Slit Lamp Flashcards
what is diffuse illumination
waht is it used on
wide beam on low mag which is used for general screening of the lids, lashes, and conj.
- flat, 2D
- beam width 3-4mm
- mag 6-10x
- beam angle 60 degrees
what is arcus
cholesterol in the corneal stroma
what is tylosis
infl of the eyelids
what is telangiectasias
dilated vesself on lid margin
what is madarosis
paritial loss of eyelashes
how can you get vortex keratophathy
-what does it involve
plaquenil or amiodraone (used for serious arrhythmias)
=nothing to do w/ cornea, redundant conj
what is direct focal illumination
focusing of the light beam and the microscope in the same specific area
-angle btwn microscope and light source is usually btwn 30-60 degrees
what are the 3 types of direct focal illumination
- parallelpiped: 3D view of tissue, wider beam of 1-2mm, mag 10-16x
- optic section: very narrow beam, 2D view of ocular tissue, mag 10-16x
- on cornea allows you to determine depth of scar or fb - conical beam: shorter slightly narrow parallelpiped, light directed into the pupil and slit lamp focused on ant chamber, highest mag, 45-60 degree angle of ill, uses tyndall effect
what are the layers of the cornea
- tear film
- epithelium
- anterior stroma
- posterior stroma
- endothelium
what is the van herick used to determine
estimate the depth of the anterior chamber
-compare the depth of the ant chamber to the width of the cornea
what illumination is used to check anterior uveitis
conical beam=> to check cells and flare (protein) in the ant chamber
where is the focus in a conical beam
just behind the corneal endo and just in front of the lens capsule
what is the tyndall effect
light is scattered by particles in suspension
what is indirect focal illumination
microscope focused on an area adjacent to the illumination system
-looking at something to the side of the light
what is indirect focal illumination good for evaluating
lid, conj, cl opacification, iris abnormalities
what is direct retro illumination
light is refelcted off deeper structures within the path of reflected light
-light about same size as pupil
how can you see iris transillumination defects
light reflects off retina and shines through defects/holes in the iris
what is indirect retro
how is the beam
how is the mag
when light is reflected off deeper strutures to view structures adjacent to the path of reflected light
-narrow or moderate beam w/ low or moderate mag
what type of illumination is best for corneal opacities and neo
indirect reto
what is sclerotic scatter
optic section focused on the corneal limbus and widened in such a way that it produces a halo around the circumference of th elimbus
- 90 degree angle btwn patient cornea and dr’s eye
- dr views this out of slit lamp
what is a good illumination to view corneal edema
sclerotic scatter
what is specular reflection
illumination lamp is posisitoned so the angle of incidence equals the angle of reflection
- parallelpiped moved into the refelction so the reflection back lights the endo
- view seen in only ONE of the doctors oculars
- thin to meduium size parallelpiped w/ high mag
what illumination is best used to assess corneal endo and lens capsule
specular reflection
what stain is good to use for epithelial defects
fluorescein
what stain is good to sue for dying cells and mucin
rose bengal and lisamine green
what is negative staining
stain goes into grooves so if something is raised/protruding, stain drains off it and you will see black color where there are irreg
what stian is good to see conj staining
rose bengal and lissamine green
what is fluramene
what is it good ot view
fluorescein sodium 1% and lissamine green 0.5%
-good for cornea and conj
what do you pair with slit lamp to view back of eye? gonio?
90 or equiv lens to look at back of eye
-goldman lens to do gonio
what is normally affected in corneal degeneration
what can it be accompanied by
when does it generally begin
usually affected peripheral cornea
accompanied by vascularization
begins in middle age or older
what is arcus
- most common degeneration
- deposits of cholesterol esters, choles, low density lipoprotiens in ring around cornea, usualy w/ a clear zone btwn arcus and limbus
where does arcus appear first
inf cornea in the stroma but near descemet’s membrane
-then still in stroma but nearer to bowman’s
what % of 40-60 year olds have arcus
70-90 years?
earlier in men/women? white/black?
