Optometry Course OPT506: Slit Lamp Biomicroscopy 2
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Questions and Answers

What condition is characterized by abnormal additional eyelash lines?

  • Entropian
  • Trichiasis
  • Distichiasis (correct)
  • Madarosis

Which of the following is NOT a method of assessing the tear film?

  • Non-Invasive Tear Break-Up-Time (NIBUT)
  • Tear prism height
  • Schirmer test (correct)
  • Fluorescein staining

Which condition involves the inward turning of the eyelashes?

  • Entropian (correct)
  • Ptosis
  • Ectropian
  • Trichiasis

What is the primary focus when examining the meibomian glands during a visual examination?

<p>Identifying changes in the duct openings (D)</p> Signup and view all the answers

In a slit-lamp examination, which anatomical structure is evaluated LAST?

<p>Crystalline lens (C)</p> Signup and view all the answers

Which of the following structures is evaluated for hyperemia during a slit-lamp examination?

<p>Limbus (C)</p> Signup and view all the answers

What is observed when evaluating the bulbar conjunctiva?

<p>Pterygium and pinguecula (D)</p> Signup and view all the answers

During a slit-lamp examination, what is the difference between a parallelepiped and an optic section?

<p>Parallelepiped highlights surface location, optic section shows depth. (A)</p> Signup and view all the answers

Which part of the eye should be examined last during a thorough slit-lamp examination?

<p>Upper palpebral conjunctiva (B)</p> Signup and view all the answers

The presence of which feature on the palpebral conjunctiva may indicate chronic allergic reaction?

<p>Papillae (A)</p> Signup and view all the answers

What is the estimated angle range for a slit beam considered closed?

<p>10° (D)</p> Signup and view all the answers

During the OSCE, how many techniques must be performed within the 12 minutes procedure?

<p>Three basic techniques and two advanced techniques (D)</p> Signup and view all the answers

Which ratio indicates a higher likelihood of angle closure?

<p>Ratio 1 &lt; 0.25 (A)</p> Signup and view all the answers

What is one requirement during the OSCE regarding findings?

<p>No need to record findings at all (D)</p> Signup and view all the answers

What is the estimated angle range indicating that angle closure is likely?

<p>20° (B)</p> Signup and view all the answers

Which technique is NOT used in indirect illumination during a slit-lamp examination?

<p>Direct illumination (C)</p> Signup and view all the answers

What is the correct focusing requirement for an emmetrope during a slit-lamp examination?

<p>Within ±0.50D (D)</p> Signup and view all the answers

When assessing the anterior chamber angle during a slit-lamp examination, which illumination technique is primarily employed?

<p>Conical beam (C)</p> Signup and view all the answers

What is critical to maintain image focus while using a slit lamp?

<p>Moving the joystick slightly and keeping hands on it (B)</p> Signup and view all the answers

What should be done after decoupling the slit lamp?

<p>Couple the slit lamp again (A)</p> Signup and view all the answers

Which of the following structures is examined first when conducting a slit-lamp examination from outside to inside?

<p>Lid margins (C)</p> Signup and view all the answers

How should the illumination arm be moved during an anterior eye assessment?

<p>From temporal to nasal (C)</p> Signup and view all the answers

What is the recommended action after a slit-lamp examination to maintain cleanliness in the examination area?

<p>Wipe down the slit lamp and leave the bay tidy (A)</p> Signup and view all the answers

What is the main purpose of using a parallelepiped in corneal assessment?

<p>To analyze surface texture and wettability (B)</p> Signup and view all the answers

What causes microcysts formation in the corneal epithelium?

<p>Oxygen deficiency leading to metabolic suppression (B)</p> Signup and view all the answers

How is corneal edema characterized at 12% swelling?

<p>Striae and folds together with other features (B)</p> Signup and view all the answers

Which term describes vertically running densifications in the stromal tissue?

<p>Striae (C)</p> Signup and view all the answers

What does Van Herick's grading primarily evaluate?

<p>Depth of the anterior chamber (A)</p> Signup and view all the answers

What causes guttata formation in the endothelium?

<p>Metabolic shock and pH shift (B)</p> Signup and view all the answers

Which of the following findings would indicate the presence of excessive corneal swelling?

<p>Presence of streaking and foggy vision (A)</p> Signup and view all the answers

Which examination method helps detect changes in the endothelium layer?

