Slit Lamp Exam

Findings

• Components:– Lids– Adnexa– Conjunctiva– Cornea– Anterior Chamber– Iris– Lens

Lids

Lids

Lids

Normal

Lids

Ectropion

• Eyelid turning outward

• Document with location (I.e. “ectropion LLL”)

Lids

Entropion

• Eyelid turning inward

• Document with location (I.e. “entropion LLL”)

Lids

Dermatochalasis

(D’chalasis)

• Redundancy of skin in eyelids

• Atrophy of elastic tissue

Lids

Upper Lid Folds

• Increased amount of folds

• Document as: “high UL folds”

Lids

Hooding

• When upper lid comes over lid margin

• Document as: “Hooding”

Lids

Ptosis

• Drooping of the upper eyelids

• Document with location (I.e. “Ptosis RUL”)

Lids

Papilloma

• Growth on eyelid• Document with

location (I.e. “papilloma RUL”)

Lids

Trichiasis

• Inward growth of eyelashes

• Document with location (I.e. “trichiasis RLL”)

Lids

Chalazion

• Inflamed lump in meibomian gland

Lids

Blepharitis

• Inflammation of eyelid margins

• Redness, swelling, itching, crusting

Lids

Ecchymosis

• Bruising• Document with

location (I.e. “ecchymosis RUL”)

Adnexa

Adnexa

Normal

Adnexa

Decreased Tear Lake

• Tear lake not smooth

• Also can have increased break up time

• Document as: “decreased tear lake”

• Misc – TBUT = 10 sec

Conjunctiva

Conjunctiva

Quiet

Conjunctiva

Injection

• Tissue redness and swelling

Conjunctiva

Sub-Conjunctival Hemorrhage (SCH)

• Blood below conjunctiva and above sclera

• Document as: “SCH” with location (i.e. “SCH OD temp, inf, nas”)

Conjunctiva

Hyperemia

• Congestion of blood vessels

• Causes redness

Conjunctiva

Bleb

• S/P trabeculectomy for glaucoma

• Document if flat or formed

Cornea

Cornea

Normal

Cornea

Arcus

• White deposit of cholesterol

Cornea

Edema

• Swelling of tissue from fluid accumulation

Cornea

Superficial Punctate Keratitis (SPK)

• Small superficial corneal lesions

• Often due to dryness• Usually seen with

staining

Cornea

Anterior Stromal Scarring

• Scarring on the Stroma (middle layer of the cornea)

Cornea

Amiodarone Whorls

• Deposits from long-term use of Amiodarone

Cornea

Abrasion

• Scraped area of corneal surface

• Accompanied by loss of epithelium

• Usually seen with staining

Cornea

Astigmatic & Radial Keratomtery (AK /

RK) cuts

• S/P AK or RK• Document with location

(I.e. “AK cuts OU”)

Cornea

Keratic Precipitates (KP)

• Inflammatory cells and white blood cells that enter aqueous and adhere to corneal endothelium

Cornea

Guttata

• Small whitish hyaline deposits on inner surface of cornea

Cornea

Lasik Flaps

• S/P Lasik• Location = direction

of flap opening• Document with

location (I.e. “Lasik flap inf. – healed”)

Cornea

Neovascularization

• New blood vessel growth

• Document location (I.e. “OD inf.”)

Cornea

Pinguecula

• Benign yellowish-brown elevation of sub-conjuntival tissue on either side of cornea

Cornea

Pterygium

• Wedge-shaped growth in bulbar conjunctiva

• May advance over the cornea

Cornea

PK

• S/P corneal transplant

• Note sutures:– None– 360*– Running 360*

Cornea

Suture

• occ. used S/P PEIOL• Document with

location (I.e. “suture temp.”)

