裂隙灯使用操作

裂隙灯的操作使用视明眼镜公司视光培训2015-05裂隙灯简介裂隙灯：全称“裂隙灯显微镜”是眼科使用最频繁的一种光学设备。通过裂隙灯显微镜可以清楚地观察眼睑、结膜、巩膜、角膜、前房、虹膜、瞳孔、晶状体及玻璃体前1/3，可确定病变的位置、性质、大小及其深度。若配以附件，其检查范围将更加广泛。因而裂隙灯不仅是眼科医生检查的重要设备，也成为配镜验光人员的必备和必须掌握的仪器。裂隙灯显微镜的原理裂隙灯：顾名思义就是灯光透过一个裂隙对眼睛进行照明。由于是一条窄缝光源，因此被称之为“光刀”。将这种“光刀”照射于眼睛形成一个光学切面，即可观察眼睛各部位的健康状况。其原理是利用了英国物理学家丁达尔的“丁达尔现象”。裂隙灯显微镜的原理裂隙灯显微镜又称活体显微镜，简称裂隙灯唯一能观察活体切片的仪器是眼科一种重要的检查工具强烈而集中的光源和双目显微镜的放大相配合，不仅能使表浅的病变观察得十分清楚，并且可以利用裂隙光带通过眼球各部的透明组织，形成一系列光学切面，使深部组织的病变也能清楚地显示出来HydronQibeiOptometryEliteInstitute结构和原理裂隙灯显微镜功能部件辅助部件投照系统观察系统托架调焦手柄控制板52/25/20202:44PM裂隙灯显微镜6HydronQibeiOptometryEliteInstitute测试前准备测试者充分洗手适当降低室内光线亮度将裂隙光线投照于调焦棒分别调节双眼目镜的焦距手轮，使焦平面清晰调整目镜间距，使测试者得以双眼同时观察目标122/25/20202:44PMHydronQibeiOptometryEliteInstitute调试裂隙灯显微镜目镜132/25/20202:44PMHydronQibeiOptometryEliteInstitute使被测试者取舒适坐姿（可适当升降座椅或操作台）面部向前，将额部和颏部紧附额托和颏托142/25/20202:44PMHydronQibeiOptometryEliteInstitute调整颏托手轮使被检查者的外眦部与托架纵杆眼位刻度线相平152/25/20202:44PMHydronQibeiOptometryEliteInstitute3.基础调试旋动裂隙宽度手轮，将裂隙宽度调整至窄裂隙162/25/20202:44PMHydronQibeiOptometryEliteInstitute调整灯臂，使基础投射角度保持大致30°左右172/25/20202:44PMHydronQibeiOptometryEliteInstitute旋动亮度手轮，使基础投照亮度保持中低度182/25/20202:44PMHydronQibeiOptometryEliteInstitute旋动倍率手轮，设置基础倍率为10×192/25/20202:44PMHydronQibeiOptometryEliteInstitute调整滤镜掣，设置基础滤镜为散热光栅旋动裂隙长度手轮，将裂隙长度设置为最长、倾斜度垂直202/25/20202:44PMHydronQibeiOptometryEliteInstitute4.投照和观察技术弥散投照法直接投照法间接投照法背面投照法镜面反射投照法全内反射投照法滤光式投照法常用投照和观察技术212/25/20202:44PMHydronQibeiOptometryEliteInstitute弥散投照法（diffuseillumination）观察方法•光源加覆磨砂滤光镜•裂隙宽度调整为宽大•放大倍率6×~10ו投照亮度为高度•滤镜调整为无光栅弥散透照法的观察视野较大222/25/20202:44PMHydronQibeiOptometryEliteInstitute弥散投照法观察方法232/25/20202:44PMHydronQibeiOptometryEliteInstitute观察内容•外眼各部：眼睑、睑缘、睫毛、球结膜、睑结膜、泪小点、泪液角膜、角巩膜缘部、前房、虹膜、瞳孔和部分晶状体•角膜接触镜配适的动态评估：镜片的覆盖度、中心定位、移动度、下垂度、松紧度242/25/20202:44PMHydronQibeiOptometryEliteInstitute软镜的配适252/25/20202:44PMHydronQibeiOptometryEliteInstitute硬镜的配适262/25/20202:44PMHydronQibeiOptometryEliteInstitute直接投射法（directillumination）观察方法•投射轴与观察轴夹角30°~50°•裂隙宽度0.2mm-1.5mm或锥形光束•放大倍率6×~25ו投照亮度从中度逐渐调至高度•滤镜调整为无光栅显微镜焦平面处在光源照亮的部位272/25/20202:44PMHydronQibeiOptometryEliteInstitute直接投照法观察方法282/25/20202:44PMHydronQibeiOptometryEliteInstitute观察内容•窄裂隙：称为光切片观察角膜弧度（如圆锥角膜），角膜厚度（如角膜水肿）角膜创伤的深度和异物的位置•宽裂隙：观察上皮层（如疤痕）、基质层、内皮层的病变镜片表面的异物和沉淀物；镜片的移动度和松紧度•锥形光束：观察房水闪辉现象292/25/20202:44PMHydronQibeiOptometryEliteInstitute圆锥角膜302/25/20202:44PMHydronQibeiOptometryEliteInstitute角膜厚度312/25/20202:44PMHydronQibeiOptometryEliteInstitute角膜疤痕322/25/20202:44PMHydronQibeiOptometryEliteInstitute镜片沉淀物332/25/20202:44PMHydronQibeiOptometryEliteInstitute间接投照法（indirectillumination）观察方法•投射轴与观察轴夹角45°~60°•裂隙宽度1.0mm~2.0mm•放大倍率16×~40ו投照亮度从中度调至高度，滤镜调整为散热光栅•显微镜焦平面位于光源照亮的旁侧，借助角膜背面分散折射的光线照亮裂隙光旁侧的观察目标342/25/20202:44PMHydronQibeiOptometryEliteInstitute间接投照法观察方法352/25/20202:44PMHydronQibeiOptometryEliteInstitute观察内容•观察泪液的脂质成分•氧代谢障碍诱发的角膜上皮微囊、微泡362/25/20202:44PMHydronQibeiOptometryEliteInstitute上皮微泡372/25/20202:44PMHydronQibeiOptometryEliteInstitute背面投照法（retroillumination）观察方法•投射轴与观察轴夹角30°~50°•裂隙宽度1.5mm~3.0mm•放大倍率16×~25ו投照亮度低度逐渐调至中度382/25/20202:44PMHydronQibeiOptometryEliteInstitute•背面投照法又称后映法•光源投射于显微镜焦平面后方的虹膜上利用虹膜组织发出的弥散反光从背面照亮角膜进行观察•分为直接法和间接法直接法的观察目标以照亮的虹膜为背景间接法观察目标以照亮的虹膜旁侧的暗区为背景392/25/20202:44PMHydronQibeiOptometryEliteInstitute背面投照法观察方法直接法间接法402/25/20202:44PMHydronQibeiOptometryEliteInstitute观察内容•直接法：观察角膜新生血管和角膜异物•间接法：利用从背面照亮的角膜发出的弥散光为背景观察角膜浸润、角膜基质层的水肿皱纹和镜片表面的沉淀物412/25/20202:44PMHydronQibeiOptometryEliteInstitute角膜新生血管422/25/20202:44PMHydronQibeiOptometryEliteInstitute角膜疤痕432/25/20202:44PMHydronQibeiOptometryEliteInstitute脂质沉淀物442/25/20202:44PMHydronQibeiOptometryEliteInstitute镜面反射投照法（mirrorreflectionillumination）方法•调整显微镜与灯臂的位置使眼轴与投射轴的夹角和眼轴与观察轴的夹角相等•投射轴与观察轴夹角60°•裂隙宽度1.5mm~2.0mm•放大倍率16×~40ו投照亮度中度至高度452/25/20202:44PMHydronQibeiOptometryEliteInstitute•镜面反射投照法又称平行光切法•移动裂隙光，使之与投射光在角膜表面上的反光点相重合可观察到角膜后弹力层如同镜面一样的的反射光•使显微镜的焦平面落在反射光上即可透过透明的后弹力层观察到角膜内皮细胞层462/25/20202:44PMHydronQibeiOptometryEliteInstitute镜面反射投照法观察方法60°472/25/20202:44PMHydronQibeiOptometryEliteInstitute观察内容角膜内皮细胞的病理性改变和泪液层的质量角膜内皮细胞层482/25/20202:44PMHydronQibeiOptometryEliteInstitute全内反射投照法（totalinternalillumination）观察方法•投射轴与观察轴夹角45°~60°•裂隙宽度1.0mm~2.0mm•放大倍率10×~16ו投照亮度从中度调至高度•滤镜调整为无光栅492/25/20202:44PMHydronQibeiOptometryEliteInstitute•全内反射投照法又称角膜缘分光法•使光裂隙集中投照角膜边缘光线在角膜上皮层和内皮层之间反复折射•投照成功的标准时角巩膜缘形成弥散光环显微镜焦平面则观察角膜中央至另一侧502/25/20202:44PMHydronQibeiOptometryEliteInstitute全内反射投照法观察方法512/25/20202:44PMHydronQibeiOptometryEliteInstitute观察内容•角膜基质层的水肿皱纹•瘢痕、上皮损伤•异物和浸润等•镜片的不透明沉淀物522/25/20202:44PMHydronQibeiOptometryEliteInstitute角膜上皮浸润532/25/20202:44PMHydronQibeiOptometryEliteInstitute滤光式投照法（filteredillumination）观察方法•裂隙宽度调整为宽大•放大倍率6×~10ו投照亮度为高度•采用钴兰光源、磨砂滤光镜、黄色滤光镜、1%荧光素钠542/25/20202:44PMHydronQibeiOptometryEliteInstitute观察内容•角膜和结膜损伤染色的形态和深度•透气硬镜的配适评估等552/25/20202:44PMHydronQibeiOptometryEliteInstitute角膜上皮损伤562/25/20202:44PMHydronQibeiOptometryEliteInstitute角膜塑形镜静态配适572/25/20202:44PMHydronQibeiOptometryEliteInstitute配镜前眼部检查PerCheckingforContactlenses582/25/20202:44PMHydronQibeiOptometryEliteInstitute1.观察方法嘱被检查者直视前方用弥散光投照法依次观察：眼睑、睑缘、睫毛、角膜、前房、虹膜、瞳孔、晶状体嘱被检眼水平转动在眼球左转和右转时充分观察侧方的球结膜、巩膜和泪阜