Lifting the “Residual Veil”: Biomicroscopy of the Eye

By Hannah Landecker ~

Originally published in Hidden Treasure: The National Library of Medicine, 2011.

An intense light that seems to shine directly into your brain, the quelling of the strong impulse to pull away, a professional stranger breathing so close by. Anyone who has gone forehead-to-forehead with an ophthalmologist will have some familiarity with biomicroscopy. But few of us have much sense of what might be seen in the depths of our own eyes with that devastating beam.

In 1943 Milton L. Berliner (1895–1981) published the first half of a two-volume compendium of biomicroscopy in clinical practice. The first volume of Biomicroscopy of the Eye, with 512 images—40 pages of color plates—was followed in 1949 by the lavish second installment, with 1,233 illustrations, 503 in color. Given the lights and lenses that constitute the technique, one wonders why the camera is so little involved. There is no angst here about the dubious objectivity of Berliner’s hand-drawn images of the living eye versus precise photographic transcription, merely a matter-of-fact statement of the impossibility of attaining adequate photographs.

Consider these drawings of changes to the aqueous humor, the watery space between the lens and the cornea.

“A residual veil (diffuse illumination), floating like a sail, in the anterior chamber.”

Delicate layers of tissues and their liquid ruptures are drawn in a sinuous style; that these are living eyes is communicated in the use of shocking color. Without the imprimatur of medicine this might appear a quintessential example of outsider art, an obsessive cataloguing of fantastic images of the diseased inner eye cut by light. Yet volume 1 was greeted by reviewers as “one of those rare books that profoundly influence clinical practice.” Volume 2 was similarly welcomed for its lack of esoteric abstraction from day-to-day clinical practice—a hinted comparison to earlier, less-accessible compendia of such material. Berliner’s books were seen to present not only the technique but the difference the technique made in the clinic.

Biomicroscopy couples a microscope with a focused beam of light; its history is entwined with that of the lightbulb. It originated in the 1910s with Allvar Gullstrand (1862–1930), ophthalmologist and Nobel Prize winner, who made a controllable beam of very intense light using a slit opening and a condensing lens (which came to be called a slit lamp), rather than shining a light directly on the eye. The biomicroscope works, Berliner tells us, like a search-light in a night sky, or sunlight entering a darkened room through a crack. Objects in the path of the searchlight beam are illuminated, or suspended particles of dust become visible as they scatter the sunlight. Similarly, the transparent tissues of the cornea, lens, and aqueous, being gels, scatter the intense “pencil of light” projected into the eye. This evocation of the light of knowledge in the darkened room of the body—applying the illuminatory focus of science to make even the transparent visible—is here made poignant by the systematic elaboration of the clouding of sight. Exudations, inflammations, coal particles, lacerations, vascularization, sclerosis, opacities, scarring: portraits of a thousand ways in which the eye can be the seat of blindness.

Hanna Landecker is a Professor at the University of California Los Angeles, in the Department of Sociology and the Center for Society and Genetics. She is the author of Culturing Life: How Cells Became Technologies. Her current research interests include the use of moving images in life science and the history and social study of metabolic sciences.