Slit Lamp

Question 1

Name the 5 congenital cataracts.

Answer 1

1. Anterior axial embryonic
2. Ant and post polar
3. Sutural
4. Pulverulent
5. Currulean

Question 2

What are the normal opacities you may find when examining the lens that are not cataracts.

Answer 2

1. Mittendorf’s Dots: remenants of the hyloid artery. Found on the nasal part of the posterior part of the lens
2. Epicapsular stars: remenenant of the tunica vasculosa lentis

Question 3

What are the 3 types of “Direct Illumination”?

Answer 3

Parallelepiped
Optic Section
Conical Beam

Question 4

Define direct light illumination in SLx

Answer 4

Direct illumination refers to the focusing of the light beam and microscope in the same specific area.

Question 5

What are the 6 Illumination Techniques?

Answer 5

Diffuse
Direct
Indirect or Proximal
Retroillumination/Transillumination
Specular Reflection
Sclerotic Scatter

Question 6

Which illumination technique is most effective illumination at detecting tissue abnormalities ?

Answer 6

Direct Illumination: Parallelpiped

Question 7

T/F: The optic section is used to determining the depth and location of a defect, most commonly used for cornea or lens.

Answer 7

True. Optic section is a type of Direct illumination technique.

Question 8

Which type of direct illumination technique provides a 2-D section of the corneal tissue?

Answer 8

Optic section

Question 9

What are the Landmarks (5-Zones) seen in an optic section?

Answer 9

Pre Corneal Tear Film
Epithelium
Bowman’s Membrane
Stroma
Descemet’s Membrane (Endothelium)

Question 10

Why does an optic section have the “grainy” appearance to the stroma?

Answer 10

Due to “keratocytes” aka corneal fibroblasts

Question 11

What is the critical difference b/n an optic section of the cornea vs lens?

Answer 11

The angle of illumination

Question 12

What is the CORRECT source of illumination in order to perform an accurate Van Herick Angle Estimation?

Answer 12

Optic Section

Question 13

What is the Van Herick angle grade when the width of the chamber interval is 1/4 of the corneal thickness?

Answer 13

2
(less than 1/4 is grade 1,
1/2- 1/4 is a grade 3,
and 1 or higher:1 is 4)

Question 14

What are the cells and flare we see in the anterior chamber examination with a conical beam?

Answer 14

flare = proteins in the AC
Cells = white blood cells that tell us that there is inflammation

Question 15

The conical beam is a type of what type of illumination?

Answer 15

Direct Illumination (conical beam, optic section and parallelepiped)

Question 16

T/F: Floating cells in the AC move UP near the warmer iris and DOWN near the cooler posterior corneal surface.

Answer 16

True

Question 17

What is the purpose of using the sclerotic scatter illumination technique?

Answer 17

To look for corneal edema (loss of corneal transparency)

Question 18

Which illumination technique uses total internal reflection of the cornea?

Answer 18

Sclerotic Scatter

Question 19

What is the purpose of Indirect Illumination?

Answer 19

Indirect illumination produces a “softer” illumination to give better detection and definition, it is the 2nd most common and important technique.

Question 20

Why do you use the specular reflection illumination technique? In other words, which structures can you study using specular reflection?

Answer 20

For cornea endothelium, anterior and posterior lens capsules.

Question 21

Which illumination technique uses snelle’s law?

Answer 21

Specular reflection

Question 22

What are the landmarks of the lens you can see when you are using optic section?

Answer 22

(Anterior to posterior)
Anterior capsule, cortex, adult nucleous, infantile nucleous, fetal nucleous, embryonal nucleous, cortex and then posterior capsule. (embryonic nucleous is at the center)

Question 23

You are focused on the ant capsule. What must you then do to focus on the post capsule?

Answer 23

Tilt the joystick towards the pt.

Question 24

You are doing retro-illumination of the lens. If the lens has lenticular opacities (such as cortical cataracts and PSCs), what color will theses opacities be?

Answer 24

The lenticular opacities on retro-illumination of the lens will appear as darkened areas.

Question 25

When you are looking at the lens using SLEx, what is the darke vertical band structure you’ll see in the center of the lens?

Answer 25

Embryonic structure.

Question 26

What is the most “posterior” structure that you can evaluate while performing an “anterior” segment exam with SLEx?

Answer 26

Anterior vitreous

Question 27

What is Berger’s space?

Answer 27

It is the dark area immediately to the posterior of the post capsule. (It should be optically empty space that is right before the anterior vitreous).

Question 28

What is Mittendorf’s Dot?

Answer 28

It is a normal finding that you can see in the lens. It is an embryological remnant of the hyaloid artery attached to the posterior surface of the lens. In retro-illumination it is seen as a little black dot that is found nasally.

Question 29

What are Epicapsular Stars?

Answer 29

Cluster of pigments (star shaped cluster depisits) that you may see in the anterior portion of the lens. They are remnants of the tunica vasculosa lentis and are normal findings.

Question 30

Name the 6 congenital cataracts that you may see?

Answer 30

Anterior Axial Embryonic
Anterior and Posterior Polar     
Sutural
Pulverulent (dust-like catarcts)
Currulean

Question 31

Which is the most common congenital cataract?

Answer 31

Anterior Axial Embryonic (found in 25% of the population)

Question 32

What is the critical component in the set-up of the retro-illumination of the lens technique?

Answer 32

Light angle should be in click

Question 33

What is a critical element in order to study the superior palpebral conj?

Answer 33

Upper eyelid eversion.