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CLIN OPT 3 > Slit Lamp > Flashcards

Slit Lamp Flashcards

1
Q

why do we use slit lamp biomicroscope?

A

-outine examination of the anterior eye and
ocular adnexa

  • assessment of contact lens fitting
  • funduscopy (with the use of Hruby / volk lens)

• contact tonometry (also known as Goldmann
applanation tonometry)*

• gonioscopy*
*These will required the use of local anaestheticOfficial (Open), Non-sensitive

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2
Q

what is the set up for SLE?

A

• Wash your hands thoroughly
• Focus the eyepiece and adjust the distance between the
eyepieces to your pupillary distance
• Check that the patient is seated comfortably
• Ensure the outer canthus aligns with the slit lamp markings
• Dim the room lights

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3
Q

what is the purpose and instructions for SLE?

A

Explain the purpose of the test:
• “I will be checking the front part of the eye health“

• Instruct the patient where to look:
“Please look at my ear (i.e., your right ear when assessing the patient’s right
eye)”

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4
Q

what makes up routine SLE?

A

diffuse
parallelepiped (direct/retro)
van herick

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5
Q

what makes up CL SLE?

A

NaF instillation?
lid eversion
TBUT and TMH

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6
Q

what makes up the 4 specialized techniques SLE?

A

optic section
conical beam
sclerotic scatter
specular reflection

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7
Q

what is the purpose and set up of diffuse illumination (beam width, height, angle, magnification, filter)

A

provides an overall assessment of the ocular anterior structure (e.g. lids,
lashes, bulbar and palpebral conjunctiva) and adnexa (i.e., area around the eyes)

width: max
height: max
angle: 30-45
magnification: low 6x-10x
filter: diffuser

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8
Q

what do we check for in diffuse illumination?

A

closed lids, bulbar, palpebral, conjuctiva
look up, left, right, down

look up:
- Check lid margins
- PULL the lower lid adequately to expose
the tarsal conjunctiva
- Check bulbar + LOWER tarsal conjunctiva

look down:
Check lid margins
- Check bulbar + LOWER tarsal conjunctiva

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9
Q

what are the symptoms to record for routine sle?

A

any bumps/lesions/bumps?

any incomplete eye closure?

lid position? (droopy/ loose eyelid skin)

MGB?

inward tuening of lashes?

crustings?

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10
Q

what is the purpose of parallelpiped (direct and retro illu)? What is its advantage?

A

Purpose: The parallelepiped can provide an overview of the ocular structures
such the eye lids, palpebral conjunctiva, etc (similar to diffuse illumination).

However, the key advantage of parallelepiped compared to diffuse is that it can
allow “some” 3D overview of the cornea and crystalline lens.

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11
Q

what is the set up of PPD (beam width, height, angle, magnification)

A

Width 2-3mm

Height Maximal

Angle 30° to 45°

Magnification Low-Medium (6x to 10x)

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12
Q

what is retroillumination? when is it used?

A

Basically, retroillumination refers to the parallelepiped technique - BUT instead of
looking at the region where the light is shining, retroillumination focusses at the area
BESIDE the direct illumination

• This observation technique is used when the structure of interest is “bleached out”
by the direct light observation (see black arrow)

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13
Q

what is the set up of retroillu (beam width, height, angle, magnification)

A

Width 1-2 mm

Height Height of pupil

Angle 0°

Magnification Low (6x)

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14
Q

what is the purpose of van herick angle? what is the set up (beam width, height, angle, magnification)

A

access the anterior chamber depth and screen patients with risk factors for angle closure glaucoma

width: narrowest
height: max
angle: 60
magnification: medium, 10-16x

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15
Q

how do we grade van herrick angle?

A

ratio of corneal limbal section to black optical space

grade 1: < 1:4
grade 2: 1:4
grade 3: 1:2
grade 4: 1:1 (or > 1:1)

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16
Q

what is the purpose of lid eversion? how do we grade?

