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Goldmann压平眼压计的操作方法

(l)用0.5％～1％丁卡因滴眼液1~2滴点眼作表面麻醉。

(2)用消毒荧光素纸条轻轻接触被测眼下睑的内表面2~3秒后取出纸条，或滴0.25%荧光素钠滴眼液，瞬目2～3次后，使角膜表面泪膜染色，能睁眼时即可开始检查。并嘱被检者放松情绪，自由呼吸，绝不可屏住呼吸。

(3)受检者头部固定于裂隙灯下颌托上，将钴蓝色滤光玻璃置于裂隙灯光前方，被照射的泪膜呈鲜绿色，并将裂隙开至最宽，使测压头照明亮度达最大，光源投射角约为60°。

(4) 将测压头转至裂隙灯显微镜目镜正前方，采用低倍目镜并用单眼观察，让受检者向正前方直视，并尽量睁大睑裂。必要时检查者可用手指协助撑开睑裂，但绝不可加压于眼球。

(5) 将测压螺旋先转至1g刻度位置，即10mmHg压力，再将裂隙灯向前移动，使测压头接近角膜，此时检查者先用肉眼从颞侧观察角巩膜缘刚出现蓝色分光时，即可从裂隙灯目镜里观察到角膜面两个鲜绿色的荧光素反光半环，调整裂隙灯的高度，使两个荧光素半环上下对称(通常用右眼观察)，继续将裂隙灯向前推移，直至观察到清晰的两个半圆形的鲜绿色的荧光素半环，微调裂隙灯的高度，使两个荧光半环上下相等，左右对称。

(6) 继续捻转测压螺旋，使上下对称的两个荧光素半环的内界刚好相接触。此时角膜压平面直径达3.06mm，记录所用重量（克）即为眼压值。如刻度为2g，眼压为20mmHg。在操作中被压平面周围的荧光素环以不宽于0.25mm为标准。如过宽则说明泪液过多，应用棉球吸去多余泪液，再行测压，否则会使测得的眼压值比实际眼压高。

(7) 如遇眼压过高，即使加压至8g仍不能使两个半圆相交，说明眼压高于>80mmHg，则需加用重力平衡杆再行测量。

(8) 重力平衡杆使用法①鉴定眼压计的准确度：操作方法为将测压螺旋转至“0”，裂隙灯之投射角为90°，将裂隙变窄，照射于测压头侧面之黑线上，然后将重力平衡杆固定，使其长端向被检者，并分别置于2g及6g重量压力的刻度线上，转动螺旋，如测压螺旋亦分别需要2g及6g重量压力时，才出现测压头的轻微摆动，则说明眼压计准确无误。②对眼压高于80mmHg者，需将重力平衡杆向检查者方向移动，根据需要置于2g或6g重量压力之刻线位置，则可测量80～140mmHg的眼压。

(9) 对角膜散光大于3D者，三棱镜与角膜接触面为椭圆形而不是圆形，必须将其弱主径线或较大的曲率半径轴置于43°轴向方位，即将测压头侧面的弱主径线轴向，对准测压头固定环的红线。因为只有在43°轴向，椭圆形的直径等于相同面积圆形的直径，方能使压平面积恰为7.35mm2。

(10) 测量完毕后，用3％双氧水溶液或1:5000洗必泰溶液擦净测压头前端，并以擦镜纸或消毒棉球拭干。

下面的英语方便大家听力训练时查找。

hello and welcome back to

learnaboutize.com in this episode we're

going to speak about the goldmann

applianation tonometry or short get

this is a basic exam to measure the eye

pressure

and while there are of course more

simple and

easy ways to measure the eye pressure

the cat is still

the gold standard and has to be learned

by every new resident

this episode is going to be more of a

step-by-step guide

and some tips for the most common

mistakes so this is more

for the first year resident if you want

to learn more about this very

interesting technique

how it works where it came from i'm

going to make a subsequent video

and link it up here where you can learn

about the history about the physics

about

how to treat special cases

[Music]

