From the Guidelines
An advanced practice nurse would use a Wood's lamp, fluorescein test, and slit lamp to detect various ocular conditions, including corneal abrasions, ulcers, foreign bodies, and certain infections, as well as to assess the integrity of the cornea and detect early signs of infection. These tools are essential for comprehensive eye examinations, particularly in primary care, urgent care, and emergency settings. The fluorescein test, for example, can help identify damaged areas of the corneal epithelium, which will stain bright green under the cobalt blue light of a Wood's lamp, making even small abrasions visible 1. The slit lamp provides magnification and illumination for detailed examination of the eye's anterior structures, allowing nurses to assess the cornea, conjunctiva, and eyelids for signs of disease or injury.
Some of the key conditions that can be detected using these tools include:
- Corneal abrasions and ulcers
- Foreign bodies
- Conjunctivitis and other infections
- Blepharitis and other eyelid conditions
- Dry eye syndrome
The slit-lamp biomicroscopy evaluation should focus on the following:
- Tear film: height of the meniscus along the inferior eyelid, debris, increased viscosity, mucous strands, and foam, break-up time and pattern
- Eyelashes: trichiasis, distichiasis, madarosis, deposits
- Anterior and posterior eyelid margins: abnormalities of meibomian glands, character of meibomian gland secretions, vascularization crossing the mucocutaneous junction, keratinization, scarring, eyelid margin hyperemia
- Puncta: patency and position, presence and position of plugs
- Conjunctiva: inferior fornix and tarsal conjunctiva, bulbar conjunctiva
- Cornea: localized interpalpebral drying, punctate epithelial erosions assessed with fluorescein dye, punctate staining with rose bengal or fluorescein dyes, filaments, epithelial defects, basement membrane irregularities, mucous plaques, keratinization, pannus formation, thinning, infiltrates, ulceration, scarring, neovascularization, evidence of corneal or refractive surgery 1.
In patients with diabetic retinopathy, the slit lamp can be used to assess the retina for signs of disease, such as microaneurysms, hemorrhages, and exudates, and to monitor the progression of the disease 2. The Wood's lamp and fluorescein test can also be used to detect corneal abrasions and ulcers, which can be a complication of diabetic retinopathy.
Overall, the use of a Wood's lamp, fluorescein test, and slit lamp is an essential part of comprehensive eye examinations, and can help advanced practice nurses to detect and manage a range of ocular conditions, including corneal abrasions, ulcers, foreign bodies, and certain infections, as well as to assess the integrity of the cornea and detect early signs of infection.
From the Research
Uses of Wood's Lamp, Fluorescein Test, and Slit Lamp
- The Wood's lamp is a handheld instrument that uses long-wave ultraviolet (UV) light with magnification of 2-3 times, commonly used by non-ophthalmologists for examining patients with eye complaints 3.
- An advanced practice nurse may use the Wood's lamp to examine patients with eye complaints, but should be aware of its limitations, as it has a sensitivity of 52% for common eye abnormalities 3.
- The Wood's lamp can be used to detect certain superficial infections, pigmentary disorders, and metabolic diseases in dermatology 4.
- The fluorescein test is often used in conjunction with the Wood's lamp to diagnose corneal abrasions, ulcers, and foreign bodies, as it can help to highlight these abnormalities under UV light.
- A slit lamp is considered the gold standard for examining patients with eye complaints, and an advanced practice nurse may inform patients of the need for a slit lamp examination whenever possible, especially if the Wood's lamp examination is inconclusive or suspicious for a serious eye abnormality 3.
Limitations of Wood's Lamp
- The Wood's lamp has limited sensitivity for detecting common eye abnormalities, such as corneal abrasions, ulcers, and foreign bodies 3.
- The Wood's lamp may not detect certain eye abnormalities, such as non-herpetic keratitis, herpes keratitis, and rust rings, highlighting the need for a slit lamp examination 3.
Informing Patients
- An advanced practice nurse should inform patients of the limitations of the Wood's lamp and the potential need for a slit lamp examination if they present with eye complaints 3.
- Patients should be educated on the importance of seeking medical attention if they experience persistent or severe eye symptoms, as delayed diagnosis and treatment can lead to serious complications.