SlideShare a Scribd company logo
DEPT. OF OPTHALMOLOGY SHER-E-BANGLA MEDICAL COLLEGE HOSPITAL, BARISAL. 
DR. MD. NURUL ISLAM 
DO STUDENT 
SESSION – JULY, 2013 
25-09-2014
INTRODUCTION
THE SLIT-LAMP BIOMICROSCOPE is a high-power binocular microscope with a slit-shaped illumination source, specially designed for viewing the different optically transparent or translucent tissues of the eye. 
It enhances the examination by : 
Excellent image quality 
Binocular stereoscopic view 
Flexible illumination 
Flexible magnification 
Providing room for specialized attachments and lenses for detailed examination and diagnostic tests
The science of examination with a slit lamp is called Biomicroscopy as it allows in vivo study of living tissues at high magnification. 
Cont…
HISTORICAL LANDMARKS
•1911, the first concept of slit-lamp was introduced by ALLVAR GULLSTRAND, it was named as “Large reflection-free ophthalmoscope” manufactured by Zeiss. 
Prof. Allvar Gullstrand 
Large Gullstrand Opthalmoscope (1911)
•1919, VOGT introduced KOEHLER illumination system to Gullstrand slit-lamp. 
•1930, LETZ introduced telescopic loupe built on the principle of Galilean Telescope which helps in increase working distance. Haag-Streit-1920 
Bausch & Lomb slit lamp (1926) 
Cont…
•1933, GOLDANN developed three control element for cross-slide stage and also common swivel axis for microscope and illumination system in HAAG-STREIT Slit-lamp. 
•1938, Joystick was added to Haag-streit. Haag-Streit-1933 
Haag-Streit-1936 
Cont…
•1950, LITTMANN with ZIESS combined joystick control from Goldmann, illumination path from Comberg prism instrument and also added stereo telescope system with magnification changer. 
Cont… 
Zeiss slit lamp (Littmann) (1950) 
Haag-Streit-1959
Fig. : Modern slit-lamp Cont… 
•Onward modern slit-lamp system began to come into light.
TYPES
•On the basis of illumination system it is of 2 types : 
1.Zeiss type 
In the Zeiss type the illumination comes from below
2. Haag-streit type 
In the Haag Streit type the illumination comes from above Cont…
•On the basis of compound microscope system it is also 2 types : 
1.The Grenough type 
Flip lever to change magnification 
Cont…
2. The Galilean changer type 
Knob to change magnification (3 or 5 step) Cont…
Also different types of HAND-HELD slit-lamp devices available for – 
•Handicap 
•Infant 
•Bedbound patients 
Cont…
OPTICAL PRINCIPLES
Illumination system Principle : 
Kohler illumination principle is used in both Zeiss & Haag-streit type illumination system. 
The light filament (F) is imaged on to the objective lens (O) but the mechanical slit (MS) is imaged on to the patient’s eye (S)
Microscope system Principle : 
The eyepiece (Ocular) uses Astronomical telescope system. 
Here two convex lenses used one in front of other separated by the distance of their focal length. Fig. : Slit-lamp biomicroscope optical principles
A Galilean telescope system is used for even higher and changeable magnification. 
Here a convex and a concave lens is used in line separated by the distance of their focal length. 
Cont… 
Fig. : Slit-lamp biomicroscope optical principles
Both telescope systems produce inverse image of an object so an inverting prism named Porro- Abbe prism is used to produce right way erect image. 
Here two triangular prisms use the total internal reflection principle of optics. 
Cont… Porro-Abbe Prism 
Fig. : Slit-lamp biomicroscope optical principles
The telescope system provide considerable distance between the microscope and the patient’s eye, so that certain maneuver like foreign body removal from the cornea or using extra lenses for fundus examination can be done. 
Cont…
Parfocality : The point at which the microscope is focused corresponds to the point on which the light is focused, this coupling effect is called parfocality. 
This is achieved by the microscope and the illumination system, having a common focal plane and their common axis of rotation also lies in that focal plane. 
Cont…
PARTS OF THE SLIT-LAMP
Basic Design : 
1.Mechanical system 
2.Illumination system 
3.Biomicroscope /Observation system 
Associated instruments : 
•Applanation Tonometer 
•Gonioscopic Lens 
•Fundoscopy Lens 
•Micrometer Eyepieces 
•Image archiving device 
•Laser delivery system
It concern with : 
•Positioning & adjustment of patient and observer 
•Maneuvering the illumination and microscope system together with joystick 
•Providing base to other parts 
Mechanical system : 
Basic 3 parts : 
1.Motorized table (Base) 
2.Patient positioning frame 
3.Joystick
Parts of mechanical system : 
Cont… Fixation target Chin rest adjustment knob 
Joystick Power switch Table height adjustment Forehead band 
Canthus alignment 
Chin rest Hand grip for patient Lock for slit lamp base 
Low friction plate
Provides a bright, evenly illuminated, finely focused, adjustable slit of light at the eye. 
Contains the following components: 
•Light source 
•Condenser lens system 
•Slit and other diaphragms 
•Filters 
•Projection lens 
•Reflecting mirror or prisms 
Illumination system :
Parts of illumination system : 
Cont… 
Scale for slit height 
Slit height control Inclined mirror Latch to tilt light column Light source Filter control 
Centering screw Slit width control
•Essentially these are compound microscopes composed of optical elements providing enlarged right way stereoscopic image to observer. 
•Provides larger working distance in front of microscope for manipulation on patient’s eye. 
•Magnification changer for detail view. 
Observation system :
Parts of observation system : 
Cont… Eyepiece 
Marked ring for 
Adjustment of examiner’s 
refractive error Prism housing Knob to change magnification Objective lens
Associated instruments :
CLINICAL PROCEDURE
Prerequisites : 
•Switch on power & unlock base screw 
•Cleaning the forehead band 
•Changing paper strip from chinrest 
•Comfortable sitting of pt. and the examiner 
•Counseling the patient 
•Proper positioning of the pt. 
•Target fixation 
•Adjust eyepieces to correct for examiner’s refractive error and interpupillary distance 
•Children may need to stand, or they can sit on parent’s lap or kneel on a stable chair 
Fig. Correct positioning at the slit lamp.
Chronology for slit-lamp examination : Eyelids 
Eyelid margins Tear film Conjunctiva Cornea 
Aqueous humor 
Iris Lens Vitreous (ant.)
Illumination techniques : 
Slit Width control knob: 
Narrow to fully open slit illumination achieved by rotating this knob
Illumination techniques : 
Slit height control knob : 
Short to long slit illumination achieved by rotating this knob 
Cont…
Illumination techniques : 
Slit angle rotation : 
Cont…
Illumination techniques : 
Tilting light column : 
Illumination column can be tilted 5-20°, with vertical axis which gives extra plane and minimize reflection during posterior segment examination with condensing lens. 
Cont…
Illumination methods : 
Direct illumination 
•Direct diffused illumination 
•Direct focal illumination 
i.Parallelepiped 
ii.Optical section 
iii.Conical beam 
•Specular reflection 
•Tangential illumination 
Indirect illumination 
•Indirect proximal illumination 
•Retro-illumination 
•Sclerotic scatter 
Oscillatory illumination
Direct diffused illumination : 
•illumination of the eye with a broad, unfocused light beam 
•directed obliquely between 30-450 
•magnification 6x to 10x 
Application : 
•General gross overview of eyelids, lashes, conjunctiva, sclera, pattern of redness, iris, pupil, gross pathology, ant capsule of lens 
Cont…
Direct diffused illumination : 
Cont…
Direct focal illumination : 
•Illumination and observation are focused in the same plane 
•slit width narrow to broad 
•Illumination angle 45° to 60° 
•Magnification 10x-40x 
Application : 
•Cornea in detail 
•Anterior chamber 
•Crystalline lens 
•Anterior part of vitreous 
•Grading cell and flare in anterior chamber 
Cont…
Direct focal illumination : 
Cont…
Direct focal illumination : 
i.Parallelepiped 
•Slit width 2-4 mm obliquely focusing on the cornea so that a quadrilateral block of light illuminate the cornea 
Application : 
•To examine corneal surface, stroma 
•To ascertain depth (FB, abration) 
Cont…
Direct focal illumination : 
ii.Optical section 
•Slit width 1mm or less 
•Illumination angle 45-60° or more 
•High illumination & magnification 
Application: 
•Corneal depth, layers, scars, vessels 
•Lens opacity 
Cont… 1. Tear film 2. Epithelium 3. Ant. Stroma 4. Post. Stroma 5. Descemet’s mem. & Endothelium
Direct focal illumination : 
iii.Conical beam 
•Assessment of particles floating in the A/C 
•Narrow, short & bright slit of light 
•45°-60° light source directed to pupil 
•Magnification 16x-25x 
Application : 
•Inflammatory cells, flare, pigmented cells, metabolic wastes 
Principle : Tyndall phenomenon 
Cont…
Specular reflection : 
•Angle of incidence = angle of reflection 
•Observation and illumination system have same angle with perpendicular axis to each other 
•Slit width < 4mm 
•The light reflected from the anterior or posterior corneal surface 
•Best view with one eye 
Application : 
•assessment of surfaces 
Corneal epithelium 
Corneal endothelium 
Lens surface 
•assessment of tear film 
Cont… 
Corneal endothelium
Tangential illumination : 
•A narrow light beam is projected almost parallel along the structure to be observed 
•Elevated structures are visible by shadowing 
•Illumination angle 90° 
•Magnification 10-25x 
Application : 
•elevated abnormities or changes in the iris 
•tumors, cysts 
Cont…
Indirect illumination : 
•The beam is focused in an area adjacent to ocular tissue to be observed 
•Decentered beam 
•Illumination 2 to 4mm slit 
•Magnification: Low to medium (depending upon object size) 
Application: 
•infiltrates 
•corneal scars 
•deposits 
•epithelial and stromal defects 
Cont…
Indirect illumination : 
Cont…
Retro-illumination : 
•Light reflected on iris or fundus 
•Microscope focused on cornea 
•Two types: direct and indirect 
Application : 
For better visualization of 
•Epithelial cysts 
•Keratic precipitates 
•Small blood vessels 
•Small scar 
Cont…
Direct retro-illumination : 
•Observed feature is viewed in direct pathway of reflected light 
•with this illumination findings are made visible with high contrast 
•medium slit width 2 to 4mm 
•Illumination angle 45-60° 
Application : 
•Infiltrations, small scars, corneal vessels, etc. 
Cont…
Indirect retro-illumination : 
•Observer at right angle to the observed structures 
•Illumination angle greatly reduced or increased 
•Feature on the cornea is viewed against a dark background 
•medium slit width 2 to 4mm 
Application : 
•Infiltrations, small scars, corneal vessels, micro cysts, vacuoles 
Cont…
Retro-illumination : 
Cont… Indirectly illuminated Vacuole Direct retro- illumination
•This technique is used to observe media clarities and opacities. 
•The pupil is dilated 
•the slit beam and microscope are made co-axial and light strikes the fundus and creates a glow behind the opacity in the media 
•The media opacity creates a shadow in the glow 
Applications 
•abnormities in the anterior vitreous, lens, anterior chamber, cornea 
Cont… 
Retro-Illumination from the Fundus :
Sclerotic scatter : 
•Light incident on the limbus with 2-4mm slit at an angle of 45° - 60° 
•Decentered slit 
•The microscope focused centrally 
•Total internal reflection of the incoming light at inner corneal boundaries (endothelium and epithelium) 
Applications 
•scars, foreign bodies, corneal defects 
•irregularities in the cornea 
Cont… Fig. : Corneal scar
Iris-transillumination : 
•Transillumination of the iris by indirect light reflected from the fundus 
•Mid dilated pupil (3 to 4mm) 
•Illumination and observation at coaxial position 
Applications 
•Visualization of defects of the pigment layer of the iris 
Cont… 
Fig. : Transillumination in Albinism
Oscillatory illumination : 
•Moves the beam (usually an optical section) from nasal to temporal limbus 
•Viewed alternately by direct and indirect illumination 
•Often possible to see minute objects or filaments, specially in the aqueous 
•Reveals subtle areas of corneal thinning. 
Cont…
Van Herrick’s Technique : 
•Used to evaluate anterior chamber angle without gonioscopy 
•Narrow slit beam close to limbus with Illumination angle 60° 
•Medium magnification 
Principle : 
•Compare the width of cornea seen by optical section with the dark section seen between ant. surface of iris & back of cornea 
Interpretation : 
Grade 4 – open anterior chamber angle 1:1 ratio 
Grade 3 – open anterior chamber angle 1:2 ratio 
Grade 2– narrow anterior chamber angle1:4 ratio 
Grade 1– risky narrow anterior chamber angle less than 1:4 ratio 
Grade 0– closed anterior chamber
Van Herrick’s Technique : to assess anterior chamber angle Cont…
Filters : 
•White filter 
•Overview of ocular surface tissues 
•Examining intraocular structures 
•Cobalt blue filter 
•Coneal abrasion, ulcer 
•Applanation tonometry 
•Red free filter 
•Rose-bengal staining
Applanation Tonometer : 
The Goldmann Applanation Tonometer is the most common tonometer that usually mounted on the standard slit- lamp biomicroscope. 
It’s easy to use and measure the IOP of a seated patient with high accuracy in most clinical situations. 
Parts : 
1.Tonometer tip (biprism) 
2.Metal rod 
3.Tonometer housing 
4.Force adjustment knob 
Associated instruments :
Principle : 
•Applanated force (AF) equals the intraocular pressure (IOP) 
•diameter of the applanated area: 3.06 mm here counteracting forces of corneal rigidity and capillary attraction cancel each other 
Application : 
•Measurement of intraocular pressure (IOP) 
Cont…
Procedure : 
1.Proper positioning of the patient 
2.Instill topical anesthetic and flurescein in pt.‘s eye 
3.Place the cobalt blue filter with broad slit illumination at 60-90° angle 
4.The dial is preset between 1 and 2 (i.e. 10–20 mmHg) 
5.Prism is advanced until it just touches the apex of the cornea 
6.Viewing into the oculars a pattern of two semicircle will appear which represent the fluorescein-stained tear film touching the prism 
Cont…
Procedure : 
7.Then gently rotate the force adjustment knob of tonometer to align the inner margins of the semicircles 
8.The reading on the dial, multiplied by 10, gives the IOP. Modern digital display system provides actual reading without multiplication 
9.Repeat the procedure for other eye 
10.At last wash B/E with antibiotic eye drop 
Cont… Video clip : GAT
Fundus Observation and Gonioscopy : 
•Different types of Contact and Non-contact lenses used for examination, diagnostic and therapeutic purpose in fundoscopy and gonioscopy 
•With classic three mirror Goldmann lens post. Segment and irido corneal angle can examined simultaneously
Cont… 
Fundoscopy : 
Contact Glasses : 
•Additional tool for fundus observation with the slit lamp 
•Mostly direct; erect and non mirrored image of the fundus 
•Required : 
•dilated pupil 
•use of coupling liquid (Hypromellose 0.3%) 
•Coaxial angle (0°) 
•Illumination – low with 2-4 mm slit 
•Magnification – 10-16 x
Cont… 
Non-contact lenses : 
•Additional tool for fundus observation with the slit lamp 
•Mostly indirect; upside-down and mirror image of the fundus (convex optics) 
•non contact 
Required: 
•dilated pupil 
•Coaxial angle (0°) 
•Illumination - low with 2-4mm slit 
•Magnification – 10-16 x 
Fundoscopy :
Cont… 
Fundus view through 90D non-contact lens :
Cont… 
Goldmann 3-Mirror gonioscopic lens : 
•Procedure same as contact fundus lens 
Observation : 
•Central lens (0) : Posterior pole 
•73° mirror (1) : Equator 
•67° mirror (2) : Ora serrata 
•59° mirror (3) : Iridocorneal angle 
Gonioscopy :
Cont… 
Application : 
•Grading of A/C angle width (Shaffer system) 
•Peripheral anterior synechiae 
•Neovascularization 
•Hyperpigmentation 
•Trauma 
Angle recession 
Trabecular dialysis 
Cyclodialysis 
Foreign bodies 
•Blood in the Schlemm canal 
Gonioscopy : 
Fig.: Shaffer system grading 
Fig.: Blood in chamber angle 
Fig.: Neovascularization
•Slit-lamps have the capability of providing laser delivery with a conjunct laser system installed on it 
•Lasers are used for the treatment procedures like photocoagulation, iridotomy or capsulotomy 
•Commonly delivered lasers – Nd:YAG 
Laser delivery system with slit-lamp : Fig.: Laser system mounted Slit-lamp
The slit lamp is one of the most commonly used and valuable diagnostic instruments for an ophthalmologist of today. 
So user level care & maintenance is very much important to get optimum performance & long life from it.
Video clip : Slit-lamp demonstration
•Clinical ophthalmology A systemic approach - Jack J Kanski - 7th ed. 
•OPHTHALMIC OPTICS – Professor M.A. Matin 2nd ed. 
•Clinical Optics – Andrw R. Elkington 3rd ed. 
•BASIC OPHTHALMOLOGY – Professor Md. Shamsul Haque – 2nd ed. 
•AMERICAN ACADEMY OF OPHTHALMOLOGY (2012-2013) – Sec.-3 
•AMERICAN ACADEMY OF OPHTHALMOLOGY (2012-2013) – Sec.-8 
•Essentials of Ophthalmology – Samar K Basak – 5th ed. 
•Internet – 
•https://www.google.com - Search Links 
•http://en.wikipedia.org 
•https://www.youtube.com

More Related Content

What's hot

Real subjective refraction in astigmatism
Real subjective refraction in astigmatismReal subjective refraction in astigmatism
Real subjective refraction in astigmatism
Bipin Koirala
 
Potential acuity meter
Potential acuity meterPotential acuity meter
Potential acuity meter
Steffy Johnson
 
Examination protocol for Contact Lenses
Examination protocol for Contact LensesExamination protocol for Contact Lenses
Examination protocol for Contact Lenses
Puneet
 
Slit Lamp Illumination Techniques
Slit Lamp Illumination TechniquesSlit Lamp Illumination Techniques
Slit Lamp Illumination Techniques
Irina Kezik
 
FUNDUS FLUORESCEIN ANGIOGRAPHY
FUNDUS FLUORESCEIN ANGIOGRAPHYFUNDUS FLUORESCEIN ANGIOGRAPHY
FUNDUS FLUORESCEIN ANGIOGRAPHY
Anuraag Singh
 
Pediatric refraction
Pediatric       refractionPediatric       refraction
Pediatric refraction
Yashaswee Bhattarai
 
Soft toric Contact Lens
Soft toric Contact LensSoft toric Contact Lens
Soft toric Contact Lens
Manish Dahal
 
Measuring interpupillary distance
Measuring interpupillary distanceMeasuring interpupillary distance
Measuring interpupillary distance
Indra Prasad Sharma
 
Contact lens fitting in keratoconus copy
Contact lens fitting in keratoconus   copyContact lens fitting in keratoconus   copy
Contact lens fitting in keratoconus copy
kamal thakur
 
Contrast sensitivity
Contrast sensitivityContrast sensitivity
Contrast sensitivity
Jagdish Dukre
 
subjective refraction
  subjective refraction  subjective refraction
subjective refraction
Hossein Mirzaie
 
Maddox rod, Maddox wing, Bagolini striated glasses, RAF ruler and Prism bar
Maddox rod, Maddox wing, Bagolini striated glasses, RAF ruler and Prism barMaddox rod, Maddox wing, Bagolini striated glasses, RAF ruler and Prism bar
Maddox rod, Maddox wing, Bagolini striated glasses, RAF ruler and Prism bar
Bhageesh Bhaskar
 
Presbyopic Contact Lenses: Bifocals and Multifocals
Presbyopic Contact Lenses: Bifocals and MultifocalsPresbyopic Contact Lenses: Bifocals and Multifocals
Presbyopic Contact Lenses: Bifocals and Multifocals
RabindraAdhikary
 
Objective refraction
Objective refractionObjective refraction
Objective refraction
sneha_thaps
 
Dispencing optics
Dispencing opticsDispencing optics
Dispencing optics
Mahantesh B
 
Test for stereopsis
Test for stereopsisTest for stereopsis
Test for stereopsis
Aliasger Fakhruddin
 
Specular microscopy
Specular microscopySpecular microscopy
Specular microscopy
Ruchi sood
 
Slit lamp ..
Slit lamp ..Slit lamp ..
Slit lamp ..
rakesh jaiswal
 
Corneal pachymetry by ben okeeffe
Corneal pachymetry by ben okeeffeCorneal pachymetry by ben okeeffe
Corneal pachymetry by ben okeeffe
OphthalmicDocs Chiong
 
Biometry & Iol calculations
Biometry & Iol calculationsBiometry & Iol calculations
Biometry & Iol calculations
rakesh jaiswal
 

What's hot (20)

Real subjective refraction in astigmatism
Real subjective refraction in astigmatismReal subjective refraction in astigmatism
Real subjective refraction in astigmatism
 
Potential acuity meter
Potential acuity meterPotential acuity meter
Potential acuity meter
 
Examination protocol for Contact Lenses
Examination protocol for Contact LensesExamination protocol for Contact Lenses
Examination protocol for Contact Lenses
 
Slit Lamp Illumination Techniques
Slit Lamp Illumination TechniquesSlit Lamp Illumination Techniques
Slit Lamp Illumination Techniques
 
FUNDUS FLUORESCEIN ANGIOGRAPHY
FUNDUS FLUORESCEIN ANGIOGRAPHYFUNDUS FLUORESCEIN ANGIOGRAPHY
FUNDUS FLUORESCEIN ANGIOGRAPHY
 
Pediatric refraction
Pediatric       refractionPediatric       refraction
Pediatric refraction
 
Soft toric Contact Lens
Soft toric Contact LensSoft toric Contact Lens
Soft toric Contact Lens
 
Measuring interpupillary distance
Measuring interpupillary distanceMeasuring interpupillary distance
Measuring interpupillary distance
 
Contact lens fitting in keratoconus copy
Contact lens fitting in keratoconus   copyContact lens fitting in keratoconus   copy
Contact lens fitting in keratoconus copy
 
Contrast sensitivity
Contrast sensitivityContrast sensitivity
Contrast sensitivity
 
subjective refraction
  subjective refraction  subjective refraction
subjective refraction
 
Maddox rod, Maddox wing, Bagolini striated glasses, RAF ruler and Prism bar
Maddox rod, Maddox wing, Bagolini striated glasses, RAF ruler and Prism barMaddox rod, Maddox wing, Bagolini striated glasses, RAF ruler and Prism bar
Maddox rod, Maddox wing, Bagolini striated glasses, RAF ruler and Prism bar
 
Presbyopic Contact Lenses: Bifocals and Multifocals
Presbyopic Contact Lenses: Bifocals and MultifocalsPresbyopic Contact Lenses: Bifocals and Multifocals
Presbyopic Contact Lenses: Bifocals and Multifocals
 
Objective refraction
Objective refractionObjective refraction
Objective refraction
 
Dispencing optics
Dispencing opticsDispencing optics
Dispencing optics
 
Test for stereopsis
Test for stereopsisTest for stereopsis
Test for stereopsis
 
Specular microscopy
Specular microscopySpecular microscopy
Specular microscopy
 
Slit lamp ..
Slit lamp ..Slit lamp ..
Slit lamp ..
 
Corneal pachymetry by ben okeeffe
Corneal pachymetry by ben okeeffeCorneal pachymetry by ben okeeffe
Corneal pachymetry by ben okeeffe
 
Biometry & Iol calculations
Biometry & Iol calculationsBiometry & Iol calculations
Biometry & Iol calculations
 

Similar to Slit lamp biomicroscope

Slit lamp examination lecture
Slit lamp examination lectureSlit lamp examination lecture
Slit lamp examination lecture
Prashant Patel
 
SLIT LAMP AND ITS DIFFERENT ILLUMINATION TECHNIQUES.pptx
SLIT LAMP AND ITS DIFFERENT ILLUMINATION TECHNIQUES.pptxSLIT LAMP AND ITS DIFFERENT ILLUMINATION TECHNIQUES.pptx
SLIT LAMP AND ITS DIFFERENT ILLUMINATION TECHNIQUES.pptx
Abhishek Kashyap
 
Slitlamp bimicroscopy
Slitlamp bimicroscopy Slitlamp bimicroscopy
Slitlamp bimicroscopy
Obehi Osoata
 
Slit Lamp Biomicroscopy.
Slit Lamp Biomicroscopy.Slit Lamp Biomicroscopy.
Slit Lamp Biomicroscopy.
Mystic Dider
 
Slitlampexamination dinesh
Slitlampexamination dineshSlitlampexamination dinesh
Slitlampexamination dinesh
Dinesh Madduri
 
Slit lamp evaluation
Slit lamp evaluationSlit lamp evaluation
Slit lamp evaluation
ManasiNayak
 
slit-lamp-160212142229.pdf
slit-lamp-160212142229.pdfslit-lamp-160212142229.pdf
slit-lamp-160212142229.pdf
anju468752
 
slit lamp photography.pdf
slit lamp photography.pdfslit lamp photography.pdf
slit lamp photography.pdf
MusabFathallah
 
Slit lamp biomicroscopy
Slit lamp biomicroscopySlit lamp biomicroscopy
Slit lamp biomicroscopy
confusionexpert1
 
SLIT LAMP
SLIT LAMPSLIT LAMP
SLIT LAMP
SubhamKumar95
 
what is slit lamp Biomicroscopy | What is a slit lamp exam used for? |Differe...
what is slit lamp Biomicroscopy | What is a slit lamp exam used for? |Differe...what is slit lamp Biomicroscopy | What is a slit lamp exam used for? |Differe...
what is slit lamp Biomicroscopy | What is a slit lamp exam used for? |Differe...
Naeem Ahmad
 
Slit lump biomicroscope
Slit lump biomicroscopeSlit lump biomicroscope
Slit Lamp Biomicroscopy
Slit  Lamp BiomicroscopySlit  Lamp Biomicroscopy
Slit Lamp Biomicroscopy
Manoj Aryal
 
Slit lamp biomicroscopy and operating microscope
Slit lamp biomicroscopy and operating microscopeSlit lamp biomicroscopy and operating microscope
Slit lamp biomicroscopy and operating microscope
SAMEEKSHA AGRAWAL
 
Slit lamp biomicroscopy
Slit lamp biomicroscopySlit lamp biomicroscopy
Slit lamp biomicroscopy
nafiz mahmood
 
Slit lamp
Slit lamp Slit lamp
Slit lamp
MushahidRaza8
 
Slit lampbiomicroscopy-jinal & dhara
Slit lampbiomicroscopy-jinal & dharaSlit lampbiomicroscopy-jinal & dhara
Slit lampbiomicroscopy-jinal & dhara
dhara sorathiya
 
Ophthalmoscopy
OphthalmoscopyOphthalmoscopy
Ophthalmoscopy
shweta goyal
 
Slit lamp in Ophthalmology
Slit lamp in OphthalmologySlit lamp in Ophthalmology
Slit lamp in Ophthalmology
Indra Prasad Sharma
 
The Slit lamp Biomicroscope
The Slit lamp BiomicroscopeThe Slit lamp Biomicroscope
The Slit lamp Biomicroscope
Akshay Nayak
 

Similar to Slit lamp biomicroscope (20)

Slit lamp examination lecture
Slit lamp examination lectureSlit lamp examination lecture
Slit lamp examination lecture
 
SLIT LAMP AND ITS DIFFERENT ILLUMINATION TECHNIQUES.pptx
SLIT LAMP AND ITS DIFFERENT ILLUMINATION TECHNIQUES.pptxSLIT LAMP AND ITS DIFFERENT ILLUMINATION TECHNIQUES.pptx
SLIT LAMP AND ITS DIFFERENT ILLUMINATION TECHNIQUES.pptx
 
Slitlamp bimicroscopy
Slitlamp bimicroscopy Slitlamp bimicroscopy
Slitlamp bimicroscopy
 
Slit Lamp Biomicroscopy.
Slit Lamp Biomicroscopy.Slit Lamp Biomicroscopy.
Slit Lamp Biomicroscopy.
 
Slitlampexamination dinesh
Slitlampexamination dineshSlitlampexamination dinesh
Slitlampexamination dinesh
 
Slit lamp evaluation
Slit lamp evaluationSlit lamp evaluation
Slit lamp evaluation
 
slit-lamp-160212142229.pdf
slit-lamp-160212142229.pdfslit-lamp-160212142229.pdf
slit-lamp-160212142229.pdf
 
slit lamp photography.pdf
slit lamp photography.pdfslit lamp photography.pdf
slit lamp photography.pdf
 
Slit lamp biomicroscopy
Slit lamp biomicroscopySlit lamp biomicroscopy
Slit lamp biomicroscopy
 
SLIT LAMP
SLIT LAMPSLIT LAMP
SLIT LAMP
 
what is slit lamp Biomicroscopy | What is a slit lamp exam used for? |Differe...
what is slit lamp Biomicroscopy | What is a slit lamp exam used for? |Differe...what is slit lamp Biomicroscopy | What is a slit lamp exam used for? |Differe...
what is slit lamp Biomicroscopy | What is a slit lamp exam used for? |Differe...
 
Slit lump biomicroscope
Slit lump biomicroscopeSlit lump biomicroscope
Slit lump biomicroscope
 
Slit Lamp Biomicroscopy
Slit  Lamp BiomicroscopySlit  Lamp Biomicroscopy
Slit Lamp Biomicroscopy
 
Slit lamp biomicroscopy and operating microscope
Slit lamp biomicroscopy and operating microscopeSlit lamp biomicroscopy and operating microscope
Slit lamp biomicroscopy and operating microscope
 
Slit lamp biomicroscopy
Slit lamp biomicroscopySlit lamp biomicroscopy
Slit lamp biomicroscopy
 
Slit lamp
Slit lamp Slit lamp
Slit lamp
 
Slit lampbiomicroscopy-jinal & dhara
Slit lampbiomicroscopy-jinal & dharaSlit lampbiomicroscopy-jinal & dhara
Slit lampbiomicroscopy-jinal & dhara
 
Ophthalmoscopy
OphthalmoscopyOphthalmoscopy
Ophthalmoscopy
 
Slit lamp in Ophthalmology
Slit lamp in OphthalmologySlit lamp in Ophthalmology
Slit lamp in Ophthalmology
 
The Slit lamp Biomicroscope
The Slit lamp BiomicroscopeThe Slit lamp Biomicroscope
The Slit lamp Biomicroscope
 

Recently uploaded

CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdfCHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
rishi2789
 
Netter's Atlas of Human Anatomy 7.ed.pdf
Netter's Atlas of Human Anatomy 7.ed.pdfNetter's Atlas of Human Anatomy 7.ed.pdf
Netter's Atlas of Human Anatomy 7.ed.pdf
BrissaOrtiz3
 
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
rishi2789
 
Cardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdfCardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdf
shivalingatalekar1
 
Basavarajeeyam - Ayurvedic heritage book of Andhra pradesh
Basavarajeeyam - Ayurvedic heritage book of Andhra pradeshBasavarajeeyam - Ayurvedic heritage book of Andhra pradesh
Basavarajeeyam - Ayurvedic heritage book of Andhra pradesh
Dr. Madduru Muni Haritha
 
Top-Vitamin-Supplement-Brands-in-India List
Top-Vitamin-Supplement-Brands-in-India ListTop-Vitamin-Supplement-Brands-in-India List
Top-Vitamin-Supplement-Brands-in-India List
SwisschemDerma
 
Chapter 11 Nutrition and Chronic Diseases.pptx
Chapter 11 Nutrition and Chronic Diseases.pptxChapter 11 Nutrition and Chronic Diseases.pptx
Chapter 11 Nutrition and Chronic Diseases.pptx
Earlene McNair
 
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...
Donc Test
 
Knee anatomy and clinical tests 2024.pdf
Knee anatomy and clinical tests 2024.pdfKnee anatomy and clinical tests 2024.pdf
Knee anatomy and clinical tests 2024.pdf
vimalpl1234
 
Physiology of Special Chemical Sensation of Taste
Physiology of Special Chemical Sensation of TastePhysiology of Special Chemical Sensation of Taste
Physiology of Special Chemical Sensation of Taste
MedicoseAcademics
 
CHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdfCHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdf
rishi2789
 
NVBDCP.pptx Nation vector borne disease control program
NVBDCP.pptx Nation vector borne disease control programNVBDCP.pptx Nation vector borne disease control program
NVBDCP.pptx Nation vector borne disease control program
Sapna Thakur
 
#cALL# #gIRLS# In Dehradun ꧁❤8107221448❤꧂#cALL# #gIRLS# Service In Dehradun W...
#cALL# #gIRLS# In Dehradun ꧁❤8107221448❤꧂#cALL# #gIRLS# Service In Dehradun W...#cALL# #gIRLS# In Dehradun ꧁❤8107221448❤꧂#cALL# #gIRLS# Service In Dehradun W...
#cALL# #gIRLS# In Dehradun ꧁❤8107221448❤꧂#cALL# #gIRLS# Service In Dehradun W...
chandankumarsmartiso
 
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptxREGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
LaniyaNasrink
 
Tests for analysis of different pharmaceutical.pptx
Tests for analysis of different pharmaceutical.pptxTests for analysis of different pharmaceutical.pptx
Tests for analysis of different pharmaceutical.pptx
taiba qazi
 
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptxANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
Swetaba Besh
 
Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
Novas diretrizes da OMS para os cuidados perinatais de mais qualidadeNovas diretrizes da OMS para os cuidados perinatais de mais qualidade
Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
Prof. Marcus Renato de Carvalho
 
Best Ayurvedic medicine for Gas and Indigestion
Best Ayurvedic medicine for Gas and IndigestionBest Ayurvedic medicine for Gas and Indigestion
Best Ayurvedic medicine for Gas and Indigestion
Swastik Ayurveda
 
Aortic Association CBL Pilot April 19 – 20 Bern
Aortic Association CBL Pilot April 19 – 20 BernAortic Association CBL Pilot April 19 – 20 Bern
Aortic Association CBL Pilot April 19 – 20 Bern
suvadeepdas911
 
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists  Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists
Saeid Safari
 

Recently uploaded (20)

CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdfCHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
 
Netter's Atlas of Human Anatomy 7.ed.pdf
Netter's Atlas of Human Anatomy 7.ed.pdfNetter's Atlas of Human Anatomy 7.ed.pdf
Netter's Atlas of Human Anatomy 7.ed.pdf
 
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
 
Cardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdfCardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdf
 
Basavarajeeyam - Ayurvedic heritage book of Andhra pradesh
Basavarajeeyam - Ayurvedic heritage book of Andhra pradeshBasavarajeeyam - Ayurvedic heritage book of Andhra pradesh
Basavarajeeyam - Ayurvedic heritage book of Andhra pradesh
 
Top-Vitamin-Supplement-Brands-in-India List
Top-Vitamin-Supplement-Brands-in-India ListTop-Vitamin-Supplement-Brands-in-India List
Top-Vitamin-Supplement-Brands-in-India List
 
Chapter 11 Nutrition and Chronic Diseases.pptx
Chapter 11 Nutrition and Chronic Diseases.pptxChapter 11 Nutrition and Chronic Diseases.pptx
Chapter 11 Nutrition and Chronic Diseases.pptx
 
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...
 
Knee anatomy and clinical tests 2024.pdf
Knee anatomy and clinical tests 2024.pdfKnee anatomy and clinical tests 2024.pdf
Knee anatomy and clinical tests 2024.pdf
 
Physiology of Special Chemical Sensation of Taste
Physiology of Special Chemical Sensation of TastePhysiology of Special Chemical Sensation of Taste
Physiology of Special Chemical Sensation of Taste
 
CHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdfCHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdf
 
NVBDCP.pptx Nation vector borne disease control program
NVBDCP.pptx Nation vector borne disease control programNVBDCP.pptx Nation vector borne disease control program
NVBDCP.pptx Nation vector borne disease control program
 
#cALL# #gIRLS# In Dehradun ꧁❤8107221448❤꧂#cALL# #gIRLS# Service In Dehradun W...
#cALL# #gIRLS# In Dehradun ꧁❤8107221448❤꧂#cALL# #gIRLS# Service In Dehradun W...#cALL# #gIRLS# In Dehradun ꧁❤8107221448❤꧂#cALL# #gIRLS# Service In Dehradun W...
#cALL# #gIRLS# In Dehradun ꧁❤8107221448❤꧂#cALL# #gIRLS# Service In Dehradun W...
 
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptxREGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
 
Tests for analysis of different pharmaceutical.pptx
Tests for analysis of different pharmaceutical.pptxTests for analysis of different pharmaceutical.pptx
Tests for analysis of different pharmaceutical.pptx
 
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptxANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
 
Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
Novas diretrizes da OMS para os cuidados perinatais de mais qualidadeNovas diretrizes da OMS para os cuidados perinatais de mais qualidade
Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
 
Best Ayurvedic medicine for Gas and Indigestion
Best Ayurvedic medicine for Gas and IndigestionBest Ayurvedic medicine for Gas and Indigestion
Best Ayurvedic medicine for Gas and Indigestion
 
Aortic Association CBL Pilot April 19 – 20 Bern
Aortic Association CBL Pilot April 19 – 20 BernAortic Association CBL Pilot April 19 – 20 Bern
Aortic Association CBL Pilot April 19 – 20 Bern
 
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists  Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists
 

