Objective 4a Basic Slit lamp exam

Question 1

What are the first 4 steps in the slit lamp exam?

Answer 1

1. wash hands
2. clean chin and head rest with alcohol swab
3. Properly position the patient at the slit lamp
4. Place the illumination arm and microscope in the straight ahead position.

Question 2

What are steps 5-11?

Answer 2

5. Place hand in front of the light and make the narrowest slit possible or focus on the limbus then move the beam on to the cornea
6. Hold the joystick to focus
7. Always keep two hands on the slit lamp
8. Do an overall sweep with diffuse illumination, check the lids and lashes
9. Proceed parallelepiped
10. Do a general survey, observe the tear film and the entire cornea
11. Narrow for an optic section and sweep across the cornea

Question 3

Step 12 and 13 are:

Answer 3

Looking at the layers of the tear film and cornea, and estimate the depth of the anterior chamber angle.

Question 4

Steps 14-17

Answer 4

14. Perform a sclerotic scatter illumination
15. Survey the lids, conjunctiva and blood vessels
16. Check under the lids for hyperemia, raised papillae or GPC
17. Check the anterior chamber for flare using an optic section

Question 5

The last steps 18-21:

Answer 5

18. Examine the iris for defects and check integrity of the pupil
19. Focus through the crystalline lens to its back surface to check for opacities
20. Instil fluorescein, do a general survey. look for corneal and conjunctiva staining
21. If dryness is suspected do a tear break up time test.