Eye EmergenciesDr Carmel Crock FACEMDirector, Emergency Department, RVEEH                                        1
2
Cornea• 5 layers• Depth0.5-0.8mm             3
4
Normal Cup/Disc ratio 0.3                            5
Normal retina                6
Optic disc swelling                      7
Malignant hypertensive retinopathy.              Grosso A et al. Br J Ophthalmol 2005;89:1646-1654©2005 by BMJ Publishing ...
Anatomy of a Slit Lamp                         9
Features• Illumination  system• Magnification  via binocular  microscope                  10
Basic Components: illumination            • Bulb            • Filters            • Slit height              control       ...
HeightFilters             Filters&                       1.UnfilteredCobaltblue                   2. Heat                 ...
Width        13
Basic Components: magnification•   Eye pieces•   Magnification changer•   Joy stick•   Lock•   Base carriage              ...
MagnificationMost slit lamps have:• 2 objective settings (1 and 1.6)• 2 eye piece options (10x and 16x)• Total magnificati...
16
Use of the Slit Lamp                       • Seat patient                         comfortably                       • Adju...
18
Focus the Microscope by                          1. Adjusting                             inter-puplillary                ...
3    20
Focus Patient’s Eye             • Microscope straight             • Light column 20-30               degrees from side    ...
Adjust the Illumination                 • Brightness: filters                 • Width: slit vs broad                   bea...
Trouble Shooting:unable to turn it on• Check all connections                          23
Trouble Shooting:power on - but no light•   Slit width closed•   Slit height too small•   Bulb burned out•   Bulb not posi...
Trouble Shooting:difficulty moving instrument• Unlock• Check patient position                               25
Trouble Shooting:difficulty focusing• Check eye-pieces  on correct setting• Make sure  patient’s head in  correct position...
Trouble Shooting:misalignment of slit and view• Check magnification changer                                27
Anterior Segment Examination• Systematic examination of the eye from  front to back                                       ...
no FB   no FB   Lashes/ Lids                Conjunctiva                Cornea                Sclera                Anterio...
30
31
http://eyelearn.med.utoronto.ca/default.htm   32
Normal cornea                33
Assessment of Depth                                                 34   http://eyelearn.med.utoronto.ca/default.htm
Oedematous thickened cornea from deeply embedded FB               Do not remove deep CFB                                  ...
Assessment ofDepth Corneal Lesion• Thin beam of light• Illumination column 35-45 degrees                                  ...
Stain Cornea• Use fluorescein  (+/- do Seidel’s test)                               Corneal abrasions                   ht...
Fluorescein• Absorbs light in blue wavelength• Emits green fluorescence                                     38
Tips - fluorescein•   Don’t forget to use it eg. HSV•   Measure size abrasion•   Total vs nil staining - chemical injury• ...
Measuring Size of Lesion                           40
Anterior ChamberSetting up to look at anterior chamber   -darkened room• 1mm beam height• Bright intensity illumination• H...
Grading of AC Cells(counted with 1x1 mm slit)Activity                 Cells+                        6-15++                ...
Removing a Foreign Body                          43
Removal of corneal foreign body withneedle and with burr
Step by step guide – how to useslit lamp - summary1. clean2. practice turn on and using3. bring in patient - adjust chin r...
Step by step guide – how to useslit lamp - summary6. Examine lids, lashes, conj, sclera, cornea,  iris, lens7. Use narrow ...
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Understanding the slit lamp

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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 of "Understanding the slit lamp"

    1. 1. Eye EmergenciesDr Carmel Crock FACEMDirector, Emergency Department, RVEEH 1
    2. 2. 2
    3. 3. Cornea• 5 layers• Depth0.5-0.8mm 3
    4. 4. 4
    5. 5. Normal Cup/Disc ratio 0.3 5
    6. 6. Normal retina 6
    7. 7. Optic disc swelling 7
    8. 8. Malignant hypertensive retinopathy. Grosso A et al. Br J Ophthalmol 2005;89:1646-1654©2005 by BMJ Publishing Group Ltd.
    9. 9. Anatomy of a Slit Lamp 9
    10. 10. Features• Illumination system• Magnification via binocular microscope 10
    11. 11. Basic Components: illumination • Bulb • Filters • Slit height control • Slit rotator • Mirror • Slit width control 11
    12. 12. HeightFilters Filters& 1.UnfilteredCobaltblue 2. Heat absorbing 1 2 3 4 3. 10% Grey 5 4. Red free 5. Cobalt blue 12
    13. 13. Width 13
    14. 14. Basic Components: magnification• Eye pieces• Magnification changer• Joy stick• Lock• Base carriage 14
    15. 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. 16
    17. 17. Use of the Slit Lamp • Seat patient comfortably • Adjust table, chair • Position patient’s head 17
    18. 18. 18
    19. 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. 20. 3 20
    21. 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. 22. Adjust the Illumination • Brightness: filters • Width: slit vs broad beam • Height: long vs pinpoint • Cobalt blue 22
    23. 23. Trouble Shooting:unable to turn it on• Check all connections 23
    24. 24. Trouble Shooting:power on - but no light• Slit width closed• Slit height too small• Bulb burned out• Bulb not positioned correctly 24
    25. 25. Trouble Shooting:difficulty moving instrument• Unlock• Check patient position 25
    26. 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. 27. Trouble Shooting:misalignment of slit and view• Check magnification changer 27
    28. 28. Anterior Segment Examination• Systematic examination of the eye from front to back 28
    29. 29. no FB no FB Lashes/ Lids Conjunctiva Cornea Sclera Anterior chamber -deep and quiet Iris Lens 29
    30. 30. 30
    31. 31. 31
    32. 32. http://eyelearn.med.utoronto.ca/default.htm 32
    33. 33. Normal cornea 33
    34. 34. Assessment of Depth 34 http://eyelearn.med.utoronto.ca/default.htm
    35. 35. Oedematous thickened cornea from deeply embedded FB Do not remove deep CFB 35
    36. 36. Assessment ofDepth Corneal Lesion• Thin beam of light• Illumination column 35-45 degrees 36
    37. 37. Stain Cornea• Use fluorescein (+/- do Seidel’s test) Corneal abrasions http://eyelearn.med.utoronto.ca/default.htm 37
    38. 38. Fluorescein• Absorbs light in blue wavelength• Emits green fluorescence 38
    39. 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. 40. Measuring Size of Lesion 40
    41. 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. 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. 43. Removing a Foreign Body 43
    44. 44. Removal of corneal foreign body withneedle and with burr
    45. 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. 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
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