Instruments

in
Ophthalmology
Slit lamp Biomicroscopy

 Biomicroscope derives its name from

the fact that it enables the practitioner
to observe the living tissue of eye under
magnification.

 It
not only provides magnified view of
every part of eye but also allows
quantitative measurements and
photography of every part for
documentation.
PRINCIPLE

A "slit" beam of very bright light

produced by lamp. This beam is
focused on to the eye which is then
viewed under magnification with a
microscope
 Haag streit slit lamp biomicroscope
Zeiss slit lamp biomicroscope
 Operational components of slit lamp
biomicroscope essentially consist of:
 Illumination system ( light source ,
condensing lens , slit & diaphraghm ,
projecting lens , reflecting mirror & prism ,
filters )
 Observation system .
 Mechanical system ( Joystick , Fixation
target , Mechanical coupling ,
Magnification control , head positioning
farme , motorized base)It concern with
Positioning & adjustment of patient and
observer system together with joystick
Providing base to other parts .
 biomicroscope

Illumination control
Reflecting mirror

Chin rest

Light beam is controlled by

knobs

Joy stick arrangement

Topcon slit lamp model SL-3E

Associated instruments

 Applanation Tonometer ( next topic ) .

 Gonioscopic Lens ( for angle examination in
glaucoma )
 Fundoscopy Lens ( next topic )
 Micrometer Eyepieces
 Image archiving device
 Laser delivery system
 Uses of slit lamp biomicroscopy
 Diagnostic:  Procedures:
- Anterior - Applanation
segment& - Tear evaluation
posterior segment - Pachymetry
diseases
- Gonioscopy
- Dry eye
- Contact lens
 Therapeutic: fitting
- Laser
- FB removal
 Tonometry
 Goldmann applanation tonometry
It’s incorporated with the slit-lamp, the most
accurate .

Biprism
(measuring prism)

Feeder arm

Housing Control weight insert

Adjusting knob
Other Types
 Pneumotonometers ( air puff )
The central part of cornea is flattened by a jet of air , the time
required to sufficiently flatten it relates directly to the level of
IOP. Advantage are no need for topical anesthesia and it’s
useful for community screening but it’s major disadvantage
are only accurate with low-middle age and the jet of air can
startle the patient.
 Reichert ocular response analyzer
 Dynamic contour tonometry
 Perkins applanation tonometer
 Tono-Pen
 iCare
 Schiotz tonometer
 Other
Schiotz tonometer

Pneumotonometers

Tono-Pen
Other method
 Palpation Method/ digital tonometry
Intraocular pressure (IOP) is estimated by response of eye to
pressure applied by finger pulp.
 indents easily – low IOP
 Firm to touch – normal IOP
 Hard to touch – high IOP
Fundoscopy/Ophthalmos
copy
1- Direct Ophthalmoscope
 This instrument provides a
quick means for fundal
examination especially the
optic disc. It characterised by
the following o Magnified view
of the fundus about 15 times o
Limited field, only 6 degrees o
Image formed is erect o Can
be affected by refractive
errors of the patient o
Monocular no stereopsis ( 3D
image) .
2- Indirect Ophthalmoscope
It is composed of head mounted light source and a
condensing lens of either 20 or 30 dioptric power in front of
the eye being examined. Thus forming a real image
between the condensing lens and the observer.
Indirect Ophthalmoscope has
the following features:
o Magnification is less than that
obtained with the direct
ophthalmoscope ( 3-5 times
only)
o The field is larger about 25
degree
o Image is inverted and laterally
reversed
o The image is little affected by
refractive errors
o Binocular vision ( stereoscopic
view)
3- by Slit lamp
 a-with condensing lens Slit lamp can also be used to
examine the posterior segment (vitreous and retina) with the
use of high power condensing lens; 66, 78 and 90 dioptric
power. It is mainly to examine the central 30 degrees of
retina .
 b-For examining the peripheral retina we should
use a special lens called 3-mirrors lens

c-Hruby lens(-58 diopter)

d-Panfundoscopic lens

4-Fundus camera with or without fluorescein

angiography
5-ultrasound scan(A-scan/B-scan)
Visual Field Assesment
1- Confrontation test: subjective,
for detecting of peripheral
visual field defects .

2- Kinetic Method:
Goldman’s perimetry (
Kinetic because a target
with fixed illumination is
continuously moved until it
is no longer seen) mainly
for peripheral field defects
like Bitemporal
hemianopia,
homonymous hemianopia
 3- Static: Humphrey Field Analyser (the target is not
moving but its illumination intensity is changed until it
is no longer seen) mainly to detect central visual
field defects for e.g. in Glaucoma and Optic nerve
diseases

Scotoma : visual loss in an

area. *Absolute no vision
*Relative loss of vision
(depressed)