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Indications for gonioscopy

Indications for gonioscopy. narrow angles glaucoma suspect—to rule out open angle vs. narrow angle, pigmentary , etc) angle neovascularization (DM or *RVO patients). Gonioscopy procedure. topical anesthetic ( proparacaine ) OU, even if examining only one eye .

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Indications for gonioscopy

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  1. Indications for gonioscopy • narrow angles • glaucoma suspect—to rule out open angle vs. narrow angle, pigmentary, etc) • angle neovascularization (DM or *RVO patients)

  2. Gonioscopy procedure • topical anesthetic (proparacaine) OU, even if examining only one eye. • explain procedure: “We’re looking to see how fluid drains out of your eye.” • patient instructions: “Please keep your forehead forward at ALL TIMES during the examination.”

  3. Structures typically seen with gonioscopy • “I Can’t See That Stupid Line” • Iris • Ciliary body • Scleral spur • Trabecular meshwork • Schwalbe’s line

  4. Considerations with Gonioscopy • Views: • “inverted & perverted” • inferior angle is seen in superior mirror • temporal angle is seen in nasal mirror • (and vice-versa) • Lens preparation: • soap & water to clean & disinfect • refresh plus or celluvisc before placing on eye • Recording: • for each quadrant, record: • most posterior surface seen • amount of pigment

  5. indications for peripheral fundus exam with 3-mirror lens: • lesion in periphery (seen with BIO) • increases magnification • gives binocular view

  6. Overview of 3-mirror lens • central lens  view of nerve • “thumb nail” lens (smallest lens)  view angle. • “barrel” lens  far periphery • “trapezoid” lens  equator to mid-periphery

  7. With a 3-mirror lens, in order to view a lesion seen on the inferior retina with BIO view • The appropriate mirror should be positioned superiorly on the eye.

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