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Slit Lamp Training Tim Buckley Product Manager

Slit Lamp Training Tim Buckley Product Manager. Basics Definition and Applications. Definition

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Slit Lamp Training Tim Buckley Product Manager

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  1. Slit Lamp Training Tim Buckley Product Manager

  2. BasicsDefinition and Applications Definition The purpose of a slit lamp is the biomicroscopy of the patient‘s eye under different lighting conditions. The slit lamp projects a bright and homogenously illuminated slit onto the eye which is variable in length, width, angle and light intensity. Fields of Application The primary field of application is the anterior eye segment (cornea, anterior chamber, lens, anterior vitreous). Using additional optics enables the user to also examine the posterior eye segment as well as the anterior chamber angle.

  3. BasicsDesign Principles • components: microscope, slit projector, instrument base • carrier arms for microscope and slit projector can be swiveled around a common axis • swivelling axis is located in the focal plane of microscope and slit projector

  4. BasicsDesign Principles - Biomicroscope • Zeiss slit lamps:Galilei type microscope • common front objective • parallel beam path • 3 or 5 magnification steps • other manufacturers also offer Greenough type microscopes • two separate, tilted beam paths • only 2 magnification steps • very few accessories

  5. BasicsDesign Principles - Slit Projector • purpose: to project a slit image focused on the patient‘s eye • the slit image is variable in length, width and angle • light source: usually halogen (high color temperature) • filters: blue, green (redfree), diffusor, heat absorbing filter

  6. BasicsDesign Principles - Instrument Base • functional coupling of carrier arms of microscope and slit projector • slit projector and stereo microscope can independantly be swiveled around a common axis • Axis is located below patient’s eye • both slit image and observation are in focus in the axial plane • three-dimensional positioning by joystick

  7. Basic Functions of the Slit LampSlit Width narrow slit circle shaped, if fully opened slit width is adjusted continuously

  8. Basic Functions of the Slit LampSlit Length short slit long slit slit length is adjusted in steps and continuously

  9. Basic Functions of the Slit LampSlit Rotation vertical slit horizontal slit vertical slit slit rotation can be adjusted continuously by ±90°

  10. Basic Functions of the Slit LampSlit Decentration decentered slit slit can be decentered continuously by ±4°

  11. Basic Functions of the Slit LampTilting Prism angle of incidence 0° angle of incidence 20° tilting prism can be tilted by 0° to 20° continuously positions 0°, 5°, 10°, 15°, 20° indexed

  12. Types of Illumination Forms of direct Illumination

  13. Types of IlluminationDirect Diffuse Illumination Principle • illumination of the eye with a broad, unfocused light beam • usage of diffusor • microscope positioned at 0° • magnification 5x ... 12x Applications • Overview • general assessment of anterior eye, eye lids • assessment of contact lenses

  14. Types of IlluminationDirect Diffuse Illumination IOL iris supported anterior chamber lens in diffuse illumination Bildquelle: Universitäts-Augenklinik Jena

  15. Types of IlluminationDirect Focal Illumination - Optic Section Principle • Illumination and observation are focused in the same plane • slit width ca. 0,1 to 0,3mm Applications • mainly findings in the cornea and lens • opacities, scars, vessels • good perception of the depth of findings

  16. Types of IlluminationDirect Focal Illumination - Optic Section Cataract anterior cortical opacities, nucleosclerosis and posterior opacities Bildquelle: www.atlasophthalmology.com

  17. Types of IlluminationDirect Focal Illumination - Optic Disc Principle • Illumination and observation are focused in the same plane • slit width ca. 2 to 4mm Applications • mainly findings in the cornea and lens • opacities, scars, vessels • good perception of shape and size of findings

  18. Types of IlluminationDirect Focal Illumination - Optic Disc Cyst on Pupillary Edge Cyst on pupillary edge stems from usage of too strong miotica Bildquelle: www.atlasophthalmology.com

  19. Types of IlluminationDirect Focal Illumination - Conical Beam Principle • assessment of particles floating in the anterior chamber by illuminating with a light beam • Tyndall‘s phenomenon • pinpoint illumination 0,3 - 0,5mm Applications • assessment of particles in aqueaous humor • inflammation cells, pigmented cells, metabolic waste

  20. Types of IlluminationDirect Focal Illumination - Conical Beam cells in anterior chamber cells in anterior chamber as a sign of uveitis Bildquelle: www.atlasophthalmology.com

  21. Types of IlluminationTangential Illumination Principle • a narrow light beam is projected almost parallel along the structure to be observed • elevated structures are visible by shadowing Applications • elevated abnormities or changes in the iris • tumors, cysts

  22. Types of IlluminationTangential Illumination Iris Iris in tangential illumination

  23. α α

  24. α α 0° Types of IlluminationSpecular Illumination Principle • angle of incidence = angle of reflection • observation and illumination have same angle to perpendicular axis • slit width < 4mm Applications • assessment of surfaces • assessment of tear film • endothelial cell layer

  25. α α 0° Types of IlluminationSpecular Illumination endothelial cells endothelial cell layer magnified ca. 192x Bildquelle: Carl Zeiss Meditec

