Overview

Gonioscopy is a diagnostic procedure used to examine the anterior chamber angle of the eye. This examination is essential for diagnosing and classifying different types of glaucoma.

Gonioscopy is crucial for distinguishing between open-angle and angle-closure glaucoma, which have different treatment approaches. It also helps identify angle abnormalities and neovascularization that may indicate underlying disease.

Indications

Glaucoma Diagnosis

Classification of glaucoma type

Angle Assessment

Evaluation of anterior chamber angle

Glaucoma Monitoring

Regular angle examination in glaucoma patients

Angle Closure Risk

Assessment of narrow angles

Neovascularization

Detection of abnormal blood vessels

Contraindications

Absolute Contraindications

Corneal abrasion or ulcer
Active corneal infection
Patient refusal

Relative Contraindications

Severe corneal edema
Recent corneal surgery
Uncooperative patient

📋 Equipment Checklist

Check off items as you gather them:

Pre-procedure Preparation

Preparation includes explaining the procedure to patient, selecting appropriate goniolens, applying topical anesthetic, ensuring proper patient positioning, and preparing for potential complications. All team members should understand their roles.

Step-by-Step Procedure

Step 1: Patient Preparation

Explain procedure to patient. Position patient at slit lamp. Apply topical anesthetic. Ensure patient comfort and cooperation.

⚠️ Common Mistakes to Avoid:

  • Inadequate explanation
  • Poor positioning
  • Insufficient anesthesia

💡 Pro Tip:

Explain that the procedure involves a lens touching the eye briefly.

Step 2: Lens Preparation

Clean goniolens thoroughly. Apply coupling agent to lens. Check lens for defects.

⚠️ Common Mistakes to Avoid:

  • Poor lens cleaning
  • Insufficient coupling agent
  • Using damaged lens

💡 Pro Tip:

Use adequate coupling agent to prevent air bubbles.

Step 3: Lens Positioning

Position lens on cornea. Ensure proper contact. Avoid excessive pressure.

⚠️ Common Mistakes to Avoid:

  • Poor lens positioning
  • Excessive pressure
  • Air bubbles under lens

💡 Pro Tip:

Apply gentle, even pressure to avoid corneal indentation.

Step 4: Angle Examination

Examine all four quadrants systematically. Document angle structures. Note any abnormalities.

⚠️ Common Mistakes to Avoid:

  • Incomplete examination
  • Poor documentation
  • Missing abnormalities

💡 Pro Tip:

Examine all quadrants systematically for complete assessment.

Step 5: Angle Grading

Grade angle using Shaffer or Spaeth system. Document findings. Compare with previous examinations.

⚠️ Common Mistakes to Avoid:

  • Inconsistent grading
  • Poor documentation
  • Missing comparison

💡 Pro Tip:

Use consistent grading system for accurate follow-up.

Step 6: Documentation

Record angle findings. Document any abnormalities. Compare with previous examinations.

⚠️ Common Mistakes to Avoid:

  • Poor documentation
  • Missing abnormalities
  • Incomplete records

💡 Pro Tip:

Document angle grade, pigmentation, and any structural abnormalities.

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Post-procedure Care

Post-procedure care involves documenting angle findings, comparing with previous examinations, monitoring for complications, and determining if additional testing is needed. Regular gonioscopy is essential for glaucoma patients.

Complications & Management

Complication Incidence Signs Management Prevention
Corneal abrasion Rare Pain, foreign body sensation, photophobia Topical antibiotics, follow-up Gentle technique, proper lens handling
Infection Very rare Redness, pain, discharge Culture, antibiotics Proper sterilization, single-use coupling agent
Patient discomfort 10-20% Anxiety, poor cooperation Reassurance, gentle approach Good communication, proper anesthesia
Incomplete examination 5-10% Missing angle structures Repeat examination Systematic approach, proper technique

Clinical Pearls

💡

Explain that the procedure involves a lens touching the eye briefly.

🎯

Use adequate coupling agent to prevent air bubbles.

Apply gentle, even pressure to avoid corneal indentation.

🔍

Examine all quadrants systematically for complete assessment.

📊

Use consistent grading system for accurate follow-up.

🎨

Document angle grade, pigmentation, and any structural abnormalities.

⚠️

Angle closure can be acute or chronic - always assess for both.