[Purkinje images in slit lamp videography : Video article].

Reflexes that accompany every examination with the slit lamp are usually regarded as annoying and therefore do not receive much attention. In the video available online, clinical information "hidden" in the Purkinje images is analyzed according to our concept of slit lamp videography. In the first part of the video, the four Purkinje images which are reflections on the eye's optical surfaces are introduced for the phakic eye. In the pseudophakic eye, however, the refracting surfaces of the intraocular lens (IOL) have excellent optical properties and therefore form Purkinje images 3 and 4 of high quality. Especially the third Purkinje image from the anterior IOL surface, which is usually hardly visible in the phakic eye can be detected deep in the vitreous, enlarged through the eye's own optics like a magnifying glass. Its area of reflection can be used to visualize changes of the anterior segment at high contrast. The third Purkinje image carries valuable information about the anterior curvature and, thus, about the power of the IOL. If the same IOL type is implanted in a patient, often a difference between right and left of 0.5 diopter in its power can be detected by the difference in size of the respective third Purkinje image. In a historical excursion to the "prenatal phase" of the slit lamp in Uppsala, we show that our most important instrument in clinical work was originally designed for catoptric investigations (of specular reflections). Accordingly A. Gullstrand called it an ophthalmometric Nernst lamp.