Station 2: Ant Seg, GAT, Gonio, Plugs, CLS

Question 1

Entering the room

Answer 1

*CTA on SLE table during observation

“Good morning Mr(s). Lee, I’m candidate 392”

• wash hands 15 seconds
• clean SLE forehead/chin

Question 2

Ant seg SLE

Answer 2

“The purpose of this procedure is to assess the health of the front portion of your eyes”

• dim room lights
• ask which eye
• adjust slit lamp and focus oculars WITH THE FOCUSING ROD

Lids and lashes
-“the upper and lower lids and lashes are healthy, clear of debris, and without lesions”

Lid margins and punctum
-“the upper and lower lid margins are healthy with normal meibomian gland secretions, no lesions or telangiectasia. The lower punctum is open”

Palpebral conj
-“the inferior/superior conjunctiva is normal, without papillae, follicles, or lesions”

Bulbar conj and sclera
-“the bulbar conjunctiva and sclera are clear and white with no lesions, inflammation, or injection”

Cornea

• 3 passes with parallelpiped, 3 optic section
• “the corneal epithelium is intact and clear. There are no signs of infiltrates. The stroma is clear without edema. The endothelium is intact and clear without guttata”
• “the von Herrick angle estimation for the temporal side is _+”

Iris

• “the iris is (color. The tissue is flat without elevation or nevi”
• “the iris is intact as indicated from a lack of red reflex from any portion around the iris”

Anterior chamber

• “I would normally dark-adapt for 5 minutes prior to assessing the anterior chamber”
• “the anterior chamber is deep and quiet, without cells or flare”

Question 3

Goldmann

Answer 3

“The purpose of this procedure is to measure the pressure inside your eye. I’m going to put a drop in your eye to numb you that also has some dye in it. Tilt your head back for me.”

• ask which eye to check
• ask for view

Corneal integrity
-“I am looking at the cornea for staining before I begin. There is no corneal staining or indications of SPK”

TBUT

• “the tear film is clear of debris”
• check
• “the tear break up time is acceptable”

IOP
-“the intraocular pressure of the eye is __ at __A.M.”

Corneal integrity again
-“the cornea is clear/trace SPK”

Question 4

3 mirror gonio

Answer 4

“The purpose of this procedure is to examine the drainage system in your eye and to make sure nothing is blocking the structures”

• which eye
• celluvisc the lens
• numb the eye

Gonio

• “this lens is going to rest on your eye. You will not be able to feel it, but you might feel the gel from the lens running on your cheek”
• apply lens
• D mirror superiorly first
• ask for view
• “I am examining the __ angle through the D mirror located ___. The most posterior visible structure is the __”
• for inferior angle only: “the iris approach is flat/steep/concave/convex

*remove lens, let pt wipe with tissue

Corneal integrity
-“the cornea is clear/mildly disrupted with trace SPK”

Question 5

Punctal plug

Answer 5

“The purpose of this procedure is to insert a collagen plug into the structure that drains your tears. This will help keep your tears on the surface of your eye longer to help with dryness”

• which eye
• pick up with forceps at the lamp
• have pt look up and opposite to punctum
• ask for view

Insert

• insert plug half way
• count “one one-thousand, two one-thousand” aloud

*remove and throw away

“In order to finish the procedure, the implant would be inserted fully into the punctum and tapped down 2 mm into the vertical canaliculus with the flat end of the forceps”

Question 6

GP and soft contact lenses

Answer 6

“The purpose of this procedure is to fit and assess two different types of contact lenses on your eyes”

• wash hands
• which eye for each lens

Insertion

• soft: “the lens is intact with no tears. It is not inside out as indicated by the readable ‘OK’ marking and the lens has toric markings at 3 and 9 o’clock”
• GP: “the lens is intact with no damage to the edges, scratches, or chips. I’m applying wetting solution to the lens…I’m instilling fluoroscein into the eye with the GP lens to evaluate fit”

Eval

• soft: “the lens covers the cornea past the limbus on both sides and is well centered. It is on the correct way as indicated by the ‘OK’ marking”
• axis, movement with blink, push-up test
• GP: “the lens has __ amount of movement. The staining pattern shows __. This is a lid attached/interpalpebral fit”

Removal

• wash hands
• remove
• corneal integrity for GP