Biomicroscopy of the conjunctiva using a slit lamp. Biomicroscopy technique. Possible complications after biomicroscopy

Biomicroscopy of the eye is an objective method of studying the structures of the eye, which is carried out with a special device - a biomicroscope (slit lamp). Using this method, you can examine the elements of the anterior and posterior sections of the eyeball (learn about the eyeball).

Device structure

The biomicroscope consists of a lighting system, which is a light source, and a microscope for two eyes.

The light from the lamp passes through a slit-shaped diaphragm, after which it is projected onto the cornea or sclera in the form of an oblong rectangle. The resulting optical section is examined under a microscope. The doctor can move the light slit to those elements that need to be examined.

Indications and contraindications

For the pathology of what eye structures is biomicroscopy indicated?

• Conjunctiva (conjunctivitis, formations)
• Corneas (inflammation, dystrophic changes).
• Sclera.
• Irises (inflammation, structural abnormalities).
• Lens.
• Vitreous body.

These techniques are also used for cataracts, glaucoma, the presence of foreign bodies in the eye, at the stage of preparation for eye surgery and in the postoperative period.

There are no absolute contraindications to this diagnostic procedure. The procedure should be rescheduled if the patient has an exacerbation of mental disorders or is intoxicated.

Methodology

First, the patient is prepared - drops are instilled into the eyes to dilate the pupil (if it is necessary to examine deep structures), or special dyes (in cases where it is necessary to diagnose corneal pathology).

The patient places his head on a special stand that has supports for the forehead and chin. The doctor stands opposite the patient and moves the microscope and lamp to the patient’s eye level. Using diaphragms, the size and shape of the light slit is adjusted (usually in the form of a rectangle, less often in the form of a small circle). Light rays are directed to the eye structures being examined, after which they are examined in detail.

By examining the cornea, you can detect foci of opacities, infiltrates, and newly formed vessels. The biomicroscopy procedure allows you to clearly examine the lens, as well as identify the localization of pathological changes. This method allows you to examine the blood vessels of the conjunctiva.

Also, using a biomicroscope, you can evaluate the sphericity and specularity of the cornea, determine its thickness, as well as the depth of the anterior chamber of the eyeball.

There are several lighting options during this diagnostic procedure:

• direct focused illumination - light is directed to the area of ​​the eye being examined. This is how the transparency of the optical media of the eyeball is assessed;
• indirect focused light - light rays are directed near the area under study, as a result of which it is possible to better examine pathological changes due to the contrast of the illuminated and unlit area;
• reflected light - this is how certain structures (for example, the cornea) are examined by light reflected from other elements (the iris), as from a mirror.

Recently, ultrasound biomicroscopy of the eye has become increasingly popular, thanks to which it is possible to examine the lateral sections of the lens, the posterior surface and section of the iris, and the ciliary body.

Also find out how other examinations are carried out by an ophthalmologist, for example, measuring pressure in the eyes and is it scary? Read

To learn more about eye diseases and their treatment, use the convenient site search or ask a specialist a question.

Biomicroscopy of the eye is a method of non-contact examination of the structures and media of the eye, it allows you to painlessly identify eye diseases and pathologies. In the diagnostic process, a special ophthalmological microscope (slit lamp) is used, which is combined with a lighting device. The slit lamp allows you to examine at multiple magnification all the components of the structure of the anterior segment of the eye: eyelids, conjunctiva, lens, etc.

What diseases can biomicroscopy detect?

Ophthalmologists prescribe examinations to their patients using biomicroscopy if they suspect the development of various pathologies of the organ of vision. Diagnostics allows us to identify eye diseases even in the initial stages.

Diseases that can be detected using a slit lamp:

• Conjunctivitis.
• Swelling, tumors, inflammation and other abnormalities of the eyelids.
• Glaucoma.
• Pathologies of the iris: inflammatory diseases, as well as structural defects.
• Endocrine diseases.
• Diseases of the cornea and sclera: scleritis, keratitis, structural pathologies.
• Injuries of various types.

Biomicroscopy can also detect a foreign body in the cornea. The procedure is shown before and after eye surgery to monitor the result. The diagnosis has virtually no contraindications; it is not carried out only for those patients who behave inappropriately, are intoxicated or under the influence of drugs.

How is biomicroscopy performed?

Biomicroscopy of the lens does not require any preliminary preparation from the patient. In case of examination using a slit lamp of the vitreous body or lens, tropicamide is instilled 15 minutes before diagnosis: for adults 1%, and for children under 6 years of age with a 0.5% solution.

If the indications for examination are injuries or inflammatory diseases of the cornea, then the eye is stained with a solution of fluorescein or rose bengal. The substance is instilled into the cavity of the conjunctiva, and then washed with eye drops - this manipulation allows you to wash off excess paint from undamaged areas, as well as color the affected areas of the epithelium. Lidocaine is instilled into the eyes if biomicroscopy is performed before surgery to remove a foreign body.

