Week 3 - CL Slit lamp assessment

Question 1

What are you looking for when assessing Lid Margin/lashes?

Answer 1

• MGD
- Capped glands, frothy tear film, uneven lid margin: toothpaste expression with pressure
•Anterior Blepharitis
• Ectropion/entropion
•Trichiasis, madarosis

Question 2

What do you look for in the Bulbar Conjunctiva?

Answer 2

• Redness
•Staining
• Pinguecula/pterygium

Question 3

What are you looking for Palpebral Conjunctiva?

Answer 3

• Redness
• Roughness - white light and fluorescein
- Follicles/papillaes
• Concretions
• Foreign body

Question 4

What are you looking for in the cornea?

Answer 4

• Staining
• Scarring

Question 5

How are corneal stains described?

Answer 5

• Type
• Depth
• Location
• Size (if appropriate e.g. foreign body or ulcer)
• E.g. inferior punctate epithelial staining

Question 6

What is looked for in the Limbus?

Answer 6

• Redness
• Neovascularisation - needs to be measured

Question 7

What is looked for in the tear film?

Answer 7

• Debris
• Tear stability - tear break-up time
• Look at the tear film with blink, is it spreading evenly?

Question 8

How is the tear break-up time done?

Answer 8

• Invasively (with fluorescein) or non-invasively with keratometry mires (B&L) or a tearscope grid pattern.
• Good to check at baseline as a risk factor for complications and to monitor changes with CL wear
• Normal time: TBUT = >10 seconds

Question 9

What are the effects of Cls on TBUT?

Answer 9

• Contact lenses significantly increase tear evaporation rate and therefore decreases tear stability
• Research has shown this is the case across different lens materials
•So if the patient is already a wearer don’t be surprised if the
TBUT is reduced (important to have good stability pre-fitting)

Question 10

What are the four types if grading scale?

Answer 10

• Efron
• CCLRU (also known as the Brien Holden Vision Institute)
• Alcon (previously known as Ciba)
• J&J/The Vision Care Institute