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64 Cards in this Set
- Front
- Back
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What is the general room illumination when doing a slit lamp exam and why?
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dim or dark to increase contrast
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When during a slit lamp exam do you set the rheostat on high?
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-when using filters
-with narrow light beam -with conical beam (2x2) |
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When during a slit lamp exam do you set the rheostat on low or medium and why?
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-when using diffuse light to help with patient comfort
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When viewing cells and protein or pigment particles you typically have the mag on _____
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high magnification
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Low mag is best for viewing ________ (3)
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1. CL evaluation
2. lids/lashes 3. conj |
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When should you use a short beam height?
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when looking at short areas like the lens or when no light should enter the pupil
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parallelopiped = ? view
optic section = ? view |
3-D view
2-D view |
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When using indirect lighting, the light house is usually _______
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out of click stop
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retroillumination is ....
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reflected off an ocular surface
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sclerotic scatter is...
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internally reflected
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specular reflection is...
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angle of incidence = angle of reflection
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The purpose of the routine slit lamp exam is to note any abnormalities in the anterior ocular structures including... (4)
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1. inflammation
2. infection 3. scarring 4. injuries/insults |
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What are the three main purposes of the slit lamp exam?
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1. note any abnormalities in the anterior ocular structures
2. to identify any diseases of the anterior ocular structures 3. to observe any structural changes |
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What does the routine slit lamp exam include (9 main structures)
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lids, adnexa, conj, cornea, iris, van herick angle grading, lens, lid eversion, anterior chamber
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What are the settings when doing the portion of the slit lamp exam with diffuse light?
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6-10x mag
3-4mm or open beam width moderate rheostat angle at 30-60 or coaxial beam height max click stop in parfocal |
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What is the procedure for the diffuse light setting portion of the slit lamp exam?
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1. sup. lash margin with lid closed
2. inf. and sup. lash margin with Meibomian glan expression 3. lower and upper bulbar and palpebral conj. (upper everted) 4. temp. and nasal bulbar conj. 5. puncta |
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Once the diffuse light portion of the exam is finsihed, what should the slit lamp setting be change to?
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-16x mag
-parallelopiped for scan iris and cornea -rheostat on high -click stop in parfocal |
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Once the diffuse setting has been changed, what should be examined next?
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iris, cornea (parallelopiped and optic section), angle estimation
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What is the purpose of the Van Herick angle evalutation?
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1. to evaluate the openness of the drainage angle
2. to identify potential dilating difficulties 3. to predict possible angle closures |
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What are the slit lamp settings when doing the Van Herick angle estimation?
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16x mag
angle of lamp at 60 degrees beam width optic section beam height max rheostat high click stop in parfocal |
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What are the Van Herick grades and what do they indicate?
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Grade 1: less than 1:1/4
Grade 2: equal to 1:1/4 Grade 3: between 1:1/4 to 1:1/2 Grade 4: greater than 1:1/2 (wide open) |
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What are the slit lamp setting when scanning the lens?
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beam height 5mm
beam width = narrow parallel. |
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What is the purpose of evaluating the anterior chamber?
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to observe small paricles floating in the A/C
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What types of particles may be found in the anterior chamber? (4)
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1. RBC
2. WBC 3. protein 4. pigment |
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If particles are observed in the anterior chamber, what might they indicate?
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inflammation, trauma, hyphema, etc.
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What are the slit lamp setting when evaluating the anterior chamber?
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25-40x mag
max rheostat angle >60 degrees conic section (~2x2) click stop in parfocal |
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What is the procedure when evaluating the anterior chamber?
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1. vault the pupil
2. focus between the cornea and iris 3. observe space within the pupil as the background 4. count at least 5 sec 5. look for particles |
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Pigment/cells in the A/C look like ______
Flare (proteins) in the A/C look like ______ |
-reddish/brown to whitish specs
-milky haze |
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When doing the A/C evaluation, you can either keep the slit lamp focused between ______ and ______ or ______
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cornea, iris, move back and forth
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What is the grading for the A/C evaluation and what does it indicate?
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Grade 0: no cells/flare
Grade 1: 4-8 cells; mild flare Grade 2: 9-15 cells; moderate flare Grade 3: too many cells to count; marked flare Grade 4: most ever seen; severe flare |
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What is the purpose of superior lid eversion and what are you looking for?
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-the purpose is to evaluate the palpebral conj.