The room where the diagnostic procedure will be performed must be dark. The microscope is placed on a special table with a head stand. The patient should sit at the table, placing his chin on the stand, his forehead should be pressed against the crossbar. The ophthalmologist sits on the other side of the alkaline lamp. The doctor will set the position most convenient for a detailed examination, adjust the width of the light beam, as well as its brightness, and begin the examination through a microscope.

During diagnosis, the doctor can use various types of lighting, this makes it possible to detect even the slightest pathological changes in the tissues of the eye. It is possible to narrow the light beam to a thin slit or, conversely, expand it to a full circle that will illuminate the entire surface of the eye.

Important! The patient must sit still during the examination, cannot move his head, and blinking is not prohibited, but it is better to do this infrequently so as not to confuse the ophthalmologist.

Biomicroscopy takes a maximum of 10-12 minutes, it has no complications or severe side effects. Some patients may have an allergic reaction to solutions used during the preparatory period.

To do biomicroscopy of the eye lens, contact the President-Med medical centers

Biomicroscopy of the eye is a diagnostic method for examining the tissues and optical media of the eyeball by creating a sharp contrast between the unlit and illuminated areas. The examination is performed using a special device – a slit lamp.

Thanks to biomicroscopy, the ophthalmologist can evaluate the condition of the cornea, retina, anterior vitreous, lens and optic nerve head. In addition, such a study can be used to identify foreign bodies in the eyeball after injury.

In this article we will introduce you to the essence of this examination method and its varieties, indications, contraindications and methods of conducting eye biomicroscopy. This information will help you understand this diagnostic procedure, and you can ask your doctor any questions you may have.

The essence of the technique

Biomicroscopy of the eye is performed using a slit lamp. This apparatus includes a lighting device (6 V, 25 W bulb), a binocular stereoscopic microscope and a lens. To create lighting slits (vertical or horizontal), a slit diaphragm is installed in the device along the path of the lighting beam. The body of a binocular stereoscopic microscope contains an optical system that allows you to magnify the image by 5, 10, 18, 35 or 60 times. A special diverging lens (60 diopters) is installed above the microscope, which allows you to examine the fundus of the eye. The study of the structures of the eye is performed in a dark room - thus creating a significant contrast between the illuminated areas of the eyeball and the darkened areas of the eyeball.

By focusing light on the cornea through an optical section, the doctor can examine the posterior and anterior surfaces of the area being examined and its substance. If cloudiness or an inflammatory focus is detected in the cornea, the specialist can determine the depth, location and extent of the pathological focus. In the same way, the doctor can detect foreign bodies.

After focusing the light on the lens, the specialist sees its optical section in the form of a transparent biconvex body. It defines the interface zones (oval stripes). When assessing the condition of the lens, the doctor may detect clouding (a sign of incipient cataracts).

By focusing light on the fundus of the eye, the condition of the retina and optic nerve head is studied. In this way, signs of nipple congestion, breaks in the central part of the retina and optic neuritis can be detected.

When studying the vitreous body, the doctor can identify signs of inflammatory and dystrophic processes in the form of fibrillar structures. In addition, during the study, the conjunctiva and iris are examined.

Objectives of the study

Using eye biomicroscopy, a doctor can evaluate:

• condition of the eyelids and conjunctiva;
• condition of the cornea: its thickness, structure, nature and area of ​​location of identified pathological changes;
• the condition of the fluid located in the anterior chamber of the eye (between the iris and cornea);
• anterior chamber depth parameters;
• condition of the iris;
• condition of the lens;
• condition of the anterior part of the vitreous: its transparency, opacities, presence of blood or deposits.

Varieties

To perform eye biomicroscopy, various lighting options can be used:

• direct focused light - to assess the transparency of optical media and identify areas of turbidity;
• reflected light - to identify foreign bodies or detect edema;
• indirect focused light - for a more detailed examination of the various detected changes;
• indirect diaphanoscopic transillumination - to determine the exact localization of pathological changes.

Indications

Biomicroscopy of the eye can be used to diagnose the following pathologies:

• diseases of the conjunctiva of various origins (cysts or tumors caused by inflammatory processes);
• inflammation, trauma, swelling and tumors of the eyelids;
• scleral pathologies: structural anomalies, keratitis, corneal dystrophy, scleritis, etc.;
• inflammatory processes and structural abnormalities of the iris;
• glaucoma;
• corneal foreign bodies;
• various injuries;
• , giving complications to the organs of vision.

In addition, eye biomicroscopy is performed to assess the effectiveness of treatment, prepare for surgical operations and analyze the results of already performed interventions.

