Ординатура / Офтальмология / Английские материалы / The Slit Lamp Primer_Ledford, Sanders_2006

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68 Chapter 5

*Adapted with permission from Stein HA, Cheskes AT, Stein RM. The Excimer: Fundamentals and Clinical Use. Thorofare, NJ: SLACK Incorporated; 1995.

•edema (see Figure 5-3) – using a narrow beam, the corneal section looks larger/thicker than usual. The surface may appear to have bubbles or folds. Cornea may look cloudy.

Doc: note, describe location (epithelial or stromal), grade (Table 5-3), draw

•filaments – tiny spiral strands that are attached at one end to the corneal epithelium. They stain with fluorescein or rose bengal.

Doc: note, give location, estimate number, draw

•Fleischer ring – an epithelial iron ring that is incident with the base of the corneal cone in keratoconus; best viewed with red-free filter.

Doc: note, draw

•foreign body – anything that does not naturally belong on/in the cornea.

Doc: note, identify (if possible), give location, draw

•ghost vessels – abnormal corneal vessels that have subsided (ie, are no longer filled with blood).

Doc: note, give location by the clock, draw

•guttata (Figure 5-10) – tiny brown dots on back surface of cornea, generally concentrated centrally and in a uniform pattern. Appear as holes when using specular reflection.

Doc: note, grade 1+ to 4+

•Hudson-Stahli line – a thin, black, horizontal iron line on the corneal epithelium at the approximate place where the upper and lower lids meet when the eye is closed; nicely viewed with red-free filter.

Doc: note, draw

•infiltrates (Figure 5-11) – whitish “cloud” within the corneal tissue, under the epithelium, often surrounding an ulcer or foreign body. They are actually white blood cells that have entered the cornea to fight infection. If they do not stain, they are not infections and thus termed “sterile.” If there is stain, then they are associated with infection.

Doc: note, draw

• iron lines – thin black line(s) on the corneal epithelium. Nicely viewed with red-free filter.

Slit Lamp Findings 71

Figure 5-15. Pterygium. (Photo by Val

Sanders.)

Figure 5-16. Corneal ulcer. (Photo by

Val Sanders.)

•rust ring – rust stain on epithelium (may be lower layers as well) surrounding a metallic foreign body or remaining after removal of a metallic foreign body.

Doc: note, measure, give location, draw

•scar – an opacity caused by injury to corneal layers below the epithelium.

Doc: note, measure, give location, draw

•striae (See Figure 5-8) – these are wrinkles on the back surface of the cornea. Common after surgery, not seen if IOP is high (pressure presses them out).

Doc: note, grade 1+ to 4+

•ulcer (Figure 5-16) – appears as round, whitish, hazy area. Stains with fluorescein. May be surrounded by white blood cells in the stroma (infiltrates).

Doc: note, give location, measure, draw, note presence of infiltrates and/or discharge

•vascularization (neovascularization; Figure 5-17) – growth of abnormal blood vessels into/onto cornea. There are normal vessels at the limbus; usually these loop back into the conjunctiva. Abnormal vessels usually branch (do not loop) and extend further out into the cornea than the normal vessels.

Doc: note, give location by the clock, draw, grade (Table 5-4)

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Corneal Staining (Figure 5-18, Table 5-5)

•abrasion – injured area that stains, may be fine linear scratches or large area with irregu- lar-shaped borders.

Doc: note, describe, location, draw

•bullae – blisterlike bubbles on cornea. If they stain, they have broken through.

Doc: note, location, draw

•dendrite (Figure 5-19) – tree-branch area of staining typical of Herpes simplex.

Doc: note, draw

•dry spots (Figure 5-20) – larger stained areas, usually have smooth edges, may be one or several. Use rose bengal or fluorescein.

Doc: note, location, number, draw

• punctate epithelial erosion (PEE) or superficial punctate keratopathy (SPK)

(Figure 5-21) – tiny dots of stain. May look like spatter paint.

Doc: note, give location (inferior, interpalpebral, superior), describe pattern (localized, scattered, diffuse), comment on number (do not count, just write “few,” “dense,” etc), grade 1+ to 4+

Figure 5-22. Narrow angle (note lack of shadow interval). (Photo by Val Sanders.)

•stained area – good junk term for corneal staining that you cannot identify.

Doc: note, location, comment on pattern, draw

•tear film – the tear film (with fluorescein) should spread smoothly over the cornea with each blink, not bead up as on a freshly-waxed car. (See Chapter 3 on break up time.)

Doc: note if decreased BUT

•ulcer (See Figure 5-16) – usually a roundish area of staining associated with infection (virus, bacteria, or fungus). May be surrounded by infiltrates.

Doc: note, give location, measure, draw, note presence of infiltrates and/or discharge

Note: corneal staining related to contact lens wear is discussed in Chapter 9.

Anterior Chamber and Angles

• angle opening- see Chapter 3.

Doc: graded 1+ to 4+ (Table 5-6) or merely termed “open,” “narrow” (Figure 5-22), or “closed”

•cell(s) – blood cells floating free (circulating, actually) in the aqueous. They are associated with inflammation and are commonly seen after surgery or trauma. They are very tiny and look like dust particles in the sunlight. These are moving targets!

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