Gonioscopy

Question 1

When to perform it

Answer 1

• narrow angle on van Herrick
• glaucoma suspect
• glaucoma
• high IOP/ angle closure suspect
• SLT/ALT
• trauma
• CRVO (90 day glaucoma)

Question 2

Normal anterior chamber angle

Answer 2

Iris root to cornea (moving anteriorly)

Question 3

Ciliary body band in normal anterior chamber angle

Answer 3

• visible portion of CB in AC
• visible due to iris insertion on level of iris insertion
• width of band depends on level of iris insertion (wider in myopic eyes, narrowed in hyperopic eyes)
• gray or dark brown in color
• sometimes can see major arterioles circle in the front portion; circumferential in pattern (sometimes can see a radially oritentd ACA in lightly pigmented eyes)

Question 4

Scleral spit in normal anterior chamber angle

Answer 4

• posterior lip of scleral sulcus
• attached to CB posteriorly and corneoscleral meshwork anteriorly
• prominent white line between CB band and posterior TM, unless hidden by dense viral meshwork or excessive dispersion
• iris processes can be seen: fine, pigmented strands crossing scleral spur from iris root to posterior TM

Question 5

TM in normal angle

Answer 5

Pigmented band anterior to scleral spur
Amount of pigment varies
Anterior part: between schwalbe line and anteiror edge of schlemm canal
Posterior part: remainder of the meshwork and is primary site of aqueous outflow

Question 6

Schwalbe line in normal angle

Answer 6

• junction between AC structure and cornea
• fine ridge just anterior to the TM
• use corneal wedge to identify (at he junction of the inner light beam along corneal endothelium and outer light beam along corneoscleral junction

Question 7

Recording for gonioscopy

Answer 7

Record most posterior sctructure along with how much pigmentation is in the TM in each angle