A

to examine the superior and inferior palpebral conjunctivae, particularly in contact lens wearers, and when looking for allergic conjunctival changes, papillae and foreign bodies

Lid eversion is COMPULSORY for ALL contact lens wearer

Use the J and J Clinical Grading Scale to document the findings of lid eversion

17
Q

what is the purpose of lid NaF instillation?

A

Assess “invasive” Tear Break-Up Time (TBUT)
Use to detect any corneal surface damage
For RGP fitting assessment

18
Q

what are the steps for NaF instillation?

A
  1. Wet the tip of a NaF strip with sterile saline solution (2-3 drops). Be careful not to contaminate the saline by touching the strip to the tip of the bottle.
  2. Shake excess fluid from the strip over a sink.
  3. Ask the patient to look up and touch the strip to the inferior bulbar or tarsal conjunctiva, being careful not to touch the cornea.
  4. Do NOT ‘paint’ the conjunctiva because it can provide too much fluorescein and create unnecessary discomfort for the patient.
  5. Ask the patient to blink several times to allow the fluorescein to spread across the cornea.

***NaF can stained a SOFT CL – Never instil NaF when patient is having their contact lens

19
Q

what is the purpose of TBUT? what do we observe?

A

to asses the wettablity and the quality of tears

TBUT = The duration from “complete” green to the FIRST black dot spotted (the “greenish” images are enhanced by Wratten filter)

20
Q

how do we record TMH? what is the norm

A

beam height 1mm

e. g if TMH is 1/10 of 1mm beam height, then we record as 0.1mm
norm: 0.2-0.4mm

21
Q

why do we need to use clinical grading scales?

A

minimise the ambiguity of assessment between clinicians

enables quantification of the severity of a condition with reference to a set of standardized descriptions or illustrations

**There are a number of grading charts available, therefore, it is important to indicate the chart used on the recording form

22
Q

what is the purpose of optical section (cornea)? what is the set up (beam width, height, angle, magnification)

A

Purpose: to assess and judge the depth of a foreign body/ lesions in the cornea

width: narrowest
height: max
angle: 30-45
magnification: med-high (16-40x)

At high mag, we can see layers of cornea in the beam

23
Q

what is the purpose of optical section (crystalline lens)? what is the set up (beam width, height, angle, magnification)

A

assess the location of the lens opacity - and hence determine
the type of cataract (i.e. anterior/ nuclear/ posterior/ cortical

Width: Narrowest
Height: Maximal
Angle: ~30 to 45°
Magnification Med-High (16x to 40x)

24
Q

what is the purpose of conical beam? what is the set up (beam width, height, angle, magnification, illumination)

A

to look for any signs of inflammation caused by uveitis of flare (protein) or cells
(white blood cells) in the anterior chamber

Width: 1mm
Height: 1mm
Angle: ~45°
Magnification Med-High (16x to 40x)
****ROOM MUST BE DARK
25
Q

what is 1x1 purpose of the set up of conical beam?

A

This set-up is MORE for GRADING – practically, it VERY
hard to pick up cells + flare with 1mm by 1mm as its
VERY small

26
Q

what is the purpose of specular reflection? what is the set up (beam width, height, angle, magnification,) what is the one thing you have to take note of!!!

A 
Purpose: to examine the endothelium for polymegathism (cell size variability)
and pleomorphism (cell shape variability), and the precorneal tear film
Width: 2-3mm
Height: Variable
Angle: ~45 to 60°
Magnification High (40x)
***For this technique to work, the angle of incidence = angle of
reflection.

So this means, it can ONLY be focus through ONE eye piece

27
Q

what is the purpose of sclerotic scatter?

what is the set up (beam width, height, angle, magnification,)

A

Purpose: useful to view subtle corneal changes such as oedema, scar, striae,
foreign bodies, etc.)

Width 1-2 mm
Height Maximum
Angle ~45° (decouple)
Magnification Low

28
Q

What does increasing and decreasing the angle of SLE do?

A

Increasing angle makes slit broader

Decreasing angle makes slit thinner

CLIN OPT 3 (10 decks)

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