Principle, Indications types of gonioscopy are all specified clearly in this presentation. The various images of gonioscopy obtainned is also shown as images in this. Also the various classification systems of grading gonioscopy angles are also explained.

1. GONIOSCOPY
SWETHA

2. INDICATIONS FOR
GONIOSCOPY
– When the VH grade is 2 or less
– Glaucoma or suspected glaucoma
– Any condition that predisposes iris neovascularization
– Syndromes associated like pigment dispersion syndrome
– Pseudoexfoliation
– History of blunt trauma

3. Diagnostic purpose
– Classification : Open or Closed angle glaucoma
– To assess AC angle recess & risk of angle closure.
– To identify plateau iris.
– To look for Abnormal angle pigmenatation,
– PEX ,
– angle recession,
– cyclodialysis,
– foreign body,
– Neoplasm,
– copper deposition ,
– blood in Schlemm’s canal, Congenital anomalies- aniridia, iris processes

4. CONTRAINDICATIONS
– Globe rupture
– Fresh/recent hyphema
– Herpes simplex infection, keratoconjunctivitis
– Epithelial basement membrane dystrophy

5. Gonioscopy imaging

7. Grading based on visible structures
– A Root of iris
– B Ciliary body band
– C Scleral spur
– D Trabecular meshwork
– E Schwalbe’s line

8. Types of gonioscopic lenses
Direct Gonioscopy
– Koeppe
– Richardson shaffer
– Layden
– Barkan
– Thorpe
– Swan Jacob
Indirect gonioscopy
– Goldmann single mirror
– Goldmann three mirror
– Zeiss four mirror
– Posner four mirror
– Sussman four mirror
– Thorpe four mirror
– Ritch trabeculoplasty lens
– Latina trabeculoplasty lens

9. Koeppe

10. Barkan

11. Swan jacob

12. Goldmann single mirror

13. Goldmann three mirror

14. Zeiss four mirror

15. Posner four mirror

16. Sussman four mirror handheld

17. Thorpe four mirror

18. Ritch trabeculoplasty lens

19. Latina trabeculoplasty lens

20. Structures seen through
gonioscope

22. Corneal wedge method

23. Structures seen according to Von-
Herick’s grading

24. Scheie system

25. Shaffer system

26. RPC system of classification

27. Spaeth system
– Angular width
– Iris Configuration
– Level of Iris Insertion
– Iris Processes
– Pigmentation of posterior Trabecular Meshwork

28. IRIS PROCESSES
– U – along angle recess
– V – upto trabecular meshwork
– W – upto Scwalbe’s Line
PIGMENTATION OF TBM
– 0 no pigmentation
– 1+ just perceptible
– 2+ definite but mild
– 3+ moderately dense
– 4+ dense black pigmentation

31. Angle closed

32. Peripheral anterior synechiae

33. Sampaolesi’s line

34. Foreign body at the angle

35. ICE syndrome

36. Hyphema

37. Posterior embryotoxon

38. Pigmentary glaucoma

39. Iris melanoma

40. Iris nevus

41. Iridodialysis

42. Silicone oil bubbles in the angle