60%
90%
earlier in men and blacks
what is arcus relationship to hyperlidpidemia
some say arcus if under 50=risk factor for coronary heart disease
what does the presence of a unilateraly arcus suggest
vascular occulsion on the side w/o arcus
what is the limbal girdle of vogt
where is it normally found
what is it realted to
what are the % of normal findings
sub-ep collagen degeneration
- may or may not be related to UV
- white crystal like appearnace w/ or w/o a clear zone almost always 3 and 9 oclock
- normal finding in any age, 55% of eyes 40-60 years, 93% 70-90 years
what is hudson-stahli line
what does it look like
when is it more common
% in age groups?
normal finding of iron deposition at level of bowman’s
-yellowish, brown irreg line just inf to mid pupil near where margins meet
-more common in ppl w/ dry eye
less tears= inc iron
-20 years old=20%
-60 years old=60%
what is descemet’s striae
small linear striation in descemet’s membrane
- often seen
- usually vertical but can be tilted
- no clinical sig except w/ stromal edema from soft cl or after refractive surgery
what is mosiac shagreen
where is it mostly seen
aka crocodile shagreen
- prob results from relaxation of the normal tension on bowman’s
- grayish white polygonal opacities separated by clear spaces, very common
- looksl ike croc leather
- ant or post
- mostly seen centrally
what are hassle-henle bodies/guttata
-what is it assoiated w/
-nodular thickening of descemet’s membrane, believed to be composed of collagen
-abnormal byproducts of the endo cells pitted and project into the endo
hassal-henle-in periphery
guttata-centrally
-ass with corneal trauma and infl
-ass w/ aging
how does guttata look in specular reflection and direct illumination
spec reflect: orange peel appearance (black hole)
direct: refractile ciruclar pits in endo
- sometimes ass w/ fine pigment througout endo
what is guttata the first sign of
fuch’s endothelelial dystrophy
- patient should be closely watched
- consider monitoring w/ pachymetry
does guttata affect vision
rarely
but if central and dense enough it can
what is corneal farinata where are depeosits more prominant best seen with what ill? does it intefere w/ vision what is the exact cause normal finding?
age related corneal change
comprised of many tiny, dust like gray dots and flecks int he deep stroma
-farinaceous=”flour like”
-more prominant centrall
-best seen w/ retro
-bilateral and doesn’t interrere w/ vision
-exact cause unknown, prob lipofuscin which is a degenerative pigment found in aged cells
-normal finding, no management needed
what is band keratopathy
- considered corneal degeneration
- calcium salts depositied in the interpalpebral zone
- calcium deposists start in the basement membrane
- start as gray and flat but as they progess they become white and elevate overlying ep and can later spread to bowman’s layer and ant stroma
how does band keratopathy form
evaporation of tears tneds to concentrate solutes and to increase tonicity of tears
- tears contain calcium, phosphate that will deposit if solubility level is exceeded
- elevated serum calcium and phosphate can push the solutes to precipitate and deposit as tears evaporate
what causes band keratopathy
localized ocular infl: uveitis, prolonged glauc, long standing corneal edema, silicon oil in eye
systemic causes: hyperparathyroid, juv rheumatoid arthritis and uveitis in children, chronic exposure of the cornea to mercry, thiazides, vit D toxicity, renal failure, sarcoid
rarely inherited
in elderly can be idiopathic
what are possible lab tests for band keratopathy
serum calcium, albumin, magnesium, phophate levels, blood urea nitrogen, creatine, parathyroid levels
- ACE
- uric acid level if gout is suspected
how do you treat band keratopathy
ocular treatment needed only if vision is reduced or if ep breaks down over deposits
- treat by removing ep and scraping w/ a knife and applying celating agent
- repeated application of calcium binding agent EDTA and scraping of the corneal surface after removing ep (mild cases)
- excimer laser keratectomy for deep involvment or “polish” corneal surface after chelating is done
what is salzmann’s nodular degeneration
rare but can happen at any age but avg age of onset is about 60
