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Because
Excellent image quality
Stereoscopic image
Flexible illumination
Flexible magnification
What can we use them for?
On their own With accessories
Routine examination of Gonioscopy
anterior segment Fundoscopy
From the ocular adnexa
Ocular photography
through the anterior vitreous
Problem-based examination Applanation tonometry
of anterior segment (Goldmann)
Contact lens evaluation Pachymetry
Assessment of anterior Laser photocoagulation
chamber depth and angle Dry Eye evaluation
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
Lever
Illumination
The slit lamp
Slit width
Continuously variable (0 to 8-
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 height
May be continuous or set to fixed
heights
Usually a combination of the two
May be graduated to allow for
measurement (caliper function)
Long slits are used to view most
structures in front of the pupil,
while short slits pass through the
pupil much better
Short slit also used to assess the
clarity of the anterior chamber
(cells & flare)
Achieved by rotating
Slit orientation lamp housing
Filters
Slit lamps may have some/all of the following filters
Diffuser
Polarising
Red free
Cobalt blue
Wratten (in observation system)
Types of illumination
Methods of illumination
Direct
Indirect
Retro-illumination
Iris
Fundus
Sclerotic Scatter
Specular View
A combination of these methods is used to view
the anterior eye structures
Direct illumination
Microscope
Lamp
Direct illumination
There are several different forms, named simply by how
wide the slit is
Diffuse (usually not a slit at all)
Wide beam
Parallelepiped
Optical section
The slit width will change what you can see
Diffuse/wide beam for an overall view
Wide parallelepiped for broad views of one plane (e.g.
Surface of a structure) and narrow parallelepiped for a
balanced view
Optical section to cut through a tissue, for thickness and
depth
Effect of slit width (cornea)
Microscope
Lamp
Indirect illumination
Good for subtle detail, which would be obscured or
washed out by large amounts of illumination
Keep the slit width narrow to medium (2-4 mm), and view
with a medium to wide angle. Magnification will vary
depending on the size and extent of the object, but its
typically medium to high for subtle defects
Directly
illuminated
Indirectly illuminated
This picture shows a contact-lens related condition called neovascularisation. These are
blood vessels in the cornea. In this example, we dont move anything but our attention
the light and focus stays where it is. We can do this because the slit doesnt light up our
whole field of view
Retro-illumination
Microscope
Lamp
Retro-illumination
Light may be reflected from 2 main structures:
Iris: this back-lights the cornea
Fundus: this back-lights the lens and the cornea
Indirectly illuminated
This is the same example from earlier. The blood vessels in the indicated section are
retro-illuminated because they are being lit from behind (the light has reflected off the
iris).
This is an example of retro-illumination of the lens (the light has
reflected from the retina). This patient has cortical spokes,
which are indicative of early cortical cataract.
keratic precipitates (direct & retro-illumination )
Vacuole
Sclerotic Scatter
Decoupling is done.
Intense light is illuminated at limbus at 45 but
optical view is at center of cornea.
Total internal reflection of light through cornea.
Lesions in stroma will manifest to observer
Specular Reflection
Technique to view the
endothelial surface
Done at high
magnification