Basics of slit lamp microscopy - Bhatti Eye · 2005. 11. 6. · Anatomy of the angle. Normally the...
Transcript of Basics of slit lamp microscopy - Bhatti Eye · 2005. 11. 6. · Anatomy of the angle. Normally the...
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Basics of slit lamp microscopy
Dr. S S Bhattiwww.bhattieye.com
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The 2 basic parts of the slit lamp biomicroscope are:
• The slit lamp (illumination system)• The biomicroscope
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The illumination system can be
1. Of the Zeiss type2. Of the Haag Streit type
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In the Zeiss type the illumination comes from below
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In the Haag Streit type the illumination comes from above
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In both types of illumination system the Kohler illumination principle is
used:
The filament is imaged on to the objective lens but the mechanical slit is imaged on to the patient’s eye
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The biomicroscope:based on the optics of a compound
microscope
• Two basic types:– The Grenough type– The Galilean changer type
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The Grenough type(Classical Haag Streit)
Flip lever to change magnification
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The Galilean Magnification changer
Knob to change magnification (3 or 5step)
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Galilean magnification changer
Objective
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Magnification can also be changed by changing the eyepiece power
10 X 16 X
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The slit lamp and the biomicroscopeare maneouvred together on a cross
slide by means of a joystick
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The coupling between the slit lamp and the biomicroscope
• This is such as to make the system “parfocal”
• i.e the focus of the slit and the focus of the microscope are at the same point.
• This parfocality may occasionally need to be dissociated as for example in the technique of sclerotic scatter
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The coupling between the slit lamp and the biomicroscope
• This allows both the slit and the microscope to rotate about the point of focus (i.e the eye)
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Dissociation of parfocality can be done in “Haag Streit” type slit lamps by loosening
the sclerotic scatter knob
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This dissociation of parfocality is useful for indirect illumination,
sclerotic scatter and retroillumination
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• The key to successful examination of the anterior segment is knowledge of the various methods of lighting which can be achieved by the slit lamp.
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Diffuse illumination• Not all slit lamps have
this option
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Diffuse illumination for surface details
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Diffuse illumination
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Diffuse illumination
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Diffuse illumination
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Focal broadbeam illumination
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Broad beam
Narrow beam
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Focal broad beam
Busacca’s nodule
on iris
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Knob to widen beam
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Focal slit illumination
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Focal slit illumination
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Retroillumination- against red glow
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Retroillumination- YAG pits on claw IOL
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Indirect illumination(similar to sclerotic scatter)
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Sclerotic scatter
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Knob for sclerotic scatter allows slit beam to be horizontally rocked
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Parfocality of slit and viewing altered for sclerotic scatter
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Sclerotic scatter
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Specular illumination
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Filter turret
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With additional dyes
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Collage
Broad beam slit
Retroilluminationagainst red glow
Retroilluminationagainst lens
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Lens precipitates
Diffuse illumination
Focal illumination
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SPKS- a collage
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Krukenberg spindle
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Traumatic rosette cataract
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Anatomy of the angle
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Normally the angle of the anterior chamber cannot be seen as light from it cannot exit
from the eye due to total internal reflection at the cornea
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A gonioscopy lens allows light from the angle to exit the eye by
eliminating the cornea air interface
Goldman gonioscopy lens
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Direct Direct GonioscopyGonioscopy
Koeppe gonioscopy lensKoeppe Gonioscopy lens
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Angle recession
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Trabecular pigmentation
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• Fundus examination can be done with a slit lamp with the use of ancillary lenses
• Ancillary lenses are required to neutralize the refractive power of the cornea .
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Use of the short reflex mirror is recommended for posterior segment examination because the upward projection of the long mirror blocks one of the eye pieces when the illumination is kept at a small 3-5
degree angle from the binocularHowever, the illumination beam column must then be tilted else the illumination beam will fall partly outside the mirror reducing the illumination entering the eye
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Broad beam
Narrow beam
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Some contact Fundus slitlamplenses
Mainster standard
MainsterHigh Magnification
Mainster PRP (widefield for panretinalphotocoagulation)
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Fundus view with slitlamp and Mainster contact lens
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Slit lamp examination with a Volk quadraspheric contact lens (dislocated crystalline lens)
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