- plaques located btwn the epi and bowman’s
- in some pt believed to be a late sequela of old keratitis
what does confocal microscopy indicate for salzmann’s nodular degeneration
elongated basal ep cells and activated keratocytes, particularly in the area of the ant stroma near the nodules
what does spectral domain oct imaging reveal about salzmann’s nodular degeneration
fibrous intraepithelial nodules w/ sig overling ep thinning
where to salzmann’s nodules usually occur
what is it associated w/ (3)
w/in or adjacent to an area of previous scarring or the edge of long-standing pannus
- may be assoicated w/ mucopolysaccharid problem
- may be associated w/ osteoporosis and pterygium
how does salzmanns develop
slowly and asymptomatic unless in visual axis which can decrease vision
what is treatment of salzmann’s
- not usually necessary
- excise if vision is decreased
- mitomycin C and PTK (phototherapeutic keratectomy) is being used on more severe cases
- occasionally ep can break down over the surface causing irritaion => use thick rewetting sol’n
what is dellen
localized thinning of stroma next to raised area, secondary to poor wetting and resultant stromal dehydration
- usually next to a raised mass such as a ping or thick cl edge
- intact ep and endo, just thinning
- no risk of perforation but may scar
what is kayser fleischer ring
what is it caused by
yellowish brown, may be fold, red, blue, green, or mixture
- 1-3mm side circumlimbal ring at level of descemets
- caused by wilson’s disease
- refer*
how is wilson disease inherited
how is copper depositied
what is treatment
autosomal recessive metabolic defect linked to chrom 13
- depositied in the liver, then the kidneys, and eventually the brain and cornea
- treatmet: low copper diet and chelating agent
what is krukenberg spindle associated w/
pxe and pds
if you see krukenberg spindle what do you monitor for and check fo
check for iris transill or pxe
monitor for glauc
-may have large diurnal changes in IOP
what is pannus
what can it be accompanied by
any growth beyond the normal arcade (superficial limbal vessels normally don’t extend onto cornea for more than 1mm)
-may be accompanied by sub ep fibrous tissue or stromal scarring (clarity of stroma reduced, looks cloudy)
what is micropannus
what are the causes
only 1-2mm beyond normal arcade
causes: inclusion (chlamydial) conjunctivias, staph bleph, cl wear, vernal conjunctivitis, acne rosacea (dries out mb glands)
what is gross pannus
what are the causes
greater than 2mm extension of vessels
causes: trachoa, phylcetenulosis, acne rasacea, cl wear, staph bleph, atopic keratoconjunctivitis
what is posterior embryotoxon
congenital, fairly common, exaggerated schwalbe’s line (termination of descet’s membrane)
- white line on cornea
- present in 15% of indiv
- viewed mostly on post on cornea at 3 and 9 o clock but can be a rign
- NORMAL
what is the diff btwn post embryotoxon and volks
more post in back=sl aka desemets
what can post embryotoxon be associate dw/
glaucoma
how can vortex keratopathy aka corneal verticillata be developed
medications can bind w/ cellular lipids of the basal ep layer of the cornea
- hydroxychloroquine (plaqenil) and amiodarone are the 2 most common ones that can cause the whorl pattern
- 100% of patients
- normal
where does vortex kertopathy occur
deep ep and ant stroma
the whorl can be a diagnostic of what …
fabry
what is fabry’s disease
- rare genetic X linked disease
- deficiency of alpha galactosidase A
- mutation causes a glycolipid known as globotriaosylceramide (gb3 or gl-3) to accumulate w/in the blood vessels, other tissues, and organs and can lead to renal failure and severe heart disease
how to treat fabry’s
no cure but there are enzyme replacements
very costly, about $250,000
what are axenfeld loops
- what is it usually beside
- what % of eyes
~12% of eyes
-large loop of ciliary nerve extends from the ant ciliary body into sclera, usually beside one of the ciliary artiers
what are epicapsular stars remnant of
tunica vasculos lentis
-on ant capsule
what is embryonic zonular opacification
zonular cataract affects one layer of lens but is surrounded by clear lens
what is a corneal scar
anything that penetrates beneath epi wil cause a scar
