Slit Lamp Biomicroscopy &
Condensing Lens
Vitreoretina workshop
For General Ophthalmologist
Semarang, November 5-6th 2016
INSTRUMENT
1. Slit lamp
2. Eye models and fixators
3. +78D and +90D aspheric lenses
Slit lamp Biomicroscopy
A dynamic examination in which eye and ocular
adnexa are scanned anteroposteriorly and
horizontally
SLIT LAMP OVERVIEW
Fixation light
Head rest
Canthal alignment mark
Chin rest
Lock for slit lamp base
Joy stick
Power unit
SCHEMATIC VIEEW OF ILLUMINATION AND MICROSCOPE
SYSTEM
Slit-Lamp Biomicroscope
Patient seated at the slit-lamp biomicroscope
The slit lamp affords the examiner stereoscopic
vision
Slit-Lamp Biomicroscope
Handheld plus-diopter condensing lenses can
be used, providing :
Biomicroscopist an inverted and reversed retinal
image,
a field of view ranging between 30° and 40°,
magnification between 7.5x and lOx
Useful for examining the optic disc and the macula
Principles of Slit-Lamp Illumination
The slit lamp offers six main illuminating options,
each with its own special properties and
particular uses:
1. Diffuse illumination
2. Direct focal illumination
3. Specular reflection
4. Transillumination, or retroillumination
5. Indirect lateral illumination
6. Sclerotic scatter
Diffuse Illumination
overview of ocular surface tissues also
intraocular structures (iris, lens capsule)
Direct Focal Illumination
full-height, medium width, medium-bright beam
obliquely and focus on the cornea used for
grading flare and cell in the anterior chamber
Specular Reflection / Reflected
Illumination
Examination of the corneal endothelium
medium to narrow beam of light 50°-60° from
the temporal side
Transillumination
Transillumination, or retroillumination, backlights
tissues to be examined
Medium-width beam of light is projected onto a
deeper part of the eye than the targeted area, it can
be seen by reflected light
Indirect Lateral Illumination
light is directed just to the side of the lesion to
be examined
Most useful for translucent lesions such as
some corneal opacities or iris nodules
Sclerotic Scatter
detecting subtle corneal opacities
A medium-width beam is directed onto the
limbus by rotating the illuminating arm
temporally, the examiner views the center
cornea
FUNDUS
Examination of the posterior segment with the
slit lamp and a Hruby lens and handheld
condensing lenses.
High-plus condensing fundus lenses are handheld
lenses used for fundus examination by indirect
slit-lamp biomicroscopy.
The +90 D and +78 D lenses are used most often.
Magnifi Field of View
Lenses View Other
cation ( Static/Dynamic)
Working distance 13 mm;
Volk 60D 1.15x 68°/81° Indirect high magnification ideal
untuk Papil N.II dan Makula
Working distance 8 mm;
good compromise
Volk 78D 0.93x 81°/97° Indirect
black/white Field of View
and magnification
Working distance 7 mm;
Volk 90D 0.76x 74°/89° Indirect ideal untuk pemeriksaan
dengan pupil kecil
Slit Lamp Funduscopy Principles
With slit lamp funduscopy we only see SLIT image,
NOTICE the glare, which is moved out of the picture
with a mild tilting of the lens
Slit Lamp Funduscopy Technique
Preparation for the examination:
Make the room as dark as possible
Fixate your arms comfortably, using the
armrest
Dilate the pupils of the patient (important if
you are not experienced)
SET UP
Disinfect forehead and chin rest
Patient BCVA + IOP, prior to dilating the
patient
Dilate the pupil 30 minutes before
examination
Adjust table height and chin rest so the
patient is comfortable
Hold the condensing lens vertical using thumb
and index finger
Step by step procedure
Patient fixate straight ahead
focus on the patient cornea
Place the lens approx.8 mm from the patients
cornea
Use joystick focus on the fundus image
Once retinal image focused, widen the slit beam,
adjust the magnification
Step by step procedure
To view spesific portion of retina, ask patient
to change fixation
Tilt the lens or increase the angle of the
illumination arm to reduce glare
To check macula, narrow the beam to a slit
and focus it in the macula. Check for gaps and
/or curves is known as the Watzke Allen slit
beam test. Positive finding= Watzke sign
Slit Lamp Funduscopy: Technique
Grab the lens with big and index finger, the rest of the
fingers will help you to tilt the lens and pull the
upper eyelid up
Set the center of the lens on the center of the pupil
(use the beam to check it)
The working distance of the lens is 5-10 mm
Slit Lamp Funduscopy: Technique
The picture is floating in the air actually.
Notice the direction of letters of the lens rim
Slit Lamp Funduscopy: Technique
Slit Lamp Funduscopy: Technique
That is how you focus a
beam on the center of a
pupil.
Notice how the fingers
are fixed.
Slit Lamp Funduscopy: The Image
Fundus of the left eye (egg), eye in horizontal cross-section.
As it should optic disc is closer to the nasal side than macula.
Slit Lamp Funduscopy: The Image
Fundus of the same left eye (egg) with the using +90D or
+78D, the image gets inverted. Macula and disc have changed
their places and inverted
Slit Lamp Funduscopy
It is wise to do the funduscopy in the next
order:
1. Optic disc (patient fixates the
contralateral ear of the examiner),
2. Macula (patient fixates straighth),
3. Periphery (patient fixated every needed
direction).
Slit Lamp Funduscopy: Retinal Periphery
Patient fixated straight. We receive macula in the field of
view.
Slit Lamp Funduscopy: Retinal Periphery
Patient fixated the contralateral ear of examiner. We receive
optic disc in the center of a fundus picture.
Slit Lamp Funduscopy: Retinal Periphery
Patient looked at the ceiling, we see upper periphery (12
o’clock).
Slit Lamp Funduscopy: Retinal Periphery
Patient looked at the floor, we see lower periphery (6 o’clock).
Slit Lamp Funduscopy: Retinal Periphery
Patient looked left, we see temporal periphery (3 o’clock).
Slit Lamp Funduscopy: Retinal Periphery
Patient looked right, we see nasal periphery (9 o’clock).
Slit Lamp Funduscopy: Retinal Periphery
Inversion of the picture of upper periphery
Slit Lamp Funduscopy: Retinal Periphery
Inversion of the picture of upper periphery
Slit Lamp Funduscopy: Fundus Structure
