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A picture of health


Nadia Michaels
BAppSci(Optom)(Hons) GradCertOcTher
Optique Barangaroo, Sydney NSW

Topcon SL-701 with DC-4 anterior camera

Device Technologies


I have always believed that a good slitlamp provides the foundation for a thorough anterior and posterior examination of the eye. Although I had had experience with Topcon slitlamps, the Topcon SL-701 with DC-4 anterior camera exceeded my expectations.

Anterior segment photography has quickly become an indispensable part of my consultation. I have found that the Topcon SL-701 and DC-4 camera is valuable not only for documenting anterior ocular disease but also for meibomian gland assessment and patient education.

Anterior imaging with the Topcon is very quick and easy. In combination with the Ez Capture software, the photographs load instantly on my computer for me and my patient to view. I can also easily obtain a series of images, which I save immediately for later revision.

As with any new skill, practice makes perfect and with the Topcon SL-701 and DC-4 camera, I progressed swiftly up the learning curve. The SL-701 has in-built background illumination which creates an evenly illuminated field that provides detail of the rest of the image but permits the slit beam to remain as the most prominent illumination.

One of my favourite features of the SL-D701 and DC-4 camera is the in-built meibomian gland observation system. In this setting, an infrared light is used to increase the contrast of the anatomical detail of the meibomian glands. The morphologic characteristics of the meibomian glands can be viewed and photographed. The resolution is incredible and the fine detail of the glandular acinus is visible.

Since the set-up for meibography is so quick and simple, I take meibography images on all patients who present with any degree of dry eye symptoms. I perform it concurrently with my slitlamp examination. Using the meibography images, I can evaluate the morphology of the glands and assess the degree of drop-out which indicates which glands are obstructed with keratinised cells and stagnant meibum.

Picture this

I have detected significant signs of drop-out in patients with minimal or no symptoms and minor eyelid morphology changes. Education is imperative for these patients because by the time they do develop symptoms, the disease process is already very advanced and treatment becomes more difficult. It is easier to explain the patient’s condition with a photograph as they can easily appreciate the changes that are occurring.

All my patients have been impressed by this technology. Showing meibography images to patients has increased their compliance with their dry eye management routine, which as optometrists we know can be difficult to maintain.

It’s easy for patients to understand that a picture is worth 1,000 words. Imaging is the only way to accurately document and assess for change over time. My patients are genuinely impressed by this technology and have a better understanding of their ocular conditions. I believe this technology will lead to greater patient retention, which is imperative for the growth of a practice.



A 41-year-old male was referred to see me by a local GP clinic. For the past month, he had been using Chlorsig ointment three times a day to treat chalazia in both eyes. Two chalazia were still present in his right eye. The chalazion in the left eye had recently resolved.

Slitlamp examination showed evidence of anterior blepharitis and meibomian gland dysfunction. His eyelid margins were inflamed and irregular. There was a large chalazion in the right superior tarsal plate. Meibography revealed severe meibomian gland drop-out in both eyes (Figure 1). Forced expression of the meibum glands showed thick and yellow meibum. Some glands showed no secretion.


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Figure 1. Meibography image of the inferior tarsal plate of the right eye. There was a significant degree of drop-out in both eyes.


The patient was educated about the condition and was recommended a treatment plan including at-home warm compress therapy, Lacritec fish oil and daily use of Optimel Manuka honey eye-drops. He also returned for a series of in-office Blephasteam sessions followed by forceps lid expression (Figure 2).


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Figure 2. Forceps expression of the left inferior eyelid. Note the quality of meibum expressed. Background illumination was not used in this image.



A 41-year-old male presented with a history of a scratchy, gritty and watery left eye of two days duration. The eye was very red nasally.

Corrected visual acuity was right 6/5 and left 6/6. Slitlamp examination showed a protruding lesion from the superior punctum of the left eye (Figure 3). The bulbar conjunctiva was very hyperaemic (grade 3) nasally, fading towards the limbus.


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Figure 3. Anterior segment photograph of the left eye. Note the foreign body protruding from superior punctum. Background illumination was not used in this image.


The eye was anaesthetised and the foreign body was carefully removed from the punctum. Fluorescein showed grade 4+ staining of the nasal conjunctiva and foreign body traction scratches on the nasal limbus of the cornea (Figure 4). Anterior chamber was quiet.


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Figure 4. Fluorescein staining pattern of the left eye


Anterior segment photographs helped explain the cause of the sore eye and resultant damage to the ocular surface from the foreign body.

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