Contraindications

Biomicroscopy of the eye has virtually no contraindications. Such a study cannot be performed only in the following cases:

• severe forms of mental illness;
• alcohol or drug intoxication.

How the research is carried out

Biomicroscopy of the eye can be performed in a specially equipped office of an ophthalmologist. Preparing the patient for such a study is not required.

Depending on the purpose of the examination, the patient may undergo the following procedures:

1. If necessary, study the condition of the lens or vitreous body. 15 minutes before the procedure, to maximize pupil dilation, Tropicamide solution is instilled into the eyes (adults - 1%, children under 6 years old - 0.5% solution).
2. When examining the cornea. A fluorescein dye solution is instilled into the eye being examined. After this, the dye is washed off with drops and an inspection is carried out. If the integrity of the cornea is violated, residues of the dye solution are detected in areas of its damage.
3. If necessary, remove a foreign body. To perform surgery, a solution of local anesthetic (Lidocaine) is instilled into the eye before the examination. Before carrying out such operations, the doctor must make sure that there is no allergic reaction to the drug used.

The eye biomicroscopy procedure is performed in the following sequence:

1. The patient sits opposite the doctor and places his chin on a special stand, and rests his forehead against a special bar. During the examination, he must remain still and try to blink as little as possible. If the examination is carried out for a child under 3 years of age, then the procedure is recommended in a state of deep sleep or in a horizontal position.
2. The specialist sets up a slit lamp and examines the necessary structures of the eye. The required lighting option is used for each part of the eyeball.

The duration of eye biomicroscopy is about 10 minutes.

Which doctor should I contact?

Biomicroscopy of the eye can be prescribed by an ophthalmologist for various eye diseases, to remove a foreign body or evaluate the effectiveness of treatment. If necessary, the doctor may recommend other diagnostic procedures:

• measurement of intraocular pressure;
• ophthalmoscopy;
• gonioscopy;
• OCT (optical coherence tomography), etc.

Biomicroscopy of the eye is a simple, accessible and non-invasive research method that allows you to diagnose many ophthalmological pathologies. Thanks to this technique, the doctor can study in detail the condition of the cornea, lens, retina, optic nerve, vitreous body, eyelids, conjunctiva and iris. In addition, this diagnostic method helps ophthalmologists remove foreign bodies from the cornea. The examination takes no more than 10 minutes and does not require special preparation of the patient.

Ophthalmologist Yakovleva Yu. V. talks about eye biomicroscopy:

Slit lamp biomicroscopy - how to do it:

Modern medicine offers various ways to diagnose health. One of them is eye biomicroscopy. What is this research method and what is it used for? Let's try to figure it out further.

Shulpina N.B. described in detail the biomicroscopy of the eye. back in 1966. She devoted an entire book of the same name to this type of research. Many ophthalmologists still use it to improve the quality of diagnostic, preventive, and therapeutic work. In general, the procedure looks like this:

1. The patient sits in a specially designated seat opposite the doctor.
2. The specialist directs a beam of light from a slit lamp onto the person's eye.
3. Thanks to high-quality lighting using a microscope, an ophthalmologist examines the visible part of the eye for various types of abnormalities and pathological changes.
4. If the patient has increased sensitivity of the eyes to light, then the doctor uses special drops with an anesthetic.
5. When the method needs to be used on a child under 3 years of age, the specialist first puts the baby into a state of sleep. The study takes place when the child is in a horizontal position.

The slit lamp is a special device used for qualitative diagnostics of eye health. With its help, it is possible to examine in sufficient detail the iris, eyelids, conjunctiva, lens, sclera, and also the cornea. The light from the slit lamp is highly focused and is adjusted by a specialist. For example, biomicroscopy of the anterior segment of the eye using a slit lamp is as painless, safe and effective as possible.

Ultrasound and its features

One of the types of eye health diagnostics is ultrasound biomicroscopy of the eye, which is abbreviated as UBM. This diagnostic method allows you to visualize with maximum accuracy the most subtle and inaccessible structures of the front part of the eye. Note that this is not available for classical biomicroscopy, as well as for gonioscopy. Let us note that with the help of this diagnosis it is quite possible to give an accurate assessment of the following anatomical features of the eye:

• iris;
• ciliary body;
• angle of the anterior chamber of the eye;
• equatorial region of the lens;
• functional interaction of the listed elements with each other.

UBM as a specific diagnostic method appeared relatively recently in our country - approximately in the 90s. This is precisely the reason for the small amount of information about UBM in the domestic literature.

