Slit lamp biomicroscopy and illumination techniquesLoknath Goswami
It is a presentation on slitlamp for beginner, shown the parts and different illumination techniques both for eye and contact lens and it have short history
Binocular Indirect Ophthalmoscopy is known to provide a wider view of the inside of the eye. It is one of the most commonly used ophthalmic instrument.
Estudo do ângulo irido-corneano localizado na câmara anterior do olho (Nov/2015)
ATENÇÃO!!!
RETIFICAÇÃO 16/01/2021 - SLIDE 13: a imagem da apresentação trata-se de uma Lente de Sussman
Slit lamp biomicroscopy and illumination techniquesLoknath Goswami
It is a presentation on slitlamp for beginner, shown the parts and different illumination techniques both for eye and contact lens and it have short history
Binocular Indirect Ophthalmoscopy is known to provide a wider view of the inside of the eye. It is one of the most commonly used ophthalmic instrument.
Estudo do ângulo irido-corneano localizado na câmara anterior do olho (Nov/2015)
ATENÇÃO!!!
RETIFICAÇÃO 16/01/2021 - SLIDE 13: a imagem da apresentação trata-se de uma Lente de Sussman
Este tema es muy importante por que nos va ayudar a conocer que es en primer lugar la meninges los tipos, causas, fisiopatología, PAE entre otros que uds. en la exploración van encontrar; espero que les sirva de ayuda ya que esto es un resumen de todo lo necesario para conocer el tema.
Se trata de una presentación en powerpoint de un trabajo sobre las alteraciones de las meninges y del líquido cefalorraquídeo realizado por un grupo de estudiantes de 1º de enfermería del centro universitario adjunto de mérida de la Universidad de Extremadura
Revisión de la la literatura acerca de la hemorragia subaracnoidea, presentación clinica y diagnostico, en el apartado de tratamiento solo se toca el tratamiento medico de soporte al paciente.
Lecture on Clinical Methods; Anterior Segment Proptosis & Ptosis examination...DrHussainAhmadKhaqan
Lecture on Clinical Methods; Anterior Segment Proptosis & Ptosis examination For 4th Year MBBS Undergraduate Students By Prof. Dr. Hussain Ahmad Khaqan
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
2. GONIOSCOPY
1. History of gonioscopy
2. Purpose of gonioscopy
3. Principles of gonioscopy
4. Indications & Contraindications
5. Methods of gonioscopy
6. Procedure of gonioscopy
7 . Sterilisation of the gonio lens
8 . Anatomy of Angle Structures
9 . Grading of Angle Width
10 . Angle abnormalities
11. Diagramatic representation of gonioscopy
12. Summary: Key Points
3. HISTORY OF GONIOSCOPY
The first person to examine the angle of
anterior chamber and coin the term
‘GONIOSCOPY’ was Trantas..
The idea of use of contact lens on cornea was of
Saltzman….later improvised by Koeppe.
The art of gonioscopy & its role in glaucoma
was highlighted by Otto Barkan in 1936.
Subsequently Goldmann introduced gonioprism
in 1938 for simplified view of the angle.
4. PURPOSE OF GONIOSCOPY
WHY DO WE NEED TO PERFORM GONIOSCOPY?
* It is an important part of comprehensive eye examination..its
omission often leads to misdiagnosis!!
* Should be done initially in all glaucoma patients and suspects
* Should be repeated periodically in all cases of angle closure
glaucoma
WHAT SHOULD WE LOOK FOR IN GONIOSCOPY?
• Recognise angle landmarks and consider
• Level of iris insertion
• Shape& profile of peripheral iris
• Estimated angle width
• Degree of trabecular pigmentation
• Any iridotrabecular apposition or synechiae
5. PRINCIPLE OF GONIOSCOPY
The anterior chamber angle is defined as the angle
between anterior surface of iris and posterior
surface of cornea, it cannot be visualised under
direct illumination because the light originating from
here undergoes TOTAL INTERNAL REFLECTION at
the tear–air interface and is reflected back into eye.
WHAT HAPPENS IN GONIOSCOPY?
Only when the light originating from the angle
structures strikes the cornea at an angle steeper than
the CRITICAL ANGLE of 46 degrees,can light exit
the eye & angle structures be visualised. Goniolens
make this possible and neutralise the refractive
power of the cornea thereby helping us visualise the
anterior chamber angle!!!
6.
7.
8. INDICATIONS &
CONTRAINDICATIONS
INDICATIONS
* Narrowness of angle as
observed by van herick’s
technique
* History of angle closure
attack
* History/ evidence of trauma
or penetrating ocular
foreign body
*Active or past inflammation
in chamber
* Evidence of neoplastic
activity in chamber
* Possibility of
neovascularisation
CONTRAINDICATIONS
* Globe rupture
* fresh/ recent hyphema
* Ocular surface infections
like herpes simplex;
epidemic
keratoconjunctivitis
* Epithelial basement
membrane dystrophy
10. TECHNIQUE OF DIRECT
GONIOSCOPY
Koeppe lens( 50 D
diagnostic lens)
available in sizes16mm
(infants) & 18 mm
(adults) is placed with
coupling agent on the
anesthetized cornea of
the supine
patient.viewing is
achieved with a hand
held biomicroscope
and illuminator.
NOTE :
It can be used for
outpatients as well as
in OT
Useful in pediatric
patients
Can also be used to
examine the angle in
patients with
nystagmus
11. DIRECT GONIOSCