SLExam Pt-I - INSTRUCTION COURSE SLIT LAMP EXAMINATION MP...

Info iconThis preview shows page 1. Sign up to view the full content.

View Full Document Right Arrow Icon
This is the end of the preview. Sign up to access the rest of the document.

Unformatted text preview: INSTRUCTION COURSE SLIT LAMP EXAMINATION MP STATE OPHTHALMIC MP CONFERENCE CONFERENCE UJJAIN 2008 December 24, 2011 Slit Lamp Examination - IC 1 Presented by Dr. Sanjay Shrivastava Dr. Nikhilesh Trivedi Dr. Dr. Kavita Kumar December 24, 2011 Slit Lamp Examination - IC 2 Slit Lamp Examination Slit The science of examination with a slit lamp is called Biomicroscopy as it allows in vivo study of living tissues at high magnification. December 24, 2011 Slit Lamp Examination - IC 3 SLITLAMP EXAMINATION • • • • Permits detailed examination of various structures of and posterior segment of eye Angle of anterior chamber with gonioscope Measurement of intra ocular pressure Endothelial cell counts December 24, 2011 Slit Lamp Examination - IC 4 SLITLAMP EXAMINATION • • • Photographic representation of every above mentioned part of the eye Modern slit lamp and its auxiliary devices provide magnified view of parts of eye from cornea to retina Measurement of Corneal thickness is also possible December 24, 2011 Slit Lamp Examination - IC 5 • • • Slit lamp is a misnomer In 1925 MAVAS introduced a term bioIn microscopy defined as examination of the living eye by means of the corneal microscope and slit lamp. and LITTMAN in1950 introduced the rotatory LITTMAN magnification charger based on the principle of GALILEAN telescope is the forerunner of current ZEISS slit lamp . December 24, 2011 Slit Lamp Examination - IC 6 December 24, 2011 Slit Lamp Examination - IC 7 PARTS A. OBSERVTION SYSTEM B. ILLUMINATION SYSTEM C. MECHANICAL SYSTEM December 24, 2011 Slit Lamp Examination - IC 8 Slit lamp December 24, 2011 Slit Lamp Examination - IC 9 The Instrument December 24, 2011 Slit Lamp Examination - IC 10 The The Instrument Instrument December 24, 2011 Slit Lamp Examination - IC 11 December 24, 2011 Slit Lamp Examination - IC 12 December 24, 2011 Slit Lamp Examination - IC 13 December 24, 2011 Slit Lamp Examination - IC 14 December 24, 2011 Slit Lamp Examination - IC 15 December 24, 2011 Slit Lamp Examination - IC 16 December 24, 2011 Slit Lamp Examination - IC 17 December 24, 2011 Slit Lamp Examination - IC 18 December 24, 2011 Slit Lamp Examination - IC 19 Posterior Segment Posterior Examination with +78 D Lens Examination December 24, 2011 Slit Lamp Examination - IC 20 OBSERVATION SYSTEM OBSERVATION a. Objective lenses -22 diopters diopters b. Eye piece- 10 diopters b. December 24, 2011 Slit Lamp Examination - IC 21 ILLUMINATION SYSTEM a. Light source a. b. Condenser lens system b. c. Slit and other diaphgram d. Filters e. Projection lens f. Reflecting mirror/prism2. f. December 24, 2011 Slit Lamp Examination - IC 22 MECHANICAL SYSTEM A. Joy stick arrangement B. Up and down arrangement B. C. Patient support arrangement C. D. Mechanical coupling December 24, 2011 Slit Lamp Examination - IC 23 Slit Lamp Examination -Method • • Prerequisites – Preferably a dark room and slit lamp biomicroscope Position – Patient is seated comfortably on an adjustable stool, with chin resting against chin rest and forehead against head rest bar. December 24, 2011 Slit Lamp Examination - IC 24 PREPARATION A. Preliminary examination of eye ball B. Illumination of room. C. Preparation and management of C. patients D. Adjustment of instruments. D. E. Stereopsis December 24, 2011 Slit Lamp Examination - IC 25 METHODS OF ILLUMINATION • • • • • • Diffuse illumination Sclerotic scatter Direct focal illumination Indirect illumination Retro-illumination Specular reflection Specular December 24, 2011 Slit Lamp Examination - IC 26 SET UP SET 1. Angle between microscope and illuminating system – 30 deg to 45 deg. 2. Slit width - widest. Slit 3. Filters - diffusing filter 4. Magnification - low to medium 4. 5. Illumination – low to high. December 24, 2011 Slit Lamp Examination - IC 27 USE 1. Topography of pathological changes. 2. Entire surface of cornea, iris, lens can 2. be viewed. be 3. Folds of descemets membrane. 4. Corneal scar. 5. Whole configuration of lens. 6. Surface of adult nucleus. December 24, 2011 Slit Lamp Examination - IC 28 SCLEROTIC SCATTER SCATTER Also called indirect lateral illumination-it is possible by concentrating the beam upon the spot at the side of the object it is proposed to examine Projecting the light upon sclera near the limbus,it is easy to examine the limbal portion of cornea,and if the incident ray is sufficient to induce total internal reflection,the whole of cornea including the opposite limbus ,is lit up. December 24, 2011 Slit Lamp Examination - IC 29 USE 1. Corneal opacities 2. Keratocele 3. Interstitial deposits 4. Perforating scars December 24, 2011 Slit Lamp Examination - IC 30 DIRECT FOCAL ILLUMINATION FOCAL BASIS OF ALL METHODS. December 24, 2011 Slit Lamp Examination - IC 31 SET UP Slit beam is regulated until it coincides with exact focus of microscope. Light - narrow slit at an oblique angle 30 deg to 45 deg angle December 24, 2011 Slit Lamp Examination - IC 32 THREE SLIT BEAM