Slit Lamp Flashcards
What is the purpose of the slit lamp exam in CL wear?
- Routine CL exam – any sign/symptom requires further examination
- Just because CL px doesn’t meant there aren’t no-CL related problems
o It’s fine to leave CL check to do another day in order to deal with what’s in front of you. - Important to examine everything at fit for baseline measurement and then aftercare appointments to monitor change
What are you looking at in the lid margin and lashes on SL?
- Look at px during H&S – any issues on periocular skin area? Redness? Dermatitis?
o Looking for general hygiene too – can this px look after lenses? - Looking for:
o Meibomian Gland Dysfunction: capped glands, frothy tear film, uneven lid margin
o Anterior Blepharitis: crusting, lashes stuck together -> ↑ chance of infection and poorer quality tear film
o Ectropion/Entropion: can disrupt ocular surface and tear film
o Trichiasis: misdirected lashes
o Madarosis: missing lashes
Describe blocked meibomian glands - on SL?
- Express glands: does oil come out at all? Completely blocked glands? Clear oils?
- Should be clear and not too viscous -> becomes more opaque and thickens as MGD worsens
- Oils coming out of lid margin should spread across tear film with each blink
- Get MGD under control before fitting CLs (or ↓ wear time if already a wearer)
Describe anterior blepharitis - on SL?
- Crusts extend length of lashes
- May get hordeolum alongside – look at base of lashes
- Manage before fitting CLs to ↓ risk of complications
Describe ectropion - on SL?
Eyelid moves slightly away so puncta no longer contacting ocular surface to allow for normal tear drainage, tear retention may not be as good and dry eye may result
Describe trichiasis - on SL?
- Eyelash can be plucked out but can come back and usually in same location – regularly needs dealing with
- Could be an emergency and in a lot of pain
Describe madarosis - on SL?
- Loss of eyelashes can indicate serious pathology or mental health issues but can also be seen in chronic blepharitis
What are you looking for when examining bulbar conjunctiva on SL?
- Looking for:
o Redness – indicates inflammation
o Staining – any signs of compromise to that layer
o Pinguecula/pterygium
Redness: different grades of bulbar conjunctival redness from very mild at the top through to severe at the bottom
Staining: Lissamine green dye is good for assessing bulbar conjunctival staining – whereas fluorescein is better for corneal staining. If don’t have access to Lissamine green dye fluorescein is still good.
Describe pinguecula - on SL?
Can affect comfort and movement with contact lens. Monitor the pinguecula and give appropriate advice
Describe pterygium - on SL?
All about location and how it will disrupt the usually smooth surface. Can affect placement of contact lens and how the patient sees
What are you looking for in the palpebral conjunctiva on SL?
- Looking for:
o Redness – signs of inflammation
o Roughness – smooth? Disrupted due to papillae? – use white light (look at integrity of reflex) and fluorescein
o Concretions – small white spots – if break through epithelium can cause a lot of irritation
o Foreign body – more expect to find as an acute presentation - Redness, roughness and concretions should be measured as baseline and then at follow up appointments
What are you looking for on the cornea on SL?
- Looking for:
o Staining – fluorescein
o Scarring – more subtle, harder to see, can tell you about previous events in eye - Describe any staining:
o Type – FB? Punctate? Linear? Dots?
o Depth – optical section to determine if epithelial, stroma etc
o Location – Inferior? Nasal? Temporal? Use clock face
o Size (if appropriate e.g. FB or ulcer) – use beam width and height to measure
o E.g. inferior punctate epithelial staining – could also say 5 o’clock to 7 o’clock
What are you looking for at the limbus on SL?
- Looking for:
o Redness – suggests inflammation
o Neovascularisation – new BV growth, indicates lack of O2 – could be caused by CL wear – lift top eyelid – measure
What are you looking for in the tear film on SL?
- Looking for:
o Debris – makeup, debris from lashes (hygiene, blepharitis)
o Tear stability – tear break-up time
o Look at tear film with blink, is it spreading evenly over ocular surface?
Describe Tear Film Break-Up Time (TBUT)?
- Can be done invasively (with Fluorescein – FBUT)
- Can be done non-invasively (NITBUT) with keatometry mires (Bausch & Lomb) or a tearscope grid pattern
- FBUT: adding fluorescein which could disrupt tearfilm or add liquid giving artificially stable tearfilm
- Non-invasive: don’t always have the eqipment available
- Good to check at baseline as a risk factor for complications & to monitor changes with CL wear
- Low TBUT can help decide if they can wear CLs, which type, how long for
- Normal time:
o TBUT >10 seconds