Cornea

Descemets Folds

• Folds in the Descemet’s membrane

Cornea

Ulcer

• Area of epithelial loss

• Associated with inflammatory cells in cornea & AC

Cornea

Band Keratopathy

• Horizontal band of calcium deposits

• In superficial layer of cornea

Cornea

Haab’s Striae

• Breaks or tears in Descemet’s membrane

• Usually from forceps use during delivery

Anterior Chamber

Anterior Chamber

Deep & Quiet

• Deep = Large distance between both beams

• Quiet = No abnormal matter in AC

• Document as “D&Q”

Anterior Chamber

Shallow

• Minimal distance between both beams

• Document as “shallow”

Anterior Chamber

Moderate Depth

• Moderate distance between both beams

• Document as “moderate depth”

Anterior Chamber

Closed

• Irido-Corneal touch• Document as

“Closed”

Anterior Chamber

Cells

• White blood cells and protein in AC

Anterior Chamber

Flare

• Scatterings of light in AC from slit lamp beam

• Due to increased protein in aqueous

Anterior Chamber

Red Blood Cells (RBC)

• Red blood cells in AC

Anterior Chamber

Hypopyon

• Collection of pus in AC

Anterior Chamber

Hyphema

• Blood in AC

Anterior Chamber

Tube Shunt (may have stitch

blocking end)

• S/P glaucoma sx• Document with

location (I.e. “shunt s-t”)

Anterior Chamber

Gas bubble in AC

• S/P PPVx• Document as “gas

bubble”

Anterior Chamber

Silicone Oil bubbles in AC

• S/P PPVx with Silicone oil

• Document as “Sil. Oil”

Iris

Iris

Normal

Iris

Nevus (multiple = nevi)

• Freckle• Document with location

(I.e. nevus I-T”)

Iris

Neovascularization

• New blood vessel growth on iris

• May be florid (everywhere)

• Document with location

Iris

Atrophy

• Wasting away of cells or tissue

Iris

Peripheral Iridotomy (PI)

• For glaucoma• Note if closed or patent

(open)• Document with location

(I.e. “PI Sup”)

Iris

Posterior Synechiae

• When iris adheres to lens• May also have pigment

on lens from previous episodes of broken Post. Syn.

• Document with location (I.e. “post. Syn. I-N & S-T)

Iris

Pupillary Membrane

• Congenital

Iris

Ectropion Pupillae

• When the pupil margin folds out• Document with location•Usually due to iris nv contraction

Lens

Lens

Clear

Lens

Nuclear Sclerosis (NS)

• Cataract with increased hardening or density at center of lens

Lens

Cortical Spokes (CS)

• Radially arranged opacities on lens cortex

Lens

Posterior Sub-Capsule (PSC)

• Cataract on rear surface of lens

Lens

Posterior Chamber Intra Ocular Lens

(PCIOL)

• Usually edges cannot be seen through an undilated pupil

• Document as “PCIOL”

Lens

Pseudoexfoliation (PXF)

• Deposits of unknown material appearing on lens and iris

Lens

Subluxated IOL

• IOL that has fallen down

• Document as “Sublux. IOL”

• Misc. – a dislocated lens may not be visible since will be in PC

Lens

Aphakic

• Without a lens• Through a peaked

pupil, you can see there is no lens edge

Lens

Posterior Capsule Opacity (PCO)

• Scar tissue that forms after PEIOL

• Document as “PCO”

Lens

Yag Capsulotomy

• Done to make opening in PCO

• Might not be seen fully til eye is dilated

• Note if open or closed• Document as “Yag

open”

Lens

Feathering

• Opacity on posterior capsule, S/P PPVx/F-Gx

• Caused when gas hits lens surface

Lens

ACIOL

• Can be seen without dilation

• Document as “ACIOL”

Lens

Mature Cataract

• Can often be seen without use of the slit lamp

• Document as “white NS”

Lens

Elshnig’s Pearls

• Cystic growth of lens epithelial remnants

• Usually S/P PEIOL

Misc.

Misc.

Scleral Thinning

• Usually noted by a bluish tint to sclera

• Document as “Scleral thinning”

Misc.

Translucent Sclera (albinism)

• Lack of pigment• Sometimes more

than others