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OHP II > Gonioscopy > Flashcards

Gonioscopy Flashcards

1
Q

van herrick angle estimation is a ratio of what?

A

ratio of width of peripheral AC to the width of the cornea

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2
Q

what can a deep anterior chamber suggest?

A

may be suggestive of pigment dispersion syndrome

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3
Q

define gonioscopy

A

a procedure used in the evaluation of the peripheral anterior chamber angle

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4
Q

indications for gonioscopy

A
  • evaluation of narrow anterior chamber angle prior to dilation
  • differential diagnosis of angle closure
  • differential diagnosis of open angle GLC
  • evaluation of iris contour changes
  • rule out neovascularization of the iris
  • history of blunt trauma
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5
Q

contraindications for gonioscopy

A
  • hyphema
  • recent refractive surgery
  • compromised corneas (epithelial damage)
  • perforated eyes
  • lacerations
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6
Q

list 3 mirrors of the goldmann 3 mirror lens

A
  1. apical mirror (bullet)
  2. peripheral mirror (square)
  3. equatorial mirror (trapezoid)
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7
Q

mirror and degree used in angle viewing and ora serrata

A

apical (bullet), 59 degrees

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8
Q

mirror and degree used in peripheral retinal evaluation

A

peripheral mirror (square), 67 degrees

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9
Q

mirror and degree used in equatorial retinal region evaluation

A

equatorial mirror (trapezoid), 73 degrees

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10
Q

which mirror system is more versatile, clearer views, better for blepharospasm, and adheres to the eye on the central axis?

A

3 mirror

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11
Q

which mirror system is used for compression gonioscopy

A

4 mirror

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12
Q

which mirror system uses little to no fluid, has a rapid assessment of the angle, is less traumatic to the eye, but requires more dexterity

A

4 mirror

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13
Q

what can indentation or compression gonioscopy assess and be used for?

A
  • assess if appositional closure or PAS present

- can be used to break ACG attack, lower IOP

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14
Q

how does indentation or compression gonioscopy work?

A

directs aqueous towards the peripheral anterior chamber and pushes the peripheral iris back to view the angle

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15
Q

how does “dynamic gonioscopy” and what does it allow for?

A
  • allows for a better view over a very convex peripheral iris
  • tilt or slide the lens towards the angle being viewed or have patient look into the mirror
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16
Q

list structures you see in gonioscopy from posterior to anterior

A

-iris
-ciliary body
-scleral spur
-trabecular meshwork
(pigmented then non-pigmented)
-Schwalbe’s line

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17
Q

color, width and visibility of ciliary body

A

color: light grey to light brown, charcoal grey in darker irides
width: 0.5 mm (wider may indicate angle recession)
visibility: may be obscured by iris processes or iris

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18
Q

what is the scleral spur and what is the color/ appearance?

A
  • a fibrous ring that attaches the CB to TM

- color is white and appearance is a radial ring that may be obscured by iris or iris processes

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19
Q

which structure of the trabecular meshwork is most posterior?

A

pigmented

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20
Q

what is important about the pigmented structure of the trabecular meshwork?

A
  • filtering portion of the angle

- Schlemm’s canal next to SS

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21
Q

when is Schlemm’s canal visible?

A

when episcleral venous pressure increases

red

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22
Q

pigment in the TM does not occur before:

A

puberty

23
Q

when does pigment in the TM increase?

A
  • in pregnancy
  • with age
  • with iris colors
24
Q

list some other related changes to pigment in the TM

A
  • pigment dispersion syndrome
  • previous injuries or surgeries
  • exfoliation
  • open angle glaucoma
  • previous uveitis
25
Q

list grading scale and definitions for pigment in TM

A 
0- granular, fine, gray color
trace
1+: scattered pigment/ slightly brown
2+: definitely visible brown pigment 
3+: dense pigment band 
4+: pigment on the iris, SS, CB (extremely thick and dense)
26
Q

what is the “termination of Descemet’s in the angle?

A

Schwalbe’s Line

27
Q

What is the anterior limit of the angle wall and the junction of the anterior and posterior cornea lines

A

Schwalbe’s Line

28
Q

describe the appearance of Schwalbe’s line

A

thin white glistening line which acts as a “shelf” where pigment may collect inferiorly

29
Q

what is posterior embryotoxon

A

15% of eyes have Schwalbe’s line anteriorly displaced

30
Q

when evaluating Schwalbe’s line, what is “Sampaolesi’s line”?

A

a wavy line of pigment seen in exfoliation patients

31
Q

list 3 common “sightings” in the angle

A
  • iris processes
  • sampaolesi’s line
  • blood in Schlemm’s canal
32
Q

the unwanted “guests” in the angle

A
  • synechiae

- neovascularization (diabetic retinopathy)

33
Q

3 reasons why you may see blood in schlemm’s canal

A
  • excessive pressure from gonio lens
  • increased episcleral venous pressure
  • low IOP
34
Q

what should you look for and what conditions can cause blood in Schlemm’s canal from increased episcleral venous pressure

A

look for engorged episcleral veins

  • cavernous sinus fistula
  • thyroid disease
  • Sturge-Weber
35
Q

Becker Shaffer 4

A

ciliary body

36
Q

Becker Shaffer 3

A

scleral spur

37
Q

Becker Shaffer 2

A

anterior TM

38
Q

Becker Shaffer 1

A

anterior TM/ SChwalbe’s line

39
Q

Becker Shaffer 0

A

no visible structures

40
Q

what is the Spaeth criterion?

A

alphanumeric documentation

  • details 3D dimensional details of the angle
  • high correlation to OCT and UBM findings
41
Q

how you you grade in Spaeth criterion?

A

made up for sup (narrowest) and inferior (widest)

  • site of iris insertion
  • angle width
  • configuration of peripheral iris
  • trabecular meshwork pigment
42
Q

iris insertion in Spaeth criterion grading

A 
A- anterior to Schwalbes
B- behind Schwalbes and scleral spur
C- scleral spur visible
D- deep CB visible 
E- extremely deep >1mm of CB visible
43
Q

with of angle recess in Spaeth criterion grading is:

A

width of angle recess can be 0, 10, 20, 30, 40

44
Q

peripheral iris configuration for Spaeth criteria

A
  • steep (bowed (b) or plateau (p))
  • regular or flat
  • queer or concave
45
Q

pigment in TM for Spaeth criteria

A

minimal to no pigment: grade 1

up to dense pigment: grade 4

46
Q

list of angle closure from slight risk to extremely risky

A
  • TM without iris bow
  • TM with iris bow
  • 1/2 TM without iris bow
  • 1/2 TM with iris bow
  • Schwalbe’s line
47
Q

documentation requirements

A
  • which eye, which angle
  • most posterior structure
  • about of pigmentation
  • iris approach (flat, moderate or bowed)
  • angle anomalies (iris processes, sampolesis line, pigment above Schwalbes)
48
Q

convexity more common in

A

hyperopia, malignant glaucoma, plateau iris, angle closure

increases in cataract

49
Q

concavity more common in

A

myopia, aphakia, pigment dispersion

50
Q

irregular iris in

A

synechiae, iris or CB tumor, lens dislocation, iris cyst

51
Q

gonio billing specifics

A

92020
(OU, 1x/year)
-can code with 92012
-need to have associated code (narrow angles, glaucoma suspect, glaucoma)

52
Q

problems with Van Herick:

A
  • only measures “apparent depth”
  • iris appears closer
  • typically underestimating angles
53
Q

what is the SL-OCT good for?

A
  • angle assessment

- iris configuration

OHP II (6 decks)

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