<p>Specular reflection (B)</p> Signup and view all the answers

What distinguishes Descemet's folds from striae?

<p>Descemet's folds are fine, horizontal lines, striae are vertical densifications (D)</p> Signup and view all the answers

Which finding correlates with chronic hypoxia in the endothelium?

<p>Polymegathism (D)</p> Signup and view all the answers

Flashcards

Ptosis

drooping of the upper eyelid

Entropian

Turning inward of the eyelid margin

Ectropian

Turning outward of the eyelid margin

Distichiasis

An abnormal, additional row of eyelashes

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Trichiasis

Eyelashes turning inwards towards the eye

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Direct illumination

A technique in slit-lamp biomicroscopy where light is focused on the cornea to assess its shape, clarity, and surface irregularities.

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Sclerotic scatter

A technique in slit-lamp biomicroscopy where light is scattered from the sclera, allowing for visualization of the anterior chamber angle.

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Retro illumination

A technique in slit-lamp biomicroscopy where light is directed from behind the eye, allowing for visualization of the retina and optic nerve.

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Conjunctiva

The outermost layer of the eye, responsible for protecting the inner structures.

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Cornea

The transparent front part of the eye that allows light to enter.

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Anterior chamber

The space between the cornea and the iris, filled with a clear fluid.

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Iris

The colored part of the eye that controls the size of the pupil.

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Crystalline lens

The lens behind the iris that focuses light onto the retina.

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Pinguecula

A common eye condition, usually appearing as a yellowish bump on the white part of the eye (sclera) closer to the cornea. It's a harmless growth caused by thickened conjunctiva.

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Pterygium

Similar to a pinguecula but extends onto the cornea itself. This growth may affect vision and require treatment if it becomes too large.

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Conjunctival Hyperemia

Redness or inflammation of the conjunctiva, the thin membrane covering the white part of the eye and the inside of the eyelids.

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Limbal Injection

A specific type of conjunctival hyperemia, where the redness is localized around the limbus (the border between the cornea and the sclera).

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Optic Section

A technique used during slit-lamp examination to view the cornea in cross-section. This helps to precisely locate the depth and position of any corneal abnormality.

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Parallelepiped Examination

A technique used to assess the cornea's surface texture, wettability, and mobility of the tear film. It helps detect scars, irregularities, and particles within the tear film.

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Optic Section Examination

A technique used to assess the cornea's curvature and thickness. It helps determine the depth of changes and scars.

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Specular Reflection Examination

A technique used to detect changes in the endothelium layer of the cornea.

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Microcysts

Small fluid-filled sacs within the corneal epithelium, often caused by oxygen deficiency.

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Vacuoles

Small fluid-filled areas within the corneal epithelium, often caused by epithelial edema, trauma, or inherited dystrophy.

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Corneal Stroma Oedema

A condition characterized by fluid accumulation between the cells of the corneal stroma, causing vision disturbances.

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Striae

Vertically oriented densifications in the corneal stroma, often caused by fluid accumulation. They are not branched and therefore are distinct from nerve fibers.

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Descemet's Folds

Horizontal, evenly spaced, fine, whitish lines within the cornea. They are often double-contoured and a sign of corneal edema.

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Polymegathism

A condition characterized by altered shape and size of endothelial cells, common in chronic hypoxia.

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VanHerick's Grading

A technique used to assess the anterior chamber depth, which is the space between the cornea and iris.

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What is the angle of the anterior chamber?

The angle between the iris and the cornea. It is considered open when the angle is 35-45 degrees, moderate when 20-35 degrees, narrow when 20 degrees, very narrow when 10 degrees and closed when the angle is less than 10 degrees, blocking the flow of aqueous humor.

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What is angle closure?

A condition that occurs when the angle between the iris and the cornea narrows, blocking the flow of aqueous humor and increasing the pressure inside the eye.

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What is a narrow angle?

A narrow anterior chamber angle that is at increased risk of angle closure.

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What is gonioscopy?

A technique used to assess the anterior chamber angle by shining a light into the eye and observing the reflection of light.

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What is a gonioscope?

An instrument used to perform gonioscopy.

