Advanced Slit Lamp Techniques
Learning Objectives
By the end of this lecture, you should be able to:
1. Use different slit-lamp illumination methods to view specific ocular structures.
2. Apply an appropriate slit-lamp examination routine.
3. Understand the advantages and uses of clinical grading scales.
4. Evaluate the anterior chamber using van Herick’s grading and percentage
estimation.
5. Detect and assess corneal staining using fluorescein and correct illumination.
Improving Your Slit-Lamp Technique
● Think like a photographer – optimize lighting and magnification for clarity.
● Important signs can be missed if illumination, focus, or angles are incorrect.
Common Errors
Error Why it’s a problem
Patient not positioned correctly Poor alignment → distorted view
Eyepieces not focussed Causes eyestrain and blurred images
- Can over accommodate when focusing
eyepieces = blurry
Beam narrowed without increasing Insufficient illumination
brightness
, Illumination arm angle fixed Must vary: wider angle for cornea, narrower for
lens
- The more anterior you go, the wider the
angle should be
Same magnification used throughout Should vary: low mag for overview, high mag for
detail
Basic Set-Up & Examination Routine
1. Focus eyepiece
2. Adjust for PD’s
3. Adjust chinrest for px
- Canthus should align with marker
4. Forehead rest
5. Table height
Lids & lashes
Conjunctiva
Cornea
Tear film
Eversion of eyelids
Anterior chamber
Angle of AC
Iris
Lens
Anterior vitreous
- This is the basic routine but if you see anything different in a specific structure, start with
that one first and then continue
1. Diffuse Illumination
● Purpose: General overview of anterior segment.
Learning Objectives
By the end of this lecture, you should be able to:
1. Use different slit-lamp illumination methods to view specific ocular structures.
2. Apply an appropriate slit-lamp examination routine.
3. Understand the advantages and uses of clinical grading scales.
4. Evaluate the anterior chamber using van Herick’s grading and percentage
estimation.
5. Detect and assess corneal staining using fluorescein and correct illumination.
Improving Your Slit-Lamp Technique
● Think like a photographer – optimize lighting and magnification for clarity.
● Important signs can be missed if illumination, focus, or angles are incorrect.
Common Errors
Error Why it’s a problem
Patient not positioned correctly Poor alignment → distorted view
Eyepieces not focussed Causes eyestrain and blurred images
- Can over accommodate when focusing
eyepieces = blurry
Beam narrowed without increasing Insufficient illumination
brightness
, Illumination arm angle fixed Must vary: wider angle for cornea, narrower for
lens
- The more anterior you go, the wider the
angle should be
Same magnification used throughout Should vary: low mag for overview, high mag for
detail
Basic Set-Up & Examination Routine
1. Focus eyepiece
2. Adjust for PD’s
3. Adjust chinrest for px
- Canthus should align with marker
4. Forehead rest
5. Table height
Lids & lashes
Conjunctiva
Cornea
Tear film
Eversion of eyelids
Anterior chamber
Angle of AC
Iris
Lens
Anterior vitreous
- This is the basic routine but if you see anything different in a specific structure, start with
that one first and then continue
1. Diffuse Illumination
● Purpose: General overview of anterior segment.
