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64 Cards in this Set

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What is the general room illumination when doing a slit lamp exam and why?
dim or dark to increase contrast
When during a slit lamp exam do you set the rheostat on high?
-when using filters
-with narrow light beam
-with conical beam (2x2)
When during a slit lamp exam do you set the rheostat on low or medium and why?
-when using diffuse light to help with patient comfort
When viewing cells and protein or pigment particles you typically have the mag on _____
high magnification
Low mag is best for viewing ________ (3)
1. CL evaluation
2. lids/lashes
3. conj
When should you use a short beam height?
when looking at short areas like the lens or when no light should enter the pupil
parallelopiped = ? view

optic section = ? view
3-D view

2-D view
When using indirect lighting, the light house is usually _______
out of click stop
retroillumination is ....
reflected off an ocular surface
sclerotic scatter is...
internally reflected
specular reflection is...
angle of incidence = angle of reflection
The purpose of the routine slit lamp exam is to note any abnormalities in the anterior ocular structures including... (4)
1. inflammation
2. infection
3. scarring
4. injuries/insults
What are the three main purposes of the slit lamp exam?
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
What does the routine slit lamp exam include (9 main structures)
lids, adnexa, conj, cornea, iris, van herick angle grading, lens, lid eversion, anterior chamber
What are the settings when doing the portion of the slit lamp exam with diffuse light?
6-10x mag
3-4mm or open beam width
moderate rheostat
angle at 30-60 or coaxial
beam height max
click stop in parfocal
What is the procedure for the diffuse light setting portion of the slit lamp exam?
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
Once the diffuse light portion of the exam is finsihed, what should the slit lamp setting be change to?
-16x mag
-parallelopiped for scan iris and cornea
-rheostat on high
-click stop in parfocal
Once the diffuse setting has been changed, what should be examined next?
iris, cornea (parallelopiped and optic section), angle estimation
What is the purpose of the Van Herick angle evalutation?
1. to evaluate the openness of the drainage angle
2. to identify potential dilating difficulties
3. to predict possible angle closures
What are the slit lamp settings when doing the Van Herick angle estimation?
16x mag
angle of lamp at 60 degrees
beam width optic section
beam height max
rheostat high
click stop in parfocal
What are the Van Herick grades and what do they indicate?
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)
What are the slit lamp setting when scanning the lens?
beam height 5mm
beam width = narrow parallel.
What is the purpose of evaluating the anterior chamber?
to observe small paricles floating in the A/C
What types of particles may be found in the anterior chamber? (4)
1. RBC
2. WBC
3. protein
4. pigment
If particles are observed in the anterior chamber, what might they indicate?
inflammation, trauma, hyphema, etc.
What are the slit lamp setting when evaluating the anterior chamber?
25-40x mag
max rheostat
angle >60 degrees
conic section (~2x2)
click stop in parfocal
What is the procedure when evaluating the anterior chamber?
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
Pigment/cells in the A/C look like ______

Flare (proteins) in the A/C look like ______
-reddish/brown to whitish specs

-milky haze
When doing the A/C evaluation, you can either keep the slit lamp focused between ______ and ______ or ______
cornea, iris, move back and forth
What is the grading for the A/C evaluation and what does it indicate?
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
What is the purpose of superior lid eversion and what are you looking for?
-the purpose is to evaluate the palpebral conj.

-looking for alergic sign, signs, signs of infection, prior, to CL fitting, contact lens complication
Superior lid eversion is part of the basic ________ workup
"red eye"
What is the superior lid eversion procedure?
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
What are the abnormalities that can be found when doing superior lid eversion?
papillae and follicles
What are papillae?
vascularized elevations containing inflammatory cells (allergic)
What are follicles?
avascular elevations (viral)
What does typical slit lamp recording include?
lids/lashes: clean and clear
conj: quiet, white, clear
cornea: clear
iris: intact
lens: clear
vitreous: normal
What are atypical recordings for lids?
inflammed, papillomas, nevi, entropian, ectropian, dermatochalasis
What are atypical recordings for lashes?
crusty, oily, flaky, blepahritis, matting, missing, distichiasis, trichiasis
What are atypical recordings for conj?
injected, chemosis (edema), follicles, tears, papillae, blebs, pinguecula, pterygia, hemorrhages
What are atypical recordings for cornea?
endothelial changes, scars, infiltrates, opacities, arcus, foreign body
What are atypical recordings for iris?
nevi, holes, tears, vascularization,
if diabetic: no rubeosis or rubeosis
What are atypical recordings for lens?
lenticular changes (ant. subcapsular, cortex, nucleus, post. subcapsular), vacuaoles, opacities, epicapsular stars (ant. capsule), Mittendorf dot
What are atypical recordings for vitreous?
liquifaction in elderly, asteroid bodies, scinchiasis scintilans
What are the recordings for puncta?
open or obstructed
What are the recordings for sclera?
white, quiet or injected, pigmented, discolored
What are the six main special procedures?
1. TBUT
2. iris transillumination or retro or the cornea
3. tear meniscus evaluation
4. indirect
5. sclerotic scatter
6. specular reflection
What are other "routine type" procedures we perform with the slit lamp?
1. CL fitting
2. corneal evaluation (iron deposits, endo, microcysts, etc.)
3. epilation
4. corneal rust ring removal
5. corneal foreign body removal
What is the purpose of TBUT?
To evaluate the integrity of the tear layer and confirm dry eye
What are the three layers in tears?
1. oil
2. water
3. mucin
What are the settings for TBUT?
6-10x mag
rheostat max
beam width ~3mm or wider
angle at 30-60 degrees
filter cobalt
click stop in parfocal
What is the procedure for TBUT?
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
What is the normal amount of seconds for TBUT?
>10 seconds
What is the purpose of iris transillimination, (a form of retroillumination)?
to identify defects in the iris and to access patency of surgical iridectomy
What are the settings for iris transillumination?
6-10x mag
beam width 2x2mm
beam angle coaxial
rheostat max
click stop in parfocal
ROOM LIGHTS OFF
What is the procedure when doing iris transillumination
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
What is the purpose of the tear meniscus evaluation?
valuate the quantity and quality of the tear layer while looking for any deficiencies and/or excess
What is the normal size of the tear meniscus?
1mm
What are the settings when evaluating the tear meniscus?
10-16x mag
rheostat low
beam width parallelopiped (1-2mm)
angle 60 degrees or less
click stop in parfocal
What is the procedure when evaluating the tear meniscus?
*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
What are the setting for sclerotic scatter?
no mag
rheostat and beam height max
angle 45-60 degrees
click stop in parfocal
What are the settings for alternate sclerotic scatter method?
6-10x mag
rheostat and beam height max
angle 45-60 degrees
click stop OUT
What is the procedure for the alternate sclerotic scatter method?
focus slit lamp at center of the cornea with light directd to limbal area by moving it out of parfocal
What are the settings for specular reflection?
25-40x mag
rheostat and beam height max
angle at 45-60 degrees
click stop in parfocal