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Study Notes

Lecture Recording Information

  • The lecture is being recorded as part of Plymouth University's Content Capture Project
  • The recording will be available via the Panopto block on the module DLE pages
  • Students can ask questions during the lecture
  • Comments may appear on the recording
  • Option to pause the recording if a question is posed that the lecturer doesn't want on the recording

Optometry Skills - Slit Lamp Biomicroscopy 2

  • Course Code: OPT506
  • Lecturer: Dr. Asma Zahidi
  • One-time code: HC-YK-UK

Practical Session Feedback

  • Wipe down the slit lamp
  • Focusing: ±0.50D emmetropic/fully corrected
  • Use joystick to focus on different structures
  • Maintain image focus by keeping hand on joystick
  • Use both hands to operate the slit lamp
  • Couple the slit lamp after decoupling
  • Leave the bay tidy

Slit Lamp Examination Flowchart

  • White light: Lid, margins/eyelashes, tears/tear film, Conjunctiva (Bulbar, Palpebral), Limbus, Cornea, Anterior chamber, Iris, Crystalline lens
  • Blue light + NaFl: Tears/tear film, Cornea, Conjunctiva (Bulbar, Palpebral)

Assessment of the Tear Film

  • Non-invasive methods:
    • Tear prism height
    • Non-invasive Tear Break-up Time (NIBUT)
    • Lipid layer evaluation (pages 109-110)

Assessment of the Conjunctiva

  • White light:
    • Bulbar (lumps/bumps, pinguecula, pterygium, hyperemia)
    • Limbus (hyperemia, limbal injection)
    • Palpebral (*leave upper palpebral conjunctiva after instilled NaFl - lumps/bumps (papillae, concretions))

Parallelepiped vs. Optic Section

  • Parallelepiped: Location on the surface of the eye
  • Optic section: Depth/layer of the eye

Assessment of the Cornea

  • Parallelepiped (medium mag):
    • Examines cornea texture and precorneal tear film
    • Identifies scars, irregularities, and tear film mobility post-blink
  • Sclerotic scatter: Identifies scars, deposits, edema, and abnormal scattered light
  • Optic section (medium/high mag): Assesses the curvature, thickness, and depth of changes/scars on the cornea
  • Specular reflection: Detects changes in the endothelium layer

Epithelium - Microcysts and Vacuoles

  • Microcysts: Caused by oxygen deficiency inducing metabolism suppression
  • Vacuoles: Caused by epithelial edema, superficial keratitis, trauma, or inherited epithelial dystrophy
  • Differential: Microcysts have opposite refraction, vacuoles have concurrent refraction

Stroma - Oedema

  • Cause: Fluid accumulation between cells
  • Findings: Subjective (streaking, foggy vision, fluctuations) and objective (classification using striae and Descemet folds)
  • Levels: 0% (no striae), 5% (single striae), 7% (several striae), 12% (striae & folds), 16% (striae, folds, microcysts, vacuoles)

Stroma - Striae

  • Vertically running densifications in the stromal tissue without ramification (delimitation to nerve fibre)

Stroma - Descemet's folds

  • Horizontal, evenly spaced, fine, whitish lines with double contours

Endothelium

  • Key features: Polymorphism, Polymegathism, Bleps, Guttata

Anterior Chamber Assessment

  • Assessment method using Van Herick's grading (Grade 4-0)

Iris Assessment

Crystalline Lens Assessment

OSCE 1 - Summative

  • Assigned to a bay: Students are assigned a specific area
  • Assessor: An assessor is at the student's bay
  • Fellow student: Serves as a patient
  • 1 minute reading time: For instructions
  • Instruction sheet: Contains 5 techniques to perform
  • One eye: Students perform the techniques on one eye only
  • Eye selection: The assessor will inform the student which eye to use

OSCE Station 1

  • Duration: 12 minutes
  • Techniques: 3 basic, 2 advanced
  • Communication: Explain each step
  • Observation: Clearly show the technique and targeted structures
  • Recording: No recording of findings is necessary

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OPT506 - L02 - Slit Lamp Biomicroscopy 2 2024-25 Updated PDF

Description

This quiz focuses on the practical skills necessary for slit lamp biomicroscopy as covered in the Optometry course OPT506. Students will be assessed on their understanding of the examination flowchart and practical session feedback. Key components include proper handling and operation of the slit lamp and attention to detail during examinations.

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