By Wallace L.M. Alward, Frederick C Blodi
Gonioscopy is a method of exam of the iridocorneal perspective of the attention. it's a serious part of the exam of all sufferers, quite people with glaucoma. it's a a part of the attention exam that is super tricky for trainees to benefit. a few older practitioners have by no means turn into specialist in gonioscopic options. This atlas offers all elements of the approach from the fundamental sciences throughout the ideas, exam strategies and interpretation of findings.
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Extra info for Colour Atlas of Clinical Gonioscopy
G. Frank Judisch, MD, et at. Published courtesy of Arch. Ophthalmol. 1979; 97: 2120-2122. ) 136 Redundant periumbilical skin in Rieger's syndrome (same patient as in 133-135). (G. Frank Judisch, MD, et at. Published courtesy of Arch. Ophthalmol. 1979; 97: 212o2122. } Aniridia Although an iridic patients usually appear to have no iris on examination with a slit lamp, some iris tissue is always present. In general the iris stump is so small that it can be seen only gonioscopically (137 and 138) or histopathologically (139).
80 37 Color Atlas of Gonioscopy Corneal Edema When the cornea is too edematous to permit adequate visualization of the angle, topical glycerin can provide some clearing (81 and 82) . The eye should be topically anesthetized before using glycerin. Even with topical anesthesia glycerin can be uncomfortable. Corneal clearing is rapid. The exami nation shou ld be carried out quickly as the effects arc short- lived. If visualizing the angle for gon iotomy presents a problem, edematous epithelium can be scraped away after wetting the cornea with 70% ethanol.
Some grading systems are quite simple - for example the ' wid e, intermediate, and narrow' classification of Go rin and Posner (1967). T he three primary alphanumeric systems that are cmrcntly used for grading the ang le a re those of Scheie, Shaffer, and Spaeth. Scheie System Scheie ( 1957) developed a grading system in which Roman numerals were used to describe the degree of angle closure. In his system one determines the angle structures that are visible on gonioscopy (107). Larger numbers signify a narrower angle.