Slit lamp biomicroscopyDr Alex Muntz
PhD MSc Optom & Vision Science Postdoctoral Research Fellow
Dept. of Ophthalmology
Patient's eye
Illumination system (lamp)
Observation system(microscope)
Slit lamp biomicroscope
Microscope
• Binocular - depth perception• Eyepiece adjustments (PD, Rx)• Magnification
Slit beam• ON / OFF• Slit height• Slit width• Focus/movement• Magnification
Important Controls
Viewing the cornea
• Turn SL on• Select low magnification level • Adjust slit to medium width• Move the SL to focus light on the eye while
watching from the side• Look through the SL and fine-tune focus• Now you should see something like…
… this!
slit beam on iris
slit beam on cornea
slit beam on anterior lens
slit beam on posterior lens
Narrow slit, high magnification
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corneal epithelium
Bowman’s layer
corneal stroma
corneal endothelium
anterior chamber overlying pupil
anterior chamber overlying iris
iris
A Suggested Examination
• Start anteriorly and work back
• Begin with low magnification and wide beam
• Examine external eye (eyelids / tears)
• Gross examination of corneal surface
• Gross examination of iris
A Suggested Examination• View red reflex to highlight media opacities
• Narrow slit beam width and increase magnification to more closely observe the cornea and anterior chamber
• Adjust focus posteriorly (move slit lamp towards patient) to examine crystalline lens
If Warranted• Examination with fluorescein• Pressure check (Goldmann)• Evert Lids• Fundal examination (Volk lens)• Gonioscopy
A Suggested Examination• View red reflex to highlight media opacities
• Narrow slit beam width and increase magnification to more closely observe the cornea and anterior chamber
• Adjust focus posteriorly (move slit lamp towards patient) to examine crystalline lens
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If Warranted• Examination with fluorescein• Pressure check (Goldmann)• Evert Lids• Fundal examination (Volk lens)• Gonioscopy
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Remember:
From... ToMagnification Low HighBeam width Wide NarrowBeam angle Straight Angled
Location Anterior/external Posterior
Inspection level General Detailed
Appropriate positioning of patient and examiner!