SlitLamp - History, Optics, types, Methods & Uses

1. SLIT LAMP
Biomicroscopy

2.  Purkinje 1823
 DeWecker 1863
 Albert & Greenough 1891
 Czapski 1897

3.  Gullstrand 1911
 Henker 1916

4.  Observation System
 Illumination System
 Mechanical support System

5.  Eyepiece +10D
 Objective lens +22D
 Prisms

7.  Czapskiscope with rotating Objectives
Haag Streit model, Bausch and Lomb,
Thorpe model
 Littman-Galilean telescope principle
Zeiss,Rodenstock and American optical slit
lamps
 Zoom system
Nikon photo SL, Zeiss 75 SL

14. Joy stick arrangement
Patient support system
Fixation target
Mechanical coupling

15.  Patient education
 Patient positioning
 Adjust Ocular eye pieces & IPD
 Fixation
 Magnification

16.  Manipulating the Light source
 Focusing
 Examination & Special procedures
 Documentation

17. 1. Diffuse illumination
2. Direct focal illumination
3. Inirect illumination
4. Retroillumination
5. Specular reflection
6. Sclerotic scatter
7. Oscillating illumination of koeppe

18.  General view of anterior eye and the
palpebral conjunctiva.
 Contact lens fitting.

21. Optical section
Parallelopiped of cornea
Conical Beam
Tangential Illumination

22.  Narrow slit beam focused obliquely
 Knife like histological section

23.  Tear layer – Bright anterior most
 Epithelium – Dark line
 Bowman’s membrane – Bright line
 Stroma –Wide granular and Grayish
 Descemet’s membrane & Endo – Bright zone

25. Corneal scars or infiltrates-
bright
Water clefts - black

26. To examine presence of
aqueous flare and cells
Magni- 25x

27.  Observe surface structure
 Medium wide beam
 Magni 10, 16 or 25x
 Anterior and posterior cornea,anterior iris,
anterior lens (pseudoexfoliation)

28. Uses:
Corneal infiltrates
Corneal microcysts
Corneal vacuoles
Epithelial cells

29. Direct
Indirect

30. 16-25x

32.  Obstructive – pigment, blood filled vessel.
 Repersive – epithelial oedema, precipitates
 Refractile - vacuole
Vacuole
I.D.R – Black area with bright surface
D.R- illuminated area with black line

33. Solid / opaque
precipitate
 Retroilluminaition from Fundus (Red Glow )
lamp & microscope coaxial
10- 16x
Cornea,lens,vitreous pathologies
D.R- Dark area
I.D.R – Bright area away from illumination

34. Pupil- mid dilated
Circular beam of light equal to size of pupil
Microscope focused on iris
Magni 10- 16x
Use- Iris defects

35. Integrity of cornea or
Lens
Start from 10-16x
Endothelial mosaic &
Lens surface

36. •Faintest corneal pathology
•6-10x

38.  Slit beam given oscillatory movement.
 Minute particles and filaments

39. SLIT LAMP EXAMINATION
Suggested Power
6X or 10X external (lids,tear film,conjunctiva),contact lenses
16X angles,cornea,iris,lens,foreign bodies,corneal abrasions
25x aqueous flare,corneal endothelium
40X corneal endothelium
Beam Width
1. narrowest angles,cornea,anterior chamber
2. a bit wider cornea,lens,etc
3. a bit wider yet external,contact lenses
4. full width external,applanation tension (with blue filter)
Beam Height
Full most areas and structures
short checking anterior chamber for cells & flare
Color/Filter
White most areas and structures
Blue (use fluorescein dye) applanation tensions,corneal staining,tear
film,staining patterns of rigid contact lenses
Green (red-free) evaluating blood vessels ,iron lines ,fleischer ring

40.  Routine examination of ocular adnexa,
anterior segment and anterior vitreous face
 Confirm fitting of contact lens
 Foreign body removal
 Suture removal
 Epilation
 Removal of membrane,crusts

41.  Gonioscopy
 Fundus examination (fundus non contact lenses)
 Pachymetry
 Applanation tonometry
 Ophthalmodynamometry
 As delivery system for argon,diode andYAG
laser
 Laser interferometry
 Potential acuity meter test
 Slitlamp photography
 Slitlamp videography