Paediatric Acute care Guidelines PMH Emergency Department
  • Enables detailed examination of the eye under bright light and magnification
  • Requires patient co-operation and size (generally > 3 years of age)
  • Used in assessing
    • Cornea: abrasion, ulcer, foreign body and removal
    • Anterior chamber: hyphema, anterior uveitis, hypopyon
    • Lens: dislocation

Slit Lamp

  • Turn on slit lamp
    • push white button on wall – automatic timer will switch off after 5 minutes
    • flip green switch at bottom left of slit lamp to turn on [A]
  • Position patient
    • chin on chinrest, forehead against white forehead strap
    • adjust chinrest height by twisting [B] under the left side of chinrest – set so that eye is at the level of the black line [C] – level of light beam
    • ask patient to look at your ear
  • Set eyepiece
    • adjust binocular position so that a single circular view is seen (push or pull apart)
    • focus eyepieces to ‘0’ by twisting binocular pieces [D] – if operator has refractive error, adjust as necessary
    • adjust magnification using lever under eyepieces [E] – start at 1x
    • hint: before looking through eye piece, move light unit up/down/left/right so that the light beam is centred on the patient’s eye
  • Set light beam brightness
    • move top black lever [F] to far right for bright or far left for less bright – no light will appear if lever is set in the middle
    • twist knob [G] located to the right of the joystick for further brightness control
    • hint: don’t start too bright as this is can be uncomfortable
  • Set light beam size
    • adjust slit length by moving lower black to the right [H]
    • adjust slit width by twisting knobs [I]
    • hint: start long and wide
  • Adjust angle of light beam by swinging mirror unit side to side
    • start close to straight on
  • Adjust light beam onto patient’s eye
    • push joystick [J] to move left and right
    • twist joystick [J] to move up and down
  • Focus image by moving joystick back and forth
    • start with joystick at the back (towards yourself) then move forward towards patient until cornea comes into focus
    • hint: if unable to focus, check that the patient’s forehead is still against forehead strap
  • Examine systematically from front to back including
    • eyelashes, eyelids, conjunctiva, cornea, sclera, anterior chamber, iris/pupil, lens
    • scan left and right with joystick, or ask patient to look left/right
    • move out and in to focus front to back
    • hint: when examining the upper sclera/cornea ask the patient to look down and to hold their upper lid open with a finger
  • Apply fluorescein to eye
    • change to blue light by pushing lower black lever [H] towards far left
    • repeat corneal examination looking for abrasions, foreign body, defects or ulcer
  • Examine the anterior chamber
    • use narrow slit by adjusting width knob [I]
    • angle the light beam by swinging unit to the side
    • use bright light by adjusting brightness [F] [G]
    • this allows you to see subtle findings of ‘floating dust’ or ‘stars’ from cells in the anterior chamber (blood or inflammatory) caused by hyphema or anterior uveitis.
  • Turn off the slit lamp [A]

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