-looking for alergic sign, signs, signs of infection, prior, to CL fitting, contact lens complication |
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Superior lid eversion is part of the basic ________ workup
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"red eye"
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What is the superior lid eversion procedure?
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1. patient gazes downward
2. at the upper edge of the tarsal plate place object and pull lashes down and out 3. rotate lid toward sup. orbital rim |
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What are the abnormalities that can be found when doing superior lid eversion?
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papillae and follicles
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What are papillae?
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vascularized elevations containing inflammatory cells (allergic)
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What are follicles?
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avascular elevations (viral)
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What does typical slit lamp recording include?
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lids/lashes: clean and clear
conj: quiet, white, clear cornea: clear iris: intact lens: clear vitreous: normal |
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What are atypical recordings for lids?
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inflammed, papillomas, nevi, entropian, ectropian, dermatochalasis
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What are atypical recordings for lashes?
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crusty, oily, flaky, blepahritis, matting, missing, distichiasis, trichiasis
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What are atypical recordings for conj?
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injected, chemosis (edema), follicles, tears, papillae, blebs, pinguecula, pterygia, hemorrhages
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What are atypical recordings for cornea?
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endothelial changes, scars, infiltrates, opacities, arcus, foreign body
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What are atypical recordings for iris?
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nevi, holes, tears, vascularization,
if diabetic: no rubeosis or rubeosis |
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What are atypical recordings for lens?
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lenticular changes (ant. subcapsular, cortex, nucleus, post. subcapsular), vacuaoles, opacities, epicapsular stars (ant. capsule), Mittendorf dot
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What are atypical recordings for vitreous?
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liquifaction in elderly, asteroid bodies, scinchiasis scintilans
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What are the recordings for puncta?
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open or obstructed
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What are the recordings for sclera?
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white, quiet or injected, pigmented, discolored
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What are the six main special procedures?
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1. TBUT
2. iris transillumination or retro or the cornea 3. tear meniscus evaluation 4. indirect 5. sclerotic scatter 6. specular reflection |
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What are other "routine type" procedures we perform with the slit lamp?
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1. CL fitting
2. corneal evaluation (iron deposits, endo, microcysts, etc.) 3. epilation 4. corneal rust ring removal 5. corneal foreign body removal |
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What is the purpose of TBUT?
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To evaluate the integrity of the tear layer and confirm dry eye
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What are the three layers in tears?
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1. oil
2. water 3. mucin |
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What are the settings for TBUT?
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6-10x mag
rheostat max beam width ~3mm or wider angle at 30-60 degrees filter cobalt click stop in parfocal |
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What is the procedure for TBUT?
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instill fluorescein on INF. BULBAR conj. and have patient blink and then open eye, scan the cornea continuously and count number of seconds until dry spot appears and record
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What is the normal amount of seconds for TBUT?
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>10 seconds
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What is the purpose of iris transillimination, (a form of retroillumination)?
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to identify defects in the iris and to access patency of surgical iridectomy
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What are the settings for iris transillumination?
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6-10x mag
beam width 2x2mm beam angle coaxial rheostat max click stop in parfocal ROOM LIGHTS OFF |
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What is the procedure when doing iris transillumination
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place beam in pupillary area and focus on iris plane, then adjust slit lamp for brightest reflex and observe any area of red retro illumination in the iris
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What is the purpose of the tear meniscus evaluation?
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valuate the quantity and quality of the tear layer while looking for any deficiencies and/or excess
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What is the normal size of the tear meniscus?
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1mm
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What are the settings when evaluating the tear meniscus?
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10-16x mag
rheostat low beam width parallelopiped (1-2mm) angle 60 degrees or less click stop in parfocal |
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What is the procedure when evaluating the tear meniscus?
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*must be done prior to the instillation of drops
focus on the inf. lid at lateral canthus and scan across the inf. tear strip and use optic section to assess depth of meniscus |
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What are the setting for sclerotic scatter?
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no mag
rheostat and beam height max angle 45-60 degrees click stop in parfocal |
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What are the settings for alternate sclerotic scatter method?
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6-10x mag
rheostat and beam height max angle 45-60 degrees click stop OUT |
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What is the procedure for the alternate sclerotic scatter method?
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focus slit lamp at center of the cornea with light directd to limbal area by moving it out of parfocal
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What are the settings for specular reflection?
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25-40x mag
rheostat and beam height max angle at 45-60 degrees click stop in parfocal |