Common varieties

Biomicroscopy of the eye media has a number of varieties, which are mainly influenced by the type of light supplied by the slit lamp. Let's look at these varieties and their features further:

1. Indirect focused light. In this case, the directed beam of light is focused not where the area of ​​interest to the specialist is directly localized, but next to it. This method allows, using the resulting contrast, to track possible changes in individual elements of the eye and assess their health.
2. Direct focused light. Classic diagnostic option. With it, a beam of light is directed to a specifically selected area of ​​the eye (eyeball) by the doctor. The method provides a good analysis of the transparency of optical media, as well as detection of possible darkening or clouding in the illuminated area.
3. Indirect diaphanoscopic transillumination. With this type of research, using the same rays, “mirror” areas are formed in areas bordering optical media. This phenomenon occurs due to different refractive indices of light. Thanks to such diagnostics, it is possible to quickly identify the localization of changes in the eye.
4. Reflected light. With this method of testing, a directed beam of light is reflected from the iris. The method is used if the doctor needs to identify swelling or detect a foreign body.

The duration of exposure and study is on average the same in all these cases. After certain complaints or existing results, the doctor independently selects a diagnostic method.

Advantages of biomicroscopy

Biomicroscopy of the eye is a high-quality, time-tested diagnostic method. What advantages does it have?

1. Checking the health of the optic nerve.
2. High accuracy in determining the localization of changes in the eye.
3. Diagnosis of the choroid.
4. The ability of light to penetrate at different angles, breaking through the transparent tissues of the eye.
5. The ability to examine the eye even at considerable depth.
6. Qualitative diagnosis of pathological changes in the retina.
7. By using a special diverging lens, it is possible to neutralize the optical system of the eye and perform biomicroophthalmoscopy.
8. The ability to make a so-called optical cut due to the fact that the light can be directed both horizontally and vertically.

Biomicroscopy of the eye was a common type of health diagnostics back in the Soviet Union. Today, slit lamps have undergone global modernization and are equipped with various advanced capabilities. Despite the high quality of diagnostics, its cost remains quite reasonable and averages about 700 rubles.

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Developer: Medelit Studio, KSMU 2006

Biomicroscopy- This is intravital microscopy of eye tissue, a method that allows you to examine the anterior and posterior parts of the eyeball under different lighting and image sizes.

The study is carried out with using a special device- a slit lamp, which is a combination of a lighting system and a binocular microscope (Fig. 1).

Rice. 1. Biomicroscopy using a slit lamp.

Thanks to the use of a slit lamp, it is possible to see the details of the tissue structure in the living eye.

The lighting system includes a slit-shaped diaphragm, the width of which can be adjusted, and filters of various colors. A beam of light passing through the slit forms a light slice of the optical structures of the eyeball, which is viewed through a slit lamp microscope. By moving the light slit, the doctor examines all the structures of the anterior part of the eye.

Patient's head placed on a special slit lamp stand with support for the chin and forehead. In this case, the illuminator and microscope are moved to the patient’s eye level.

The light slit is alternately focused on that tissue eyeball which is subject to inspection. The light beam directed at translucent fabrics is narrowed and the light intensity is increased to obtain a thin light slice.

In an optical section of the cornea, you can see foci of opacities, newly formed vessels, infiltrates, assess the depth of their occurrence, and identify various tiny deposits on its posterior surface. When examining the marginal looped vascular network and the vessels of the conjunctiva, one can observe the blood flow in them and the movement of blood cells.

With biomicroscopy It is possible to clearly examine the different zones of the lens (anterior and posterior poles, cortex, nucleus), and if its transparency is impaired, determine the localization of pathological changes.

Distinguish four methods of biomicroscopy depending on the nature of the lighting:

- in direct focused light when the light beam of a slit lamp is focused on the area of ​​the eyeball being examined. In this case, it is possible to evaluate the degree of transparency of optical media and identify areas of opacification;

- in reflected light. This way you can examine the cornea in rays reflected from the iris when searching for foreign bodies or identifying areas of swelling;

- in indirect focused light, when the light beam is focused near the area under study, which makes it possible to better see changes, thanks to the contraction of strongly and weakly illuminated areas;

- with indirect diaphanoscopic transillumination, when luminous (mirror) zones are formed at the interface between optical media with different refractive indices of light, which makes it possible to study tissue areas near the exit point of the reflected beam of light (studying the angle of the anterior chamber).

With the specified types of lighting You can also use two methods:

- carry out grazing beam research(when the handle of a slit lamp moves a light strip across the surface left and right), which makes it possible to detect unevenness in the relief (corneal defects, newly formed vessels, infiltrates) and determine the depth of these changes;

- perform research in a mirror field, which also helps to study the surface topography and at the same time identify irregularities and roughness.

Use when biomicroscopy Additionally, aspheric lenses (such as Gruby lenses) make it possible to perform ophthalmoscopy of the fundus (against the background of drug-induced mydriasis), identifying subtle changes in the vitreous body, retina and choroid.

Modern design and devices of slit lamps also make it possible to additionally determine the thickness of the cornea and its external parameters, evaluate its specularity and sphericity, and also measure the depth of the anterior chamber of the eyeball.