• Lectures of Slit lamp examination

    The slit lamp is essentially a simple and generally under-used piece of equipment. It consists of an illumination system and a binocular observation system, which when correctly aligned will result in a coincidental focus of the slit and microscope.
    Illumination system
    Basically a short focus projector projecting an image of the illuminated slit aperture on to the eye. This part of the system should be flexible to allow various sizes and shape of slit beam. Usually a rheostat is incorporated and the lamp house can be rotated. Neutral density, cobalt blue and red free filters are usually available, and occasionally a diffuser and polariser.
    Observation system
    Consists of a binocular microscope with parallel or convergent eyepieces (some practitioners may get diplopia with parallel eyepieces). Generally magnification from 6x to 40x is allowed by varying the eyepiece and objective lens of the microscope.
    Note
    The illuminating system and observation system are normally focused at the same point - coupled. Although there are some occasions when it is better to focus the slit at a different point to where the observation system is set-de-coupled.
    Before commencing any work with the slit lamp it is important to ensure that your instrument is correctly set up:

    • The eyepieces should be focused for the observer (this can be facilitated if the observer knows their refractive error and uses the dioptric scale found on most slit lamps). Often a little more minus is required than the observer's refractive error due to proximal accommodation and convergence (it is always wise to 'think far' when viewing through this type of instrument). Before examining a patient it is essential that the eyepieces are correctly set for your own refractive state. Because the eyepieces are mounted convergently, this setting will be at a more myopic point than expected. Since no cross lines are provided within the microscope, the focussing rod, which is in the drawer of the slit lamp table must be used. This rod, which has a flat end, should be mounted in front of the microscope by removing the flat grooved alloy plate which is engraved 'Clement Clarke' and by inserting the rod in its place. The slit beam should be directed to the centre of the flat face of the rod and set at about 1-2 mm in width. The eyepieces should be set individually by focussing on the slit image moving the eyepiece from the positive side of the scale and stopping at the point at which the image first appears sharply focussed, thus avoiding stimulating accommodation. You should then note the setting on the eyepiece scale and always use this setting when using the slit lamp. There is no need to use the focussing rod after this occasion. If the focussing rod is missing the slit beam should be positioned on the closed upper lid of the subject and then illumination system swung from side to side checking for parallax movement. Adjust the position of the illumination system until there is no parallax movement and then focus the eyepieces in turn. (ask for a demonstration).
    • The pupillary distance (pd) is adjusted for the observer (again perhaps the pd should be slightly less than that usually measured to account for proximal convergence).
    • Check that the slit lamp is parallel on the runners of the table.
    • Check that the observation and illumination systems are coupled, and that the slit beam is of even illumination and has sharply demarcated edges (otherwise irregularity of the beam may be falsely interpreted as irregularity of tissues).
    • The locations of the controls are known.
    • The observer and patient are comfortable in the mid-travel of the slit lamp. Mid-travel is the location of the slit lamp when it is half-way up or down its possible vertical range.




    Slit Lamp Exam video

    Slit lamp examination 1/6 ( diffuse illumination - focal illumination) video

    Slit lamp examination 2/6 ( aqueous flare) video

    Slit lamp examination 3/6 ( indrect illumination - Retro illumination) video

    Slit lamp examination 4/6 ( Specular reflection : epithelial and endotheilal) video

    Slit lamp examination 5/6 ( Scerotic scatter) video

    Slit lamp examination 6/6 ( measurement, fundus exam and fillters) video
    This article was originally published in forum thread: Essential Lectures of Slit lamp examination videos started by Medical Videos View original post
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