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Protocol of Examination of Anterior Segment of of Eye

Examination of anterior segment of the eye involves examination by:

  • Diffuse illumination
  • Direct focal illumination
  • Specular reflection
  • Transillumination or Retro-illumination
  • Indirect lateral illumination
  • Sclerotic scatter

The steps involved in anterior segment examination may be summarized as:

  1. Introduction
  2. Visual acuity checked grossly
  3. Torch: General appearance, HZO marks, facial asymmetry, iris, pupil size.
  4. Check Setting. There should be:
    • Low magnification
    • Low illumination
    • Diffuse filter
    • Full circle beam
  5. Place patient face and adjust it
  6. One sweep Lower lid margin
  7. One sweep Upper margin lid margin
  8. Check Caruncle, Puncta
    • Pull the lower lid, and ask to look up
    • Pull the upper lid and ask to look down
    • Hold the upper lid up ask to look right and left
    • Give a general look on cornea and iris
  9. Check setting, now there should be:
    • Medium illumination
    • Low magnification
    • Sharp filter
    • Slit beam
  10. Two sweeps on Cornea, anterior chamber, Iris, Lens
    • Maximum illumination
    • High magnification
    • Sharp filter
    • Slit beam
  11. Check setting, now turn to maximum illumination, high magnification, sharp filter and slit beam
  12. Two separate sweeps on cornea
    • Anterior chamber (Setting for counting cells)
    • Iris, lens anterior vitreous face (Setting for counting cells)
  13. Scleral scatter
  14. Retro illumination
  15. I would like to evert upper lid, check corneal sensation, stain with fluoresin, check intraocular pressure and perform gonioscopy.
  16. Thank the patient, make him sit back and turn off the slit lamp

Signs likely to be missed on slit lamp:

  • Difference in corneal diameter
  • Heterochromasia
  • Anisocoria
  • Mild ptosis
  • Herpes Zoster scars

For anterior chamber depth:

  • Set the slit beam mounting at 60 degrees to microscope
  • Use horizontal slit beam
  • Adjust slit beam to join corneal and iris reflection.
  • Measure slit 3 X 1 mm length and multiply by 1.4 for anterior chamber depth in mm.

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