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II. Advanced Ocular Technique > Gonioscopy (M1) > Flashcards

Gonioscopy (M1) Flashcards

1
Q

What is the purpose of gonio?

A

assess the anterior chamber angle

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2
Q

What are the four different gonio brand lenses?

A
  1. Zeiss
  2. Posner
  3. Sussman
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3
Q

Which mirror in the 3 mirror gonio lens is used for the anterior angle?

A

D-shaped mirror

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4
Q

What are the types of coupling solutions that can be used for 3 mirror gonio?

A
  1. goniosol
  2. celluvisc
  3. preservative free artificial tears
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5
Q

What is the degrees of incline for each of the mirrors in the 4 mirror gonio lens?

A

59-62 deg

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6
Q

What are the benefits of 4 mirror over 3 mirror?

A
  1. coupling solution not required and easier to apply
  2. requires minimal rotation for 360 deg views
  3. easier to compare between two eyes
  4. small lens better for small apertures
  5. allows for indentation gonio
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7
Q

What occurs if there is too much or asymmetric pressure applied with 4 mirror?

A

corneal wrinkling and folds

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8
Q

What does increasing the pressure on the central cornea during indentation gonio cause?

A

artificially open a narrow angle

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9
Q

What does too much pressure on the central cornea during indentation gonio cause?

A

blood to back up from Schlamm’s canal, leading to a pale pink appearing line in posterior TM

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10
Q

What are the benefits of 3 mirror over 4 mirror?

A
  1. higher quality views

2. no corneal folds

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11
Q

What is the disinfectant cleaning procedure done for the practical for the gonio lenses?

A
  1. clean with Boston GP cleaner
  2. rinse with saline
  3. soak in Opticide for 3 minutes
  4. allow to dry
  5. rinse with saline
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12
Q

What is the order of the structures seen in the anterior angle?

A
  1. iris
  2. ciliary body
  3. scleral spur
  4. pigmented TM
  5. non-pigmented TM
  6. Schwalbe’s line
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13
Q

What is always documented following gonio?

A
  1. most posterior structure found
  2. iris insertion
  3. pigmentation (0-4)
  4. peripheral anterior synechiae (+/-)
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14
Q

When is a convex or steep iris insertion seen?

A
  1. hyperopia

2. narrow angles

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15
Q

When is a flat iris insertion seen?

A

normal patients

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16
Q

When is a concave iris insertion seen?

A
  1. myopia

2. Pigment dispersion syndrome

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17
Q

What is the grade (and description) of the angle when the ciliary body band is the most posterior structure seen in gonio?

A

4 (wide open)

18
Q

What is the grade (and description) of the angle when the ciliary body band somewhat visible or scleral spur is the most posterior structure seen in gonio?

A

3 (open)

19
Q

What is the grade (and description) of the angle when the scleral spur/TM is the most posterior structure seen in gonio?

A

2 (narrow)

20
Q

What is the grade (and description) of the angle when the anterior portion of TM is the most posterior structure seen in gonio?

A

1 (extremely narrow)

21
Q

What is the grade (and description) of the angle when there are no structures seen in gonio?

A

0 (closed)

22
Q

What is the procedure for the corneal wedge technique?

A
  1. w/ gonio on eye, narrow beam to optic section
  2. create 45deg angle with beam
  3. scroll up with slit lamp until splits into two (at Schwalbe’s line)
23
Q

What are the potential side effects of gonioscopy?

A
  1. vasovagal syncope

2. transient SPK

24
Q

What is the transient loss of consciousness with rapid onset, short duration with spontaneous, prompt and complete recovery? 1. What are the other transient loss of consciousness’ that need to be ruled out? 2

A
  1. vasovagal syncope

2. seizure, hypoglycemia, cardiac arrest

25
Q

What is gonio used for to investigate further?

A
  1. narrow angles
  2. angle pigmentation in PDS or pseudoexfoliation
  3. neovascularization of angle
  4. angle recession
  5. iris nevi/tumor
  6. anterior synechiae
26
Q

What is gonio used for in regards to laser treatment?

A
  1. Laser Peripheral Iridotomy (LPI)
  2. Laser Trabeculoplasty (SLT or ALT)
  3. Iridoplasty
27
Q

What are the contraindications for gonio?

A
  1. penetrating corneal injury
  2. hyphema
  3. keratitis or significant epithelial disruption
28
Q

What are the risk factors for angle closure?

A
  1. hyperopia
  2. short AC depth
  3. age, female>male
  4. East Indian/Inuit races
29
Q

What is the structure that if it is visible then it is nearly impossible to close the angle?

A

scleral spur

30
Q

For patients that have an iris bombe, what conditions can lead to intermittent angle closure?

A

scotopic conditions

31
Q

What is the iris called when it is flat centrally and steep peripherally? 1. What is the sign associated with this? 2

A
  1. plateau iris

2. double hump sign

32
Q

What is a peripheral anterior synechia usually associated with?

A
  1. trauma/penetrating injury (iris capture)

2. inflammation (uveitis)

33
Q

What results from a tear in the ciliary body resulting from blunt trauma to the eye? 1. What do they sometimes eventually develop? 2

A
  1. angle recession

2. second degree glaucoma

34
Q

What is a pigment deposition anterior to Schwalbe’s line called? 1. What is the disease it is associated with? 2

A
  1. Sampaolesi Line

2. Pigment dispersion syndrome and pseudoexfoliation glaucoma

35
Q

What is a pigment deposition on the posterior lens capsule/zonular insertion called? What is the disease it is associated with? 2

A
  1. Scheie’s Line

2. Pigment dispersion syndrome and pseudoexfoliation glaucoma

36
Q

What is the common cause of neovascularization of the iris (NVI)?

A

cardiovascular disease that leads to hypoxia of ocular tissues

37
Q

What is a prominent anterior displacement of Schwalbe’s line called?

A

posterior embryotoxon

38
Q

What is a posterior embryotoxon with prominent iris processes/strands called?

A

Axenfeld Anomaly

39
Q

What is an Axenfeld anomaly with iris atrophy/thinning called?

A

Rieger anomaly

40
Q

What is a Rieger anomaly with dental, craniofacial, or developmental abnormalities?

A

Axenfeld-Riger Syndrome

41
Q

What disease has a dense central corneal leukoma, iris atrophy, and iris strands extending to the corneal opacity?

A

Peter’s anomaly

42
Q

What are four other ways to view the angle other than gonio?

A
  1. direct gonio (Koeppe lens)
  2. tilting slit lamp post
  3. Optical coherence tomography (OCT)
  4. Ultrasound biomicroscopy (UBM)

II. Advanced Ocular Technique (9 decks)

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