all right so let's start with the

step-by-step guide first you're going to

want to apply an anaesthetic eye drop to

the patient's eye

and put in some fluorescein dye some

clinics have combination eye drops which

contain

both of these agents the anesthetic drop

can hurt pretty badly

so tell the patient the burning is going

to go away after about 10

seconds and give them a tissue in case

the eye

starts tearing then you're going to take

a clean measurement tip

we have single-use tips at our clinic

but if you have the original ones they

can be re-sterilized after every patient

make sure to slide it in correctly so

the first engraved line

lines up with the white line on the

measurement device

the measurement device itself is usually

mounted directly to the slit lamp

you just swing it forward until it locks

in place

and then make sure your measurement head

is nice and straight switch your slit

lamp to blue light

and turn the brightness up as much as

you can put it at about a 45 degree

angle and then play with the light a bit

until the measurement head is nicely

illuminated

now look through the eyepieces of the

slit lamp

note that during the whole measurement

you're only going to see with your right

eye

this is the first time that you can see

the prism that is

built into the measurement head if you

want to know more about these prisms

wait for the second more detailed video

where i'm going to tell you all about

that

for now all you have to do is make sure

that the prism

forms a straight horizontal line

now you have to put in the expected eye

pressure

on the side of the device there is a

wheel with a lot of numbers on it

this is where you're going to read off

the eye pressure that you measured

before you start measuring put it to the

eye pressure measurement

that you're expecting if you have no

idea what to expect put it to around 20.

once you're happy with your settings

look back at the patient's eye

and check whether it's full of tears if

that's the case

try them off because it's going to give

you a bad measurement

if your patient is squinting or blinking

too much you can use a q-tip

or your fingers to open the lids but

please

be very careful not to push on the globe

as this

is going to falsify your measurements

next you're going to put the joystick of

your slit lamp all the way back

and slide the whole slit lamp forward

in direction of the patient very slowly

while

looking at the patient from the side not

through the slit lamp once you're fairly

close

you switch over back to your eyepieces

from now on

only use the joystick to move back and

forth

a lot of beginners struggle at this

point you can see the measurement prisms

perfectly sharp

but the patient's eye is completely

blurred out

this can be very disorienting and make

you scared that you're going to hit the

patient's

eye too fast and hurt them so if you

have trouble orienting yourself

here's a little tip turn down the

magnification of your slit lamp to 6.3

this allows you to see more of the

patient's face and get a

greater depth of field this way you can

safely approach the patient's eye

and once you actually touch the cornea

you can still switch back to a 10 time

magnification

once you actually touch the cornea two

semi-circles are going to appear

they might not look perfectly centered

like this but we're going to talk about

that a little bit later

first let's assume you hit it perfectly

what you want

is two semi-circles that are the same

size and touch

each other on the inside of the arc do

not

put them straight on top of each other

so what do you do if your circles don't

look like that

let's go through a couple of situations

that you might encounter

and what to do in each situation

situation number one

your semicircles are very small and far

away from each other

this means that the eye pressure is

higher than what you set on the machine

so you need to set it higher but please

go off the corner to do so

situation number two the two semicircles

are very

big and overlap each other this means

that the pressure is lower than what

you've set on the machine

you need to go off the corner go back a

little bit and set

the pressure down situation number three

the two semi-circles do not have the

same size

this means you're not in the center of

the cornea if the top one is bigger

you have to go up if the bottom one is

bigger you have to go down

situation number four your semi-circles

are slightly off to the side and one of

them is cut off of course you have to

move to the side of the one

that is cut off but please for that also

don't touch the cornea come off the

corner

go over a little bit and go back on

there are a couple of ways how you can

cause yourself some problems

one of them is not touching the cornea

correctly if you touch the cornea too

little

the measurement is wrong if you touch

the cornea too hard

the measurements wrong there is a

certain

range where you feel like the two

circles

are kind of locked in you have to find

this range

just slowly touch the cornea move

forward a bit

until you feel like it's completely

locked in if you move further

you start to see movement again another

one of the problems that you're causing

yourself

i've already mentioned if you're using

your fingers or a q-tip to open the

patient's eye

you can apply pressure on the globe this

usually shows itself as a very volatile

measurement

that is changing every time you put the

measurement head

on the eye again so if this is happening

to you

try to lift up the lid without putting

pressure on the eyeball

another very common issue is too much

tears

if your semicircles are too thick your

measurements going to be wrong

so try to dry off your patient's eye and

measure again

another common problems are pulsations

this is when the semicircles go back and

forth

with the heartbeat some patients just

have that

so if you have the situation just take

about the average

that you're measuring that was it for

this quick step-by-step guide

please comment down below if you still

have some problems if you're still

measuring something else then your

colleagues and your superiors

i might be able to help you or some

other users might be able to help you

but please do consider all the problems

that i

mentioned before especially the one with

not being locked in perfectly and the

one with your fingers

and your q-tips putting pressure on the

globe

if you're interested in more details

about this

pretty interesting technique i will

release another video

i will link it up here and down in the

description

and until then please subscribe to the

channel

and practice as much as you can