Slit lamp biomicroscope

  • 1. DEPT. OF OPTHALMOLOGY SHER-E-BANGLA MEDICAL COLLEGE HOSPITAL, BARISAL. DR. MD. NURUL ISLAM DO STUDENT SESSION – JULY, 2013 25-09-2014
  • 3. THE SLIT-LAMP BIOMICROSCOPE is a high-power binocular microscope with a slit-shaped illumination source, specially designed for viewing the different optically transparent or translucent tissues of the eye. It enhances the examination by : Excellent image quality Binocular stereoscopic view Flexible illumination Flexible magnification Providing room for specialized attachments and lenses for detailed examination and diagnostic tests
  • 4. The science of examination with a slit lamp is called Biomicroscopy as it allows in vivo study of living tissues at high magnification. Cont…
  • 6. •1911, the first concept of slit-lamp was introduced by ALLVAR GULLSTRAND, it was named as “Large reflection-free ophthalmoscope” manufactured by Zeiss. Prof. Allvar Gullstrand Large Gullstrand Opthalmoscope (1911)
  • 7. •1919, VOGT introduced KOEHLER illumination system to Gullstrand slit-lamp. •1930, LETZ introduced telescopic loupe built on the principle of Galilean Telescope which helps in increase working distance. Haag-Streit-1920 Bausch & Lomb slit lamp (1926) Cont…
  • 8. •1933, GOLDANN developed three control element for cross-slide stage and also common swivel axis for microscope and illumination system in HAAG-STREIT Slit-lamp. •1938, Joystick was added to Haag-streit. Haag-Streit-1933 Haag-Streit-1936 Cont…
  • 9. •1950, LITTMANN with ZIESS combined joystick control from Goldmann, illumination path from Comberg prism instrument and also added stereo telescope system with magnification changer. Cont… Zeiss slit lamp (Littmann) (1950) Haag-Streit-1959
  • 10. Fig. : Modern slit-lamp Cont… •Onward modern slit-lamp system began to come into light.
  • 11. TYPES
  • 12. •On the basis of illumination system it is of 2 types : 1.Zeiss type In the Zeiss type the illumination comes from below
  • 13. 2. Haag-streit type In the Haag Streit type the illumination comes from above Cont…
  • 14. •On the basis of compound microscope system it is also 2 types : 1.The Grenough type Flip lever to change magnification Cont…
  • 15. 2. The Galilean changer type Knob to change magnification (3 or 5 step) Cont…
  • 16. Also different types of HAND-HELD slit-lamp devices available for – •Handicap •Infant •Bedbound patients Cont…
  • 18. Illumination system Principle : Kohler illumination principle is used in both Zeiss & Haag-streit type illumination system. The light filament (F) is imaged on to the objective lens (O) but the mechanical slit (MS) is imaged on to the patient’s eye (S)
  • 19. Microscope system Principle : The eyepiece (Ocular) uses Astronomical telescope system. Here two convex lenses used one in front of other separated by the distance of their focal length. Fig. : Slit-lamp biomicroscope optical principles
  • 20. A Galilean telescope system is used for even higher and changeable magnification. Here a convex and a concave lens is used in line separated by the distance of their focal length. Cont… Fig. : Slit-lamp biomicroscope optical principles
  • 21. Both telescope systems produce inverse image of an object so an inverting prism named Porro- Abbe prism is used to produce right way erect image. Here two triangular prisms use the total internal reflection principle of optics. Cont… Porro-Abbe Prism Fig. : Slit-lamp biomicroscope optical principles
  • 22. The telescope system provide considerable distance between the microscope and the patient’s eye, so that certain maneuver like foreign body removal from the cornea or using extra lenses for fundus examination can be done. Cont…
  • 23. Parfocality : The point at which the microscope is focused corresponds to the point on which the light is focused, this coupling effect is called parfocality. This is achieved by the microscope and the illumination system, having a common focal plane and their common axis of rotation also lies in that focal plane. Cont…
  • 24. PARTS OF THE SLIT-LAMP
  • 25. Basic Design : 1.Mechanical system 2.Illumination system 3.Biomicroscope /Observation system Associated instruments : •Applanation Tonometer •Gonioscopic Lens •Fundoscopy Lens •Micrometer Eyepieces •Image archiving device •Laser delivery system
  • 26. It concern with : •Positioning & adjustment of patient and observer •Maneuvering the illumination and microscope system together with joystick •Providing base to other parts Mechanical system : Basic 3 parts : 1.Motorized table (Base) 2.Patient positioning frame 3.Joystick
  • 27. Parts of mechanical system : Cont… Fixation target Chin rest adjustment knob Joystick Power switch Table height adjustment Forehead band Canthus alignment Chin rest Hand grip for patient Lock for slit lamp base Low friction plate
  • 28. Provides a bright, evenly illuminated, finely focused, adjustable slit of light at the eye. Contains the following components: •Light source •Condenser lens system •Slit and other diaphragms •Filters •Projection lens •Reflecting mirror or prisms Illumination system :
  • 29. Parts of illumination system : Cont… Scale for slit height Slit height control Inclined mirror Latch to tilt light column Light source Filter control Centering screw Slit width control
  • 30. •Essentially these are compound microscopes composed of optical elements providing enlarged right way stereoscopic image to observer. •Provides larger working distance in front of microscope for manipulation on patient’s eye. •Magnification changer for detail view. Observation system :
  • 31. Parts of observation system : Cont… Eyepiece Marked ring for Adjustment of examiner’s refractive error Prism housing Knob to change magnification Objective lens
  • 34. Prerequisites : •Switch on power & unlock base screw •Cleaning the forehead band •Changing paper strip from chinrest •Comfortable sitting of pt. and the examiner •Counseling the patient •Proper positioning of the pt. •Target fixation •Adjust eyepieces to correct for examiner’s refractive error and interpupillary distance •Children may need to stand, or they can sit on parent’s lap or kneel on a stable chair Fig. Correct positioning at the slit lamp.
  • 35. Chronology for slit-lamp examination : Eyelids Eyelid margins Tear film Conjunctiva Cornea Aqueous humor Iris Lens Vitreous (ant.)
  • 36. Illumination techniques : Slit Width control knob: Narrow to fully open slit illumination achieved by rotating this knob
  • 37. Illumination techniques : Slit height control knob : Short to long slit illumination achieved by rotating this knob Cont…
  • 38. Illumination techniques : Slit angle rotation : Cont…
  • 39. Illumination techniques : Tilting light column : Illumination column can be tilted 5-20°, with vertical axis which gives extra plane and minimize reflection during posterior segment examination with condensing lens. Cont…
  • 40. Illumination methods : Direct illumination •Direct diffused illumination •Direct focal illumination i.Parallelepiped ii.Optical section iii.Conical beam •Specular reflection •Tangential illumination Indirect illumination •Indirect proximal illumination •Retro-illumination •Sclerotic scatter Oscillatory illumination
  • 41. Direct diffused illumination : •illumination of the eye with a broad, unfocused light beam •directed obliquely between 30-450 •magnification 6x to 10x Application : •General gross overview of eyelids, lashes, conjunctiva, sclera, pattern of redness, iris, pupil, gross pathology, ant capsule of lens Cont…
  • 43. Direct focal illumination : •Illumination and observation are focused in the same plane •slit width narrow to broad •Illumination angle 45° to 60° •Magnification 10x-40x Application : •Cornea in detail •Anterior chamber •Crystalline lens •Anterior part of vitreous •Grading cell and flare in anterior chamber Cont…
  • 45. Direct focal illumination : i.Parallelepiped •Slit width 2-4 mm obliquely focusing on the cornea so that a quadrilateral block of light illuminate the cornea Application : •To examine corneal surface, stroma •To ascertain depth (FB, abration) Cont…
  • 46. Direct focal illumination : ii.Optical section •Slit width 1mm or less •Illumination angle 45-60° or more •High illumination & magnification Application: •Corneal depth, layers, scars, vessels •Lens opacity Cont… 1. Tear film 2. Epithelium 3. Ant. Stroma 4. Post. Stroma 5. Descemet’s mem. & Endothelium