THREE EFFECTS EFFECTS • • • OPTICAL SECTION OPTICAL PARALLELOPIPED CORNEAL SECTION CONICAL BEAM EFFECT CONICAL December 24, 2011 Slit Lamp Examination - IC 33 I. OPTICAL SECTION I. • Produced by a very narrow slit beam Produced focused obliquely. focused • It resemble a knife like histological section It of tissue focused. of Corneal section uses Corneal • changes in corneal curvature. • change in corneal thickness. • depth of corneal pathologies; foreign body depth localization. localization. December 24, 2011 Slit Lamp Examination - IC 34 OPTICAL SECTION Corneal optic section showing; Tear layer-anterior most bright zone Epithelial layer-dark line immediately behind it. Bowmen’s membrane-a bright line. Stroma-wider granular and greyer zone. Descemets membrane and endothelial layers-posterior most bright zone. December 24, 2011 Slit Lamp Examination - IC 35 II. PARELLOPIPED CORNEA 2-3 mm. wide focused slit beam. beam. Because beam traverse Because cornea obliquely, shape of resulting rectangular block is paralellopiped prism. the ext. and internal surface of which slightly curved owing to anatomic shape of cornea cornea December 24, 2011 Slit Lamp Examination - IC 36 USES 1. Pathologies of epithelium and Stroma. 2. Corneal scar or infiltrates. Appear brighter. 3. Water clefts have low density so appear black. December 24, 2011 Slit Lamp Examination - IC 37 III. CONICAL BEAM Small circular beam Used to detect the aqueous flare December 24, 2011 Slit Lamp Examination - IC 38 INDIRECT ILLUMINATION Slit beam is focused at a point just behind a area to be examined. December 24, 2011 Slit Lamp Examination - IC 39 SET UP Angle between slit beam and microscope is 30 deg to 45 deg microscope - Beam width - moderate - Illumination - low medium or high December 24, 2011 Slit Lamp Examination - IC 40 USES • Corneal infiltration Corneal • Corneal microcysts • Corneal vacuoles Corneal • Epithelial cells Epithelial December 24, 2011 Slit Lamp Examination - IC 41 RETROILLUMINATION Examination of normal or pathological structures in light reflected from tissue situated more posteriorly December 24, 2011 Slit Lamp Examination - IC 42 RETROILLUMINATION December 24, 2011 Slit Lamp Examination - IC 43 Direct retro illumination Observer in direct pathway of light Light is reflected from structures Light so pathology seen against illuminated background illuminated December 24, 2011 Slit Lamp Examination - IC 44 Indirect retro illumination Observer is right angle to observed Observer structures not in line so pathology seen against dark non illuminated background background December 24, 2011 Slit Lamp Examination - IC 45 Pathologies can be Pathologies 1. Obstructive – seen as dark against light background eg pigment or blood filled vessels vessels 2. Respersive –these scatter light but not 2. obstruct completely seen as bright against dark background eg epithelial edema, precipitates. edema, December 24, 2011 Slit Lamp Examination - IC 46 Pathologies can be Pathologies 3. Refractile – they distort the view of junction of illuminated and dark area because there refractive index is different from surroundings eg Vacuoles. Vacuoles. December 24, 2011 Slit Lamp Examination - IC 47 SPECULAR REFLECTION • • • It is one of the most difficult methods. Not It possible to use on all kind of slit lamps possible Reflection of light occurs when beam of Reflection light is incident on an optical surface called zone of discontinuity, such zones may be found in cornea and lens When observer is placed in pathway of When reflected light a dazzling reflex seen called specular reflection December 24, 2011 Slit Lamp Examination - IC 48 SET UP SET • Illuminating and viewing arms each forms Illuminating and angle of about 30 deg to the central perpendicular • Slit beam height of 2 mm and focused onto Slit the central corneal endothelium • Golden sheen with darker lines outline the Golden hexagonal endothelial cells • Magnification of atleast 40X is needs to see Magnification endothelial pattern December 24, 2011 Slit Lamp Examination - IC 49 USES USES • • Surface pathologies scatter the light Surface irregularly. therefore create dark area in reflex. reflex. Using an eye piece reticule endothelial Using cells can be measured and counted and also used to study the tear film details . December 24, 2011 Slit Lamp Examination - IC 50 Oscillating illumination of Koppe • Slit beam is given an oscillatory Slit movement by which it is often possible to see minute objects and filaments especially in the aqueous which would otherwise escapes detection December 24, 2011 Slit Lamp Examination - IC 51 SPECIALISED USES 1. Gonioscopy 2. Fundus examination with focal illumination 3. Pachymatery 3. 4. Applanation tonometry 4. 5. Ophthalmodynamometry 5. December 24, 2011 Slit Lamp Examination - IC 52 SPECIALISED USES 6. Slit lamp photography 7. As a delivery system for argon , diode and Nd YAG laser 8. Laser interferometry 8. 9. Potential acuity meter test December 24, 2011 Slit Lamp Examination - IC 53 END OF PART ONE THANKS December 24, 2011 Slit Lamp Examination - IC 54 ...
View Full Document

This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

Ask a homework question - tutors are online