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.
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Indications
Classification of glaucoma type
Evaluation of anterior chamber angle
Regular angle examination in glaucoma patients
Assessment of narrow angles
Detection of abnormal blood vessels
Contraindications
Absolute Contraindications
Relative Contraindications
📋 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.