The Slit Lamp Exam – in plain language for ED folk

14 Jan

This is the slit lamp:

slitlamp1

Don’t be afraid.

 

Use this instrument when thinking about the anterior segment of the eye (think corneal abrasion, foreign body, and iritis).

 

  1. Turn the machine on.
  2. Adjust the machine so the patient is comfortable (forehead against headrest, chin in chinrest, align the patient’s eye level with the mark on the headrest support rods)
  3. The light source is on the swinging arm. There are knobs to adjust the width and height of the light beam.
  4. Select 1x magnification, white light, max height, medium width. Start with the beam at the temporal side of the eye.
  5. Set the rheostat (controls the intensity of light) to the lowest setting possible that still allows you to see what you need to see.
  6. Scan across the upper lid, then back across the lower lid.
  7. Invert the lids and repeat step 6. This is the part where you are looking for foreign bodies.
  8. Check out the cornea– notice anything irregular?
  9. Now for the infamous cell and flare (sign of anterior uveitis). You may want to darken the room to optimize visualization. Plus, it will really make things more dramatic for you if you see the cell and flare. Make a small, narrow box with the light. Focus the beam from an extreme temporal angle.

Artistic interpretation:

slitlamp2

 

What you might actually see:

slitlamp3

Cells these are literally cells floating in the anterior chamber, WBC’s or RBC’s (“sparkles”)

Flare protein floating in the anterior chamber (“fog”)

 

  1. Switch to the blue light. Administer flourescein. Repeat the corneal exam, looking for corneal irregularities, which will light up.

 

slitlamp4

Submitted by K. Estes

 

References: Roberts: clinical procedures in emergency medicine (2009); Rosen’s Emergency Medicine. (2010); ACEP slit lamp skills lab, 2011 scientific assembly (http://webapps.acep.org/sa/Syllabi/SA-12.pdf)

Pictures: Slit lamp pic- Roberts: Clinical procedures in emergency medicine (2009); Space to look for c&f – Rosen’s Emergency Medicine. (2010); C&f – http://www.rootatlas.com/wordpress/video/209/cell-and-flare-photo/; Corneal abrasion – Rosen’s Emergency Medicine. (2010)

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One Response to “The Slit Lamp Exam – in plain language for ED folk”

  1. eyetechtips January 3, 2015 at 08:59 #

    Thank you for this great post 🙂
    I will add it to my posts and refer this site, thanks!
    http://www.facebook.com/eyetechtips

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