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Slit Lamp Illumination Techniques Author:  Irina Jagiloviča e-mail:   [email_address] www:  www.optometristiem.lv
Diffuse Illumination <ul><li>Light is spread evenly over the entire observed surface </li></ul><ul><li>The beam is opened ...
Diffuse Illumination
Diffuse Illumination
Direct Illumination Techniques <ul><li>Beam </li></ul><ul><li>The microscope is usually directed straight ahead but may al...
Beam
Beam
Tangential Illumination <ul><li>This technique is used to observe surface texture.  </li></ul><ul><li>Medium-wide beam of ...
Tangential Illumination
Specular Reflection <ul><li>Specular reflection is used to visualize the integrity of the corneal and lens surfaces. If th...
Specular Reflection
Specular Reflection
Indirect Illumination <ul><li>Proximal </li></ul><ul><li>Use a short, fairly narrow slit beam.  </li></ul><ul><li>Place th...
Proximal
Sclerotic Scatter <ul><li>A tall, wide beam is directed onto the limbal area.  </li></ul><ul><li>When the light is properl...
Sclerotic Scatter
Sclerotic Scatter
Sclerotic Scatter
Retroillumination <ul><li>Retroillumination is used to evaluate the optical qualities of a structure.  </li></ul><ul><li>T...
Retroillumination
Indirect Retroillumination from the Iris <ul><li>the beam is directed to an area of the iris bordering the portion of the ...
Retroillumination from the Fundus (Red Reflex) <ul><li>The slit beam at 2 to 4 degrees </li></ul><ul><li>Shorten the beam ...
Retroillumination From the Fundus (Red Reflex)
Van Herrick Technique <ul><li>Use to evaluate anterior chamber angle without gonioscopy </li></ul><ul><li>Medium magnifica...
Van Herrick Technique
Van Herrick Technique 1. grade –  risky narrow anterior chamber angle less than 1:4 ratio
<ul><li>Thank you  ! </li></ul>
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Slit Lamp Illumination Techniques

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Description of slit lamp illumination techniques to observe different structures

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Slit Lamp Illumination Techniques

  1. 1. Slit Lamp Illumination Techniques Author: Irina Jagiloviča e-mail: [email_address] www: www.optometristiem.lv
  2. 2. Diffuse Illumination <ul><li>Light is spread evenly over the entire observed surface </li></ul><ul><li>The beam is opened all the way. </li></ul><ul><li>Direct the light onto the eye at a 45 degree angle </li></ul><ul><li>The microscope is directed straight ahead. </li></ul><ul><li>Observe: eyelids, lashes, conjunctiva, sclera, pattern of redness, iris, pupil, gross pathology, and media opacities </li></ul>
  3. 3. Diffuse Illumination
  4. 4. Diffuse Illumination
  5. 5. Direct Illumination Techniques <ul><li>Beam </li></ul><ul><li>The microscope is usually directed straight ahead but may also be moved to an angle opposite the illuminator. </li></ul><ul><li>The greater the angle between the illuminator and the microscope, the greater the width of the illuminated section. </li></ul><ul><li>A very narrow beam (optical section) directed onto the cornea can be used to evaluate corneal shape, elevation, and thickness. </li></ul><ul><li>Observe: cornea, iris, lens, vitreous </li></ul>
  6. 6. Beam
  7. 7. Beam
  8. 8. Tangential Illumination <ul><li>This technique is used to observe surface texture. </li></ul><ul><li>Medium-wide beam of moderate height </li></ul><ul><li>Swing the slit lamp arm to the side at an oblique angle </li></ul><ul><li>Magnifications of 10X, 16X, or 25X are used </li></ul><ul><li>Observe: anterior and posterior cornea, iris, anterior lens (especially useful for viewing pseudoexfoliation) </li></ul>
  9. 9. Tangential Illumination
  10. 10. Specular Reflection <ul><li>Specular reflection is used to visualize the integrity of the corneal and lens surfaces. If the surface is smooth, the reflection will be smooth and regular; if the surface is broken or rough </li></ul><ul><li>Position the illuminator about 30 degrees to one side and the microscope 30 degrees to the other side </li></ul><ul><li>To visualize the endothelium, start with lower magnification (10X to 16X). Direct a relatively narrow beam onto the cornea </li></ul><ul><li>Switch to the highest magnification available. </li></ul><ul><li>Endothelium is best viewed using only one ocular, so you may want to close one eye. </li></ul><ul><li>Observe: corneal epithelium and endothelium, endothelial mosaic, lens surfaces </li></ul>
  11. 11. Specular Reflection
  12. 12. Specular Reflection
  13. 13. Indirect Illumination <ul><li>Proximal </li></ul><ul><li>Use a short, fairly narrow slit beam. </li></ul><ul><li>Place the beam at the border of the structure or pathology </li></ul><ul><li>Observe: corneal opacities (infiltrates, vessels, foreign bodies) </li></ul>
  14. 14. Proximal
  15. 15. Sclerotic Scatter <ul><li>A tall, wide beam is directed onto the limbal area. </li></ul><ul><li>When the light is properly aligned with regard to the eye, a ring of light will appear around the cornea. </li></ul><ul><li>The light is absorbed and scattered through the cornea </li></ul><ul><li>highlighting pathology. </li></ul><ul><li>Use 10X magnification, with the microscope directed straight ahead </li></ul><ul><li>Observe: general pattern of corneal opacities </li></ul>
  16. 16. Sclerotic Scatter
  17. 17. Sclerotic Scatter
  18. 18. Sclerotic Scatter
  19. 19. Retroillumination <ul><li>Retroillumination is used to evaluate the optical qualities of a structure. </li></ul><ul><li>The light strikes the object of interest from a point behind the object and is then reflected back to the observer </li></ul>
  20. 20. Retroillumination
  21. 21. Indirect Retroillumination from the Iris <ul><li>the beam is directed to an area of the iris bordering the portion of the iris behind the pathology </li></ul><ul><li>This provides a dark background, allowing corneal opacities to be viewed with more contrast </li></ul>
  22. 22. Retroillumination from the Fundus (Red Reflex) <ul><li>The slit beam at 2 to 4 degrees </li></ul><ul><li>Shorten the beam to the height of the pupil to avoid reflecting the bright light off of the iris. </li></ul><ul><li>Focus the microscope directly on the pathology using 10X to 16X magnification. Opacities will appear in silhouette. </li></ul><ul><li>This view is best accomplished if the pupil is dilated. </li></ul>
  23. 23. Retroillumination From the Fundus (Red Reflex)
  24. 24. Van Herrick Technique <ul><li>Use to evaluate anterior chamber angle without gonioscopy </li></ul><ul><li>Medium magnification </li></ul><ul><li>Angle 60 degrees </li></ul><ul><li>Narrow beam close to limbus </li></ul><ul><li>Depth of anterior chamber is evaluated it to the thickness of cornea: </li></ul><ul><li>4. grade – open anterior chamber angle 1:1 ratio </li></ul><ul><li>3. grade – open anterior chamber angle 1:2 ratio </li></ul><ul><li>2. grade – narrow anterior chamber angle1:4 ratio </li></ul><ul><li>1. grade – risky narrow anterior chamber angle less than 1:4 ratio </li></ul><ul><li>0. grade – closed anterior chamber , cornea “sits” on iris </li></ul>
  25. 25. Van Herrick Technique
  26. 26. Van Herrick Technique 1. grade – risky narrow anterior chamber angle less than 1:4 ratio
  27. 27. <ul><li>Thank you ! </li></ul>

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