By Wallace L.M. Alward, Frederick C Blodi
Gonioscopy is a method of exam of the iridocorneal attitude of the attention. it's a severe element of the exam of all sufferers, quite people with glaucoma. it's a a part of the attention exam that is tremendous tough for trainees to profit. a few older practitioners have by no means turn into professional in gonioscopic options. This atlas provides all features of the strategy from the fundamental sciences throughout the rules, exam suggestions and interpretation of findings.
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Extra info for Colour Atlas of Clinical Gonioscopy
Pathologic angle vessels tend to be fine, cross the scleral spur, and branch. They do not follow any radial or circumferentia l pattern. Pathologic vessels have associated fibrous tissue, which is not visible. The angle between the iris and the cornea is usually wide enough to permit a good view of all angle structures (104). The angle is generally quite wide in myopic eyes (105) and narrower in hyperopic eyes . , 1969). Aphakic and pseudophakic eyes tend to have rather wide angles because of the loss of lens thickness behind the iris.
A l though some distortion is unavoidable in indentation gonioscopy due to the folds in Descemet's membrane (see 76), this does not preclude an adequate view. AI very hi gh intraocular p ressures indentation is quite difficu l t and is minimall y effective. The deepening of the angle as a resu lt of indentation probably arises from a combi nation of forces. Aqueous is forced into the angle, which pushes the iris to the posterior (Forbes, 1966). The bending of the cornea also results in mechanical rotation of the limbus, which gives the examiner a more direct view of the angle (Palm berg, 1989).
Cholinergic stimulating agents, such as pilocarpine, cause the lens-iris diaphragm to move fo rward. This narrows the angle and makes the approach to the angle steeper. Rarely, cholinergic agents can cause pupillary block and closure of the angle. Angle narrowing caused by cholinergic agents can be reversed by anticholinergic drugs, which tend to widen the angle. Uneven angle width can be caused by cysts of the iris or ciliary body, angle recession, and cyclodialysis. Systems for grading the width of the angle are described in Chapter 6.
Colour Atlas of Clinical Gonioscopy by Wallace L.M. Alward, Frederick C Blodi