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What is gonioscopy?
procedure to view the anterior eye using a gonioscope
What can you see with gonio when dilated/not dilated?
- anterior chamber angle without dilation
- peripheral fundus when dilated
What are the reasons to evaluate the anterior angle chamber?
- determination of likelihood of angle closure
- examination of abnormal structures in angle
- iris tumours
- ocular trauma
- Pseudoexfoliation syndrome
- Pigment dispersion syndrome
- Rubeosis irides
What are the contraindications for gonio?
- Corneal abrasions or ocular trauma
- Lacerated or perforated globe
- Following ocular surgery including cataract surgery
- Recurrent corneal erosion syndrome
- Corneal keratopathy
- Anterior uveitis-iritis including patients with known recurrent attacks
What are the 6 layers visible with the anterior angle?
- LICKING TOILETS SHALL CAUSE ILLNESS
- schwalbe's line
- trabecular meshwork
- schlemm's canal
- scleral spur
- ciliary body
What are the characterisitics of schwalbe's line?
- fine white line- not always visible
- indicates termination of descemet's membrane
- line becomes pigmented with age
what is psuedoexfoliation?
accumulation of granular amyloid-like fibres found in schwalbe's line
What are the characteristics of the trabecular meshwork?
contains 2 distinct bands- non pigmented anterior line, pigmented posterior line
What are the characteristics of schlemm's canal?
- not visible
- only seen if contains blood
What are the characteristics of the scleral spur?
- defined light coloured band
- point of attachment of ciliary body to sclera
What are the characteristics of the ciliary body band?
- darker brown/grey uniform colour
- if visible- angle is very wide
What is the characteristic of the image in gonio?
inverted but NOT reversed
Why is the goldmann lens gonio limited?
- 4 mins
- needs coupling fluids
- corneal dehydration
What are the advantages of using a goldmann?
- Gonioscopic angle evaluations
- Direct posterior pole examination through contact
- Peripheral retinal examinations extending to ora if good dilation
What are the disadvantages of using a goldmann?
- corneal dehydration
- only 1 view of the angle at a time
- need to rotate for view
- scary for px
Zeiss type advantages?
- 360 view without rotation
- no coupling fluids needed
- allows indentation gonio
- less imposing for px
Zeiss type disadvantages?
- view less mag and sharp
- harder stability
What is the Schaffer classification of anterior chamber angles?
- 0/0/iridocorneal contact present, apex of corneal wedge not present
- 1/10/schwalbe line present
- 2/20/only trabeculum present
- 3/25-35/scleral spur present
- 4/35-45/ciliary body easily visible
What is the modified Schaffer classification of anterior chamber angles?
- narrow angle/<10/less than 1/3 of trabecular seen
- intermediate/10-20/entire trab seen
- wide/>20/ciliary body present
How can you tell that the angle is acutally closed?
if beam from iris and posterior cornea are coincident
What would you like to do?
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