conjunctiva
➢ Assess tear break up time
➢ Assess tear meniscus height
➢ Use yellow (Wratten) filter over observation to enhance image
o Lid eversion
➢ Assess tarsal conjunctiva under white/blue light (with fluorescein)
o Van Herick’s Technique
➢ Comparing width of cornea to anterior chamber
o Tonometry
➢ Goldmann applanation tonometry with aid of flourescein
o Gonioscopy
➢ Gonioscopy lens using mirrors to directly view anterior chamber
o Pachymetry
➢ Measurement of corneal thickness and regularity
o Fundoscopy
o Lens fitting and assessment

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