Biomicroscopy

Slitlamp biomicroscopy reveals shallow anterior chamber depth signs of previous attacks include peripheral anterior synechiae, iris atrophy, glaukomflecken, and pupillary dysfunction. 

Slit-lamp biomicroscopy (with dilated pupils)... 

A 59-year-old woman who for 20 years had taken chlorpromazine up to 1200 mg/day (mean dose 400 mg/day) gradually developed blurred vision in her left eye. Slit-lamp biomicroscopy showed multiple fine creamy-white deposits on her corneal endothelium and anterior crystalline lens capsule bilaterally. Microstructural analysis of the corneal endothelium showed that there were no abnormalities in cellular morphology resulting from these deposits. 

Aiso, smaii animai scanners that operate at frequencies beyond 40 MHz, thereby making US biomicroscopy (UBM) practicai, have recentiy become avaiiabie and tested in biomedicai US research. These scanners have aiso been used together with opticai coherence tomography, which measures iow-coherence opticai interferometry to obtain micron-scaie resoiution tomographic images of subsurface tissue. 

For routine examinations most clinicians dilate patients pupils only after most other examination procedures have been performed. Complete ocular and medical histories, visual acuities, external examination, pupillary examination, refraction, biomicroscopy, tonometry, and other routine evaluations precede instilling the mydriatic (Figure 20-1). This approach ensures that dilation does not interfere with the refraction, assessment of accommodation or binocularity, or any other refractive finding. In addition, the predilation examination procedures allow the clinician to identify any cautions or contraindications to dilation. In most routine cases ophthalmoscopy or fundus biomicroscopy is the only procedure remaining after dilation. After drops have been instilled for dilation, the patient may proceed to the reception area, the dilation room, or the dispensary for spectacle frame selection while the pupils dilate. While the patient s pupils dilate, the practitioner can examine the next scheduled patient. In 20 to 30 minutes, after all procedures except dilation have been performed on the second patient and the mydriatic drops instilled, the first... 

Pavlin CJ, Ritch R, Foster FS. Ultrasound biomicroscopy in plateau iris syndrome. Am J Ophthalmol 1992 13 390-395. 

The diagnosis of lagophthalmos or incomplete blink is usually made based on the patient s symptoms, slit-lamp examination, and gross observation during a blink. Patients usually complain of ocular irritation, which is worse upon awakening. Biomicroscopy reveals SPK over the inferior portion of the cornea or over the area of exposure. The patient should be asked to blink while at the slit lamp they should be closely examined outside of the slit lamp, which will often reveal the exposure or occasionally a femily member will confirm that the patient sleeps with his or her eyes open. 

With careful biomicroscopy examination, the most common findings in ABMD are gray chalky patches, intraepithelial microcysts, and fine lines, or a combination of these seen in the central two-thirds of the cornea. These findings are known as maps, dots, and fingerprints. These corneal changes may vary in appearance at each examination. 

Traditional examination alone may not always be adequate to diagnose or manage scleritis, to identify areas of early vascular closure (see Figure 28-6), to differentiate benign nondestructive scleritis from necrosis, or to adequately monitor the success of treatment. Although not readily available, high-frequency ultrasound biomicroscopy... 

Flurbiprofen, 100 mg three times daily, is a well-established first-line NSAID providing there is no evidence of vascular closure or scleral destruction on biomicroscopy. Flurbiprofen should provide pain relief within 2 days and improvement in clinical signs within 1 week. Indomethacin SR fiarmulation, 75 mg twice daily, is a well-established second-choice drug when flurbiprofen is not effective but has also been used as first line. NSAIDs that have shown efficacy and are now available in over-the-counter formulations include naproxen, 500 mg twice daily, and ibuprofen, 600 mg four times daily. If a simplified dosing schedule is a consideration, then pirox-icam, 20 mg/day, may be considered. Once effective control is established, a lower maintenance dose may suffice until the scleritis enters remission. To reduce the risk of gastrointestinal side effects, patients should be instructed to take NSAIDs with food or antacids. 

Biomicroscopy is critical in the uveitis assessment. It allows for accurate diagnosis as well as identification of potentially sight-threatening complications. The following structures and areas should be given special attention ... 

Biomicroscopy of the anterior segment typically reveals little in cases of intermediate uveitis, although occasionally a few spillover cells may be seen in the aqueous. Hallmark findings of anterior uveitis, such as conjimctival hyperemia, KPs, and iris nodules, are characteristically absent. Late-stage findings may include corneal band keratopathy, anterior and/or posterior synechia, and cataract (most commonly of the posterior subcapsular variety). 

Biomicroscopy of the anterior segment is often unremarkable in posterior uveitis. In cases of severe vitreitis, some spillover of inflammatory cells may be seen in... 

Patients presenting with a retinal detachment typically report an onset of flashing lights (photopsia) and floaters. Patients may also report decreased peripheral or central vision. Any patient presenting with these symptoms requires prompt dilation and a thorough examination of the central and peripheral retina. Slit-lamp biomicroscopy and indirect ophthalmoscopy with scleral depression are... 

Fluorescein angiography reveals subtleties in vasculature not readily apparent with ophthalmoscopy or fundus biomicroscopy. The two diseases most often evaluated angiographically are macular degeneration and diabetic retinopathy. 

Retropulsion of the globe (rules out orbital tumor) Biomicroscopy (evaluates corneal integrity/tear film/ superior limbic keratoconjimctivitis)... 

TeUo C, Tran HV, Liebmann J, Ritch R. Angle closure classification, concepts, and the role of ultrasound biomicroscopy in diagnosis and treatment. Semin Ophthalmol 2002 17 69-78. 

Baseline exam within the first year of using tamoxifen, including slit-lamp, fundus biomicroscopy, CV,Amsler,... 

Ultrasound biomicroscopy is helpful in assessing the angle, iris, and ciliary body to rule out anatomical pathology and secondary causes of elevated lOP. 

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