Slit lamp examination
The slit lamp is an instrument
consisting of a high-intensity light
source that can be focused to shine a
thin sheet of light into the eye.
It is used in conjunction with a
biomicroscope
Why slit lamps are so great
Slit lamp assessment is considered to be the
gold standard device for the assessment of
the anterior segment of the eye in clinical
practice
This is because they provide…
Excellent image quality
Stereoscopic image
Flexible illumination
Flexible magnification
Therefore there are many different uses
Even more when attachments are added
What can we use them for?
On their own With accessories
Routine Gonioscopy
examination of Fundoscopy
anterior segment Ocular
Adnexa through to photography
anterior vitreous Contact
Problem-based tonometry
examination of (Goldmann)
Contact lens Pachymetry
examination Corneal
Assessment of sensitivity
anterior chamber measurements
depth and angle Laser
photocoagulation
It provide
Uses of slit lamp
magnified view from cornea to
retina and also provide quantitative
measurements e.g IOP,Endothelial cell
count , pupil size , corneal thickness,ant-
chamber depth etc
Photography of every part for
documentation
The slit lamp exam may detect many
diseases of the eye, including:
Cataract
Conjunctivitis
Corneal injury such as corneal ulcer or
corneal swelling
Diabetic retinopathy
Keratoconus
Macular degeneration
Retinal detachment
Retinal vessel occlusion
Retinitis pigmentosa
Sjögren's syndrome
Uveitis
Wilson's disease
Parts of slit lamp
1- Observation system (microscope)
2-Illumination system
3-Mechanical system
1- observation system (microscoe)
It is a compound microscope composed of
two optical elements ,objective and
eyepiece
It presents an enlarge image to the observer
Objective lens is a Planoconvex lens of
+22D
Eyepiece is of +10D lens
A pair of prism b/w objective and eyepiece
to reinvert the image
Illumination system
Light source
Condensing lens system
Slit and other diaphragms
Filters
Projection lens
Reflecting mirror or prism
What makes a good slit?
A good slit needs to be
Bright
Evenly illuminated
Finely focused
Have well defined, straight edges
Flexible in terms of size, shape, colour and
intensity
The illumination also needs to
Provide good colour rendering to detect subtle
colour changes
Basic Design
Viewing arm
Biomicroscope
Adjustable focus eyepieces
Magnification dial
Illumination arm
The “slit lamp”
Slit size, shape and filter controls
Variable size, shape, colour and brightness
Biomicroscope and illumination are mechanically
coupled around central pivot point (copivotal)
Both focus at the same point (parfocal)
Both arms can swing independently 180º along
horizontal – there is a scale in degrees
Both always central regardless of angle
(isocentric)
Moveable base plate and joystick control
Slit lamp technique
Start w/ 10x eyepieces & lower powered objective
(“1x” or “12” )
Use lowest voltage setting on transformer
ensure open aperture
Select the longest slit length
Adjust chin rest
Pt's eyes approx level w/ marker on head rest
Slit arm in line w/ microscope
Lamp height w/ slit beam centered vertically on
Pt's medial canthus
Focus by moving joystick
slit width
adjustment
magnification
adjustment
beam
height
slit-width adjustment
filter rheostat
focus slit-arm locking knob
&
lamp
height locking nut (horizontal)
intensity locking bar
Magnification
adjustment can be
found in various
locations, including
between the
eyepieces
The filter rheostat
can be used to
decrease Pt
discomfort under
exam w/ the lamp
(neutral density
filter)
Slit width
Continuously variable
(0 to 12-14mm)
May be graduated to
allow measurement
Narrow slits are used
to “slice” through the
cornea to determine
depth or thickness
Wide slits are used to
inspect surfaces
Slit hight
May be continuous or
set to fixed heights
Short slit also used
May be graduated to to assess the clarity
allow for measurement of the anterior
Long slits are used to chamber
view most structures in
front of the pupil, while
short slits pass through
the pupil much better
Filters
Slit lamps may have some/all of the following
filters
Diffuser
Heat reduction
Neutral density
Polarizing
Red free
Cobalt blue
locking nut: loose for free
Ocular focus to 0 movement
adjust beam height for tall, adjust width for narrow beam w/
narrow vertical beam good illumination
Optics of illumination system
The instrument is known as slit lamp
because the illumination is arranged so that
a narrow vertical slit of a light is projected
on to the eye
The alignment of microscope and
illumination is such that the point on which
the microscope is focused corresponds to
the point on which the light is focused
This is achieved by the microscope
and lighting system having a common
focal plane.
An other common feature is that there
is a considerable distance b/w the
microscope itself and the patient s’ eye
This is because the microscope have a
long working distance
The resulting gap b/w the microscope
and the pt allows the observer to carry
out his work such as removing FB from
cornea
Mechanical system
Joystick
Up and down movement arrangement
Patient support arrangement
Fixation target
Principle
A narrow "slit" beam of very bright
light produced by lamp.
This beam is focused on to the eye
which is then viewed under
magnification with a microscope
Magnification
Slit lamps provide variable
magnification
Lower magnifications are used for
general assessment and orientation
Higher magnifications are used for
detailed inspections of areas of interest
