Slit lamp examination

Opaque deposits in the cornea and lens may occur with chronic phenothi-azine treatment, especially with CPZ. Although visual acuity is not usually affected, periodic slit-lamp examinations are recommended with use of long-term phenothiazines. Baseline and periodic slit-lamp examinations are also recommended for quetiapine-treated patients because of cataract development and lenticular changes in animal studies. 

Various parts of the ophthalmological examination are shown in Table 20.14. The most important common ophthalmological test to evaluate patients for the occurrence of chronic drug-induced toxicity is slit-lamp examination. Specific types of drugs with known potential for ocular toxicity may require that special attention be directed to other evaluations shown in Table 20.14. Most drugs that are to be taken... 

Visual acuity tests, slit-lamp examinations, funduscopy and audiometry are recommended periodically in patients treated for prolonged periods of time... 

Rengstorff et al.2 applied 0.025 ml of a SX solution of CR 5 d/wk for 4 wk. The animals were kept under observation for 60 d. Instillation of the dally doses was followed by a brief period of blepharospasm (about 15 min), after which the eyes appeared to be normal. During the test period, superficial and slit-lamp examination did not reveal any Injury to the eyes. At the end of the experimental period, the eyes were examined by light and electron microscopy. No abnormalities were found. 

Clinicians should not prescribe glucocorticoid-containing eye-drops unless they have performed a slit-lamp examination with tonometry, have assurance of appropriate followup, and understand the differential diagnosis, evaluation, and treatment. Unless clearly indicated, prescribing volumes larger than 5 ml or providing refillable prescriptions should be avoided. It should be stressed that excessive use of glucocorticoids can result in corneal Herpes infection and mycosis. 

Since glucocorticoids reduce the immunological defences of the body to most types of infection, their use in the eyes should be monitored carefully. When longterm use is necessary, even with oral or inhalation therapy, eye examination should be performed every 6 months. The ophthalmological follow-up of patients using topical glucocorticoids should include tonometry at least twice a year, careful slit-lamp examination for... 

In another study, treatment for 2 years with fluticasone propionate (500 micrograms bd) had no significant effect on ophthalmic parameters (glaucoma and posterior subcapsular cataracts) (31). Slit lamp examinations were carried out in 157 asthmatic children treated with inhaled budesonide at a mean daily dose of 504 (range 189-1322) micrograms for 3-6 years (mean 4.4 years). Posterior subcapsular cataract due to budesonide was not detected (32). 

A 62-year-old man with diabetes was given metformin 750 mg bd and his blood glucose concentration fell from 22 to 15 mmol/1 within 4 days. The dose of metformin was increased to 850 mg bd and the blood glucose concentration fell to 8.7 mmol/1 over the next week. Within 2 days of starting therapy his vision became blurred. Slit lamp examination 2 weeks later showed cracked shaped lines on the lens. The cracks resolved spontaneously by 3 months. 

This test has been used since then many times each with slight variations. For instance, exposure of only one eye to the test substance and no exposure of the other eye or exposure of the other eye to the vehicle. To minimize discomfort to the animal, a local anesthetic is sometimes instilled before use of the test substance. The qualitative scoring system hasbeen extended using also measures of eye blinks or wipes. Examinations can also include magnifying glasses, slit lamp examination, fluorescein staining and photodocumentation. After observed toxicity, animals are sacrificed, the eyes removed and subjected to microscopic and histological examinations. 

A 50-year-old woman with schizophrenia had a 1-year history of gradual deterioration of vision in both eyes. For several years she had been taking chlorpromazine 300 mg/day, trifluoperazine 10 mg/day, and trihexyphenidyl 4 mg/day. Slit lamp examination showed fine, discrete, brown refractile deposits on the corneal endothelium in both eyes, and characteristic bilateral stellate cataracts with dense, dust-like brown-yellow granular deposits were noted along the suture lines in the anterior pole of the lens and obscured the visual axis. 

Deposits in the lens or cornea probably result from melanin-drug complex deposition and are best detected by slit-lamp examination. These deposits are probably dose-and time-related, since they generally occur only after years of treatment. Fortunately, they are in large part reversible, but if undetected they may progress to interfere with vision. They are most often reported with chlor-promazine or thioridazine and can occur in association with pigmentary changes in the skin. 

Patients receiving topical ocular steroids must be examined periodically for corneal, lens, and lOP changes. Slit-lamp examination for pimctate, herpetic, or fungal keratitis... 

If, however, the patient exhibits only a unilateral fixed and dilated pupil without evidence of ptosis or extraocular muscle involvement, the clinician should perform the pilocarpine test, first using a 0.125% solution to reveal any cholinergic hypersensitivity as evidence for Adie s pupil. If there is no local iris damage by slit-lamp examination, no sector palsy of the iris sphincter, and no cholinergic hypersensitivity demonstrated by the 0.125% pilocarpine test, then the condition might be associated with interruption of the preganglionic innervation to the iris sphincter (i.e., third-nerve palsy). If the patient has third-nerve palsy, topically instilled pilocarpine in moderate concentrations activates the muscarinic receptor sites on the iris sphincter. Therefore if 0.125% pilocarpine reveals no cholinergic hypersensitivity, the practitioner... 

Diagnosis is made based on careful slit-lamp examination, which readily detects the eggs (nits) attached to the eyelashes or eyebrows (Figure 23-20).The adult lice vary in size from 1.0 to 1.5 mm and have a translucent body, which makes them more difficult to visualize. After they have fed, reddish brown fecal material in the lower abdomen can be easily seen (Figure 23-21), and occasionally they may be seen moving on the eyelash margin. 

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. 

It is often useful to grossly observe the patient before conducting a slit-lamp examination. A patient who is complaining of constant watering of the eyes but who... 

Slit-lamp examination without dyes or anesthetic Observe tear meniscus height Observe quality of tear film Evaluate integrity of ocular surface Evaluate lids, lashes... 

Slit-lamp examination Instill rose bengal or lissamine green... 

Slit-lamp examination of acute hydrops reveals prominent central or inferior corneal edema and clouding along with conjunctival hyperemia (Figure 26-ll).The contralateral eye generally exhibits findings of keratoconus but without hydrops. 

In the event of a large object impaled into the eye, such as a nail or fishhook (Figure 26-25), the etiology of the corneal wound is obvious. Otherwise, careful slit-lamp examination is needed to determine the extent of... 

External examination reveals erythema and swelling of the affected skin areas. Slit-lamp examination reveals diffuse conjunctival injection and pimctate epithelial erosions of the cornea with corresponding NaFl staining. If the epithelial lesions are extensive and if lacrimation is profuse, corneal edema also may be noted. 

Slit-lamp examination reveals single or multiple phlyctenules that appear as pinkish white nodules on the cornea or conjunctiva, ranging in size from just visible to several millimeters in diameter.They typically appear first at the limbus and can easily be mistaken for catarrhal ulcers. Unlike catarrhal ulcers, phlyctenules are adjacent to the limbus, and the long axis of a phlyctenule is perpendicular to the limbus rather than parallel to it. 

Slit-lamp examination typically reveals moderate to severe edema and inflammation of the lid and conjunctiva, a purulent discharge, and ulceration of the corneal epithelium (Figure 26-43). As previously described, these ulcerations can take on many appearances, usually accompanied by surrounding corneal edema and stromal infiltration beneath the ulcer. A mild to severe anterior chamber reaction, which can cause hypopyon, cataracts. 

Mild to moderate conjunctival injection occurs and may be enhanced in the perilimbal area. Careful slit-lamp examination reveals a dense collection of tiny, clear, epithelial cysts in the central cornea. This appearance is best viewed using indirect illumination and retroillumina-tion techniques (Figure 26-60). Instillation of NaFl reveals an irregular central epithelial surface with almost a discoid collection of punctate positive and negative stains. Positive stains occur when the microcysts have emptied onto the epithelial surfece and caused microerosions negative stains occur over the tiny bumps in the epithelium where the microcysts have invaded the epithelium but not yet eroded it. 

Patients often report that their visual acuity was fairly good after surgery and then slowly decreased, as though the cataract had returned. Decreased visual acuity and glare are common symptoms. Slit-lamp examination with a dilated pupil shows a thickened capsule with a bubblelike appearance or sheet-like haze (Figure 30-11). The cornea, anterior chamber, vitreous, and fundus should be examined to exclude other sources for the symptoms. 

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