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Understanding the slit lamp

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Dr Carmel Crock RVEEH Melbourne, explains basics of slit lamp use

Dr Carmel Crock RVEEH Melbourne, explains basics of slit lamp use

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  • Anterior chamber –aqueous Slit lamp –to anterior vitreous
  • Cup disc ratio 0.3
  • http://www.google.com.au/imgres?q=retina+cup+disc&hl=en&client=safari&rls=en&biw=1280&bih=693&tbm=isch&tbnid=DZYAk_baW5KhTM:&imgrefurl=http://www.mims.com/USA/diagnoses/info/1653&docid=2udEbHJ7sHZdhM&imgurl=http://www.mims.com/resources/drugs/common/CP0033.gif&w=450&h=360&ei=iF3MTvebHaeOmQXSu5ThBA&zoom=1&iact=hc&vpx=194&vpy=155&dur=6121&hovh=201&hovw=251&tx=131&ty=116&sig=108216024329223823048&page=1&tbnh=153&tbnw=191&start=0&ndsp=15&ved=1t:429,r:0,s:0
  • Lecture notes p 27
  • Transcript

    • 1. Eye EmergenciesDr Carmel Crock FACEMDirector, Emergency Department, RVEEH 1
    • 2. 2
    • 3. Cornea• 5 layers• Depth0.5-0.8mm 3
    • 4. 4
    • 5. Normal Cup/Disc ratio 0.3 5
    • 6. Normal retina 6
    • 7. Optic disc swelling 7
    • 8. Malignant hypertensive retinopathy. Grosso A et al. Br J Ophthalmol 2005;89:1646-1654©2005 by BMJ Publishing Group Ltd.
    • 9. Anatomy of a Slit Lamp 9
    • 10. Features• Illumination system• Magnification via binocular microscope 10
    • 11. Basic Components: illumination • Bulb • Filters • Slit height control • Slit rotator • Mirror • Slit width control 11
    • 12. HeightFilters Filters& 1.UnfilteredCobaltblue 2. Heat absorbing 1 2 3 4 3. 10% Grey 5 4. Red free 5. Cobalt blue 12
    • 13. Width 13
    • 14. Basic Components: magnification• Eye pieces• Magnification changer• Joy stick• Lock• Base carriage 14
    • 15. MagnificationMost slit lamps have:• 2 objective settings (1 and 1.6)• 2 eye piece options (10x and 16x)• Total magnification ranges thus from 10x- 25x 15
    • 16. 16
    • 17. Use of the Slit Lamp • Seat patient comfortably • Adjust table, chair • Position patient’s head 17
    • 18. 18
    • 19. Focus the Microscope by 1. Adjusting inter-puplillary distance 2. Adjusting the eye pieces2 2 (set at 0 or dial in your refraction) 1 3. Checking magnification is on 1x setting 19
    • 20. 3 20
    • 21. Focus Patient’s Eye • Microscope straight • Light column 20-30 degrees from side • Microscope moves via joystick • Move laterally • Move in and out • Bimanual 21
    • 22. Adjust the Illumination • Brightness: filters • Width: slit vs broad beam • Height: long vs pinpoint • Cobalt blue 22
    • 23. Trouble Shooting:unable to turn it on• Check all connections 23
    • 24. Trouble Shooting:power on - but no light• Slit width closed• Slit height too small• Bulb burned out• Bulb not positioned correctly 24
    • 25. Trouble Shooting:difficulty moving instrument• Unlock• Check patient position 25
    • 26. Trouble Shooting:difficulty focusing• Check eye-pieces on correct setting• Make sure patient’s head in correct position• Adjust joy stick in and out 26
    • 27. Trouble Shooting:misalignment of slit and view• Check magnification changer 27
    • 28. Anterior Segment Examination• Systematic examination of the eye from front to back 28
    • 29. no FB no FB Lashes/ Lids Conjunctiva Cornea Sclera Anterior chamber -deep and quiet Iris Lens 29
    • 30. 30
    • 31. 31
    • 32. http://eyelearn.med.utoronto.ca/default.htm 32
    • 33. Normal cornea 33
    • 34. Assessment of Depth 34 http://eyelearn.med.utoronto.ca/default.htm
    • 35. Oedematous thickened cornea from deeply embedded FB Do not remove deep CFB 35
    • 36. Assessment ofDepth Corneal Lesion• Thin beam of light• Illumination column 35-45 degrees 36
    • 37. Stain Cornea• Use fluorescein (+/- do Seidel’s test) Corneal abrasions http://eyelearn.med.utoronto.ca/default.htm 37
    • 38. Fluorescein• Absorbs light in blue wavelength• Emits green fluorescence 38
    • 39. Tips - fluorescein• Don’t forget to use it eg. HSV• Measure size abrasion• Total vs nil staining - chemical injury• Fluorescein under lid – upper lid abrasion• Seidel’s + or –ve -document• Self sealing wounds• Apply fluorescein then wait for bit to see more subtle staining 39
    • 40. Measuring Size of Lesion 40
    • 41. Anterior ChamberSetting up to look at anterior chamber -darkened room• 1mm beam height• Bright intensity illumination• High magnification• Is the anterior chamber deep and quiet? 41
    • 42. Grading of AC Cells(counted with 1x1 mm slit)Activity Cells+ 6-15++ 16-25+++ 26-50 SUN 2005 Am J Opthalmol 2005: 140: 509 42
    • 43. Removing a Foreign Body 43
    • 44. Removal of corneal foreign body withneedle and with burr
    • 45. Step by step guide – how to useslit lamp - summary1. clean2. practice turn on and using3. bring in patient - adjust chin rest, lat. canthus at line, forehead against band4. prepare microscope - interpupillary distance, oculars set at 0, low mag5. prepare light - low volt, 10% grey, wide beam 45
    • 46. Step by step guide – how to useslit lamp - summary6. Examine lids, lashes, conj, sclera, cornea, iris, lens7. Use narrow beam to examine corneal lesion – measure depth8. Set up to look at anterior chamber - depth, cells, flare - bright/1mm beam/high mag9. Use fluorescein –measure size lesion10.Turn off and clean 46