  26. Types of Illumination Forms of indirect Illumination

  27. Types of IlluminationIndirect focal Illumination Principle • illumination by stray light • slit is slightly decentered so that stray light is created in direct neighbourhood of the finding • slit width ca. 2 to 4mm Applications • mainly corneal lesions and scars

  28. Types of IlluminationIndirect focal Illumination no example

  29. Types of IlluminationDirect Retro-Illumination from the Iris Principle • Illumination of the finding with indirect light rflected from the iris • observation with light background • medium slit width, ca. 2 to 4mm Applications • Infiltrations, small scars, corneal vessels, micro cysts, vacuoles • with this illumination findings are made visible with high contrast

  30. Types of IlluminationDirect Retro-Illumination from the Iris Keratitis Superficialis Punctata finding after moderate cauterization by acid, defects of epithelium and conjunctiva have been stained with bengal rose Bildquelle: www.atlasophthalmology.com

  31. Types of IlluminationIndirect Retro-Illumination from the Iris Principle • Illumination of the finding with indirect light reflected from the iris • observation with dark background • medium slit width, ca. 2 to 4mm Applications • Infiltrations, small scars, corneal vessels, micro cysts, vacuoles

  32. Types of IlluminationIndirect Retro-Illumination from the Iris Keratitis Punctata, contact lens wearer multiple erosions of the central cornea due to inappropriate contact lens fitting Bildquelle: www.atlasophthalmology.com

  33. Types of IlluminationRetro-Illumination from the Lens Principle • Illumination of the finding with indirect light reflected from the lens • observation with light background • medium slit width, ca. 2 to 4mm Applications • corneal defects, foreign bodies, scars • (type of illumination not frequently used)

  34. Types of IlluminationRetro-Illumination from the Lens no example

  35. Types of IlluminationRetro-Illumination from the Fundus Principle • Illumination of the finding with indirect light reflected from the fundus • observation with red/yellowish background • dilated pupil Applications • abnormities in the anterior vitreous, lens, anterior chamber, cornea • findings are visible like silhouettes

  36. Types of IlluminationRetro-Illumination from the Fundus Aniridia missing iris and zonular cataract made visible by retro-ilumination Bildquelle: www.atlasophthalmology.com

  37. Types of IlluminationIris-Transillumination Principle • transillumination of the iris by indirect light reflected from the fundus • half dilated pupil (3 to 4mm) • Illumination and observation at ca. 0° Applications • Visualization of defects of the pigment layer of the iris

  38. Types of IlluminationIris-Transillumination Albinism Iris-Transillumination shows the light transmission of the iris Bildquelle: www.atlasophthalmology.com

  39. Types of IlluminationSclerotic Scatters Principle • Illumination of the limbus region with a broad light beam at an angle of 45° - 60°, decentered slit • total reflection of the incoming light at inner corneal boundaries (endothelium and epithelium) Applications • scars, foreign bodies, corneal defects • irregularities in the cornea cause straylight

  40. Types of IlluminationSclerotic Scatters corneal scar corneal scarring after infection Bildquelle: www.atlasophthalmology.com

  41. Fundus Observation and Gonioscopy

  42. Fundus Observation and GonioscopyContact Glasses Contact Glasses • additional tool for fundus observation with the slit lamp • mostly direct: erect and non mirrored image of the fundus • required: dilated pupil, use of gliding liquid Fundus Image Microscope Bildquelle: www.ocular-instruments.com

  43. Inverted fundus image microscope Fundus Observation and GonioscopyLenses Lenses • additional tool for fundus observation with the slit lamp • mostly indirect: upside-down and mirrored image of the fundus (convex optics) • non contact • required: dilated pupil Bildquelle: www.ocular-instruments.com

  44. Fundus Observation and GonioscopyGonioscopy Three mirror contact glass • Goldmann contact glass • central lens: posterior pole • 73° mirror: equator • 67° mirror: ora serrata • 59° mirror: anterior chamber angle central lens Bildquelle: www.ocular-instruments.com

  45. 73° mirror Fundus Observation and GonioscopyGonioscopy Three mirror contact glass • Goldmann contact glass • central lens: posterior pole • 73° mirror: equator • 67° mirror: ora serrata • 59° mirror: anterior chamber angle Bildquelle: www.ocular-instruments.com

  46. 67° mirror Fundus Observation and GonioscopyGonioscopy Three mirror contact glass • Goldmann contact glass • central lens: posterior pole • 73° mirror: equator • 67° mirror: ora serrata • 59° mirror: anterior chamber angle Bildquelle: www.ocular-instruments.com

  47. 59° mirror Fundus Observation and GonioscopyGonioscopy Three mirror contact glass • Goldmann contact glass • central lens: posterior pole • 73° mirror: equator • 67° mirror: ora serrata • 59° mirror: anterior chamber angle Bildquelle: www.ocular-instruments.com

  48. Fundus Observation and GonioscopyExample: Fundus retinal scar microscope Bildquelle: UAK Jena / Carl Zeiss

  49. Fundus Observation and GonioscopyExample: Anterior Chamber Angle blood in chamber angle vessels in chamber angle

  50. Examination using Fluorescein

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