“Cell and flare” in the eye (Video)

This video demonstrates what cell and flare look like under the slit-lamp microscope. “Cell” is the individual inflammatory cells while “flare” is the foggy appearance given by protein that has leaked from inflamed blood vessels. This finding is commonly seen with uveitis, iritis, and after surgery … and actually seeing it can be challenging for the beginning ophthalmology residents.

The technique for seeing inflammation is to shorten your light beam, widen it slightly, and angle your light-path such that the beam hits the cornea on the left, the iris on the right, with you focusing on the anterior chamber in the middle of the eye. This allows you to use the pupil as a black background.

The first eye in this movie shows copious pigment floating in AC after a laser iridotomy. You can’t miss the pigment cells floating there. The second segment shows mild inflammatory cells, but a lot of flare (it looks like the beam a film-projector would make in a smokey movie theater). The last segment shows a moderate amount of cell that is moving by convection currents: the cells in the back float upward because the chamber is warmer there, and sink in the front where the aqueous is cooler.

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cellandflare.wmv (8.4 meg, Windows video file)

Screenshots

Cell and Flare
This photo shows what cell and flare look like under the slit-lamp. The “cell” are indidual cells, such as WBCs, that are floating in the aqueous. The “flare” is protein that has released through inflammed vasculature inside the eye.
Cell in the anterior chamber
This photo shows anterior chamber cell and flare. The cells are individual white blood cells floating in the aqueous.
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Dr. Timothy Root is a practicing ophthalmologist and cataract surgeon in Daytona Beach, Florida. His books, video lectures, and training resources can be found at:

18 COMMENTS

  1. Well, all comments about iridotomies aside, this is a great video. I am going to use it in a presentation to our residents.

    Out of curiosity, Dorri, were your iridotomies done by an ophthalmologist or an optometrist? Some states allow optoms to do them and it seems like everyone and their mother are getting one. Regardless, it’s a shame you weren’t put on steroids. Undoubtedly, you developed an immune response to the uveal tissue floating around in your eye, and your other problems stem from the resultant uveitis.

  2. Just wanted to say thank you for this video, it was very helpful…It will strengthen my ability to perform a more complete eye exam

  3. Thanks for this video!!
    It has helped me understand cells and flare much better!
    I searched hi and low for such a good explanation.
    thanks !!!!!

  4. VERY VERY EDUCATIVE VIDEO WHICH GAVE A RICH IDEA AS TO WHAT IS TO BE SEEN IN CASE OF EYE FLARE.
    THANK YOU VERY MUCH FOR THIS WONDERFUL STUFF.

  5. I am a doctor of optometry student (O.D. program) in my 2nd year and really enjoy and appreciate your site. I am planning on doing a post-doctoral optometric residency in ocular disease (1 yr) followed by a glaucoma research fellowship (2 yrs). I will be writing topical Beta blockers, prostaglandins, etc…all day long lol… Your site is a great “brush -up” for me and I really appreciate it! Keep up the good work….

  6. Tim,

    How can I contact you to ask about using some of your excellent material in a publication I am working on?

    Thanks,

    Kevin

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