  • 47. Direct focal illumination : iii.Conical beam •Assessment of particles floating in the A/C •Narrow, short & bright slit of light •45°-60° light source directed to pupil •Magnification 16x-25x Application : •Inflammatory cells, flare, pigmented cells, metabolic wastes Principle : Tyndall phenomenon Cont…
  • 48. Specular reflection : •Angle of incidence = angle of reflection •Observation and illumination system have same angle with perpendicular axis to each other •Slit width < 4mm •The light reflected from the anterior or posterior corneal surface •Best view with one eye Application : •assessment of surfaces Corneal epithelium Corneal endothelium Lens surface •assessment of tear film Cont… Corneal endothelium
  • 49. Tangential illumination : •A narrow light beam is projected almost parallel along the structure to be observed •Elevated structures are visible by shadowing •Illumination angle 90° •Magnification 10-25x Application : •elevated abnormities or changes in the iris •tumors, cysts Cont…
  • 50. Indirect illumination : •The beam is focused in an area adjacent to ocular tissue to be observed •Decentered beam •Illumination 2 to 4mm slit •Magnification: Low to medium (depending upon object size) Application: •infiltrates •corneal scars •deposits •epithelial and stromal defects Cont…
  • 52. Retro-illumination : •Light reflected on iris or fundus •Microscope focused on cornea •Two types: direct and indirect Application : For better visualization of •Epithelial cysts •Keratic precipitates •Small blood vessels •Small scar Cont…
  • 53. Direct retro-illumination : •Observed feature is viewed in direct pathway of reflected light •with this illumination findings are made visible with high contrast •medium slit width 2 to 4mm •Illumination angle 45-60° Application : •Infiltrations, small scars, corneal vessels, etc. Cont…
  • 54. Indirect retro-illumination : •Observer at right angle to the observed structures •Illumination angle greatly reduced or increased •Feature on the cornea is viewed against a dark background •medium slit width 2 to 4mm Application : •Infiltrations, small scars, corneal vessels, micro cysts, vacuoles Cont…
  • 55. Retro-illumination : Cont… Indirectly illuminated Vacuole Direct retro- illumination
  • 56. •This technique is used to observe media clarities and opacities. •The pupil is dilated •the slit beam and microscope are made co-axial and light strikes the fundus and creates a glow behind the opacity in the media •The media opacity creates a shadow in the glow Applications •abnormities in the anterior vitreous, lens, anterior chamber, cornea Cont… Retro-Illumination from the Fundus :
  • 57. Sclerotic scatter : •Light incident on the limbus with 2-4mm slit at an angle of 45° - 60° •Decentered slit •The microscope focused centrally •Total internal reflection of the incoming light at inner corneal boundaries (endothelium and epithelium) Applications •scars, foreign bodies, corneal defects •irregularities in the cornea Cont… Fig. : Corneal scar
  • 58. Iris-transillumination : •Transillumination of the iris by indirect light reflected from the fundus •Mid dilated pupil (3 to 4mm) •Illumination and observation at coaxial position Applications •Visualization of defects of the pigment layer of the iris Cont… Fig. : Transillumination in Albinism
  • 59. Oscillatory illumination : •Moves the beam (usually an optical section) from nasal to temporal limbus •Viewed alternately by direct and indirect illumination •Often possible to see minute objects or filaments, specially in the aqueous •Reveals subtle areas of corneal thinning. Cont…
  • 60. Van Herrick’s Technique : •Used to evaluate anterior chamber angle without gonioscopy •Narrow slit beam close to limbus with Illumination angle 60° •Medium magnification Principle : •Compare the width of cornea seen by optical section with the dark section seen between ant. surface of iris & back of cornea Interpretation : Grade 4 – open anterior chamber angle 1:1 ratio Grade 3 – open anterior chamber angle 1:2 ratio Grade 2– narrow anterior chamber angle1:4 ratio Grade 1– risky narrow anterior chamber angle less than 1:4 ratio Grade 0– closed anterior chamber
  • 61. Van Herrick’s Technique : to assess anterior chamber angle Cont…
  • 62. Filters : •White filter •Overview of ocular surface tissues •Examining intraocular structures •Cobalt blue filter •Coneal abrasion, ulcer •Applanation tonometry •Red free filter •Rose-bengal staining
  • 63. Applanation Tonometer : The Goldmann Applanation Tonometer is the most common tonometer that usually mounted on the standard slit- lamp biomicroscope. It’s easy to use and measure the IOP of a seated patient with high accuracy in most clinical situations. Parts : 1.Tonometer tip (biprism) 2.Metal rod 3.Tonometer housing 4.Force adjustment knob Associated instruments :
  • 64. Principle : •Applanated force (AF) equals the intraocular pressure (IOP) •diameter of the applanated area: 3.06 mm here counteracting forces of corneal rigidity and capillary attraction cancel each other Application : •Measurement of intraocular pressure (IOP) Cont…
  • 65. Procedure : 1.Proper positioning of the patient 2.Instill topical anesthetic and flurescein in pt.‘s eye 3.Place the cobalt blue filter with broad slit illumination at 60-90° angle 4.The dial is preset between 1 and 2 (i.e. 10–20 mmHg) 5.Prism is advanced until it just touches the apex of the cornea 6.Viewing into the oculars a pattern of two semicircle will appear which represent the fluorescein-stained tear film touching the prism Cont…
  • 66. Procedure : 7.Then gently rotate the force adjustment knob of tonometer to align the inner margins of the semicircles 8.The reading on the dial, multiplied by 10, gives the IOP. Modern digital display system provides actual reading without multiplication 9.Repeat the procedure for other eye 10.At last wash B/E with antibiotic eye drop Cont… Video clip : GAT
  • 67. Fundus Observation and Gonioscopy : •Different types of Contact and Non-contact lenses used for examination, diagnostic and therapeutic purpose in fundoscopy and gonioscopy •With classic three mirror Goldmann lens post. Segment and irido corneal angle can examined simultaneously
  • 68. Cont… Fundoscopy : Contact Glasses : •Additional tool for fundus observation with the slit lamp •Mostly direct; erect and non mirrored image of the fundus •Required : •dilated pupil •use of coupling liquid (Hypromellose 0.3%) •Coaxial angle (0°) •Illumination – low with 2-4 mm slit •Magnification – 10-16 x
  • 69. Cont… Non-contact lenses : •Additional tool for fundus observation with the slit lamp •Mostly indirect; upside-down and mirror image of the fundus (convex optics) •non contact Required: •dilated pupil •Coaxial angle (0°) •Illumination - low with 2-4mm slit •Magnification – 10-16 x Fundoscopy :
  • 70. Cont… Fundus view through 90D non-contact lens :
  • 71. Cont… Goldmann 3-Mirror gonioscopic lens : •Procedure same as contact fundus lens Observation : •Central lens (0) : Posterior pole •73° mirror (1) : Equator •67° mirror (2) : Ora serrata •59° mirror (3) : Iridocorneal angle Gonioscopy :
  • 72. Cont… Application : •Grading of A/C angle width (Shaffer system) •Peripheral anterior synechiae •Neovascularization •Hyperpigmentation •Trauma Angle recession Trabecular dialysis Cyclodialysis Foreign bodies •Blood in the Schlemm canal Gonioscopy : Fig.: Shaffer system grading Fig.: Blood in chamber angle Fig.: Neovascularization
  • 73. •Slit-lamps have the capability of providing laser delivery with a conjunct laser system installed on it •Lasers are used for the treatment procedures like photocoagulation, iridotomy or capsulotomy •Commonly delivered lasers – Nd:YAG Laser delivery system with slit-lamp : Fig.: Laser system mounted Slit-lamp
  • 74. The slit lamp is one of the most commonly used and valuable diagnostic instruments for an ophthalmologist of today. So user level care & maintenance is very much important to get optimum performance & long life from it.
  • 75. Video clip : Slit-lamp demonstration
  • 76.
  • 77. •Clinical ophthalmology A systemic approach - Jack J Kanski - 7th ed. •OPHTHALMIC OPTICS – Professor M.A. Matin 2nd ed. •Clinical Optics – Andrw R. Elkington 3rd ed. •BASIC OPHTHALMOLOGY – Professor Md. Shamsul Haque – 2nd ed. •AMERICAN ACADEMY OF OPHTHALMOLOGY (2012-2013) – Sec.-3 •AMERICAN ACADEMY OF OPHTHALMOLOGY (2012-2013) – Sec.-8 •Essentials of Ophthalmology – Samar K Basak – 5th ed. •Internet – •https://www.google.com - Search Links •http://en.wikipedia.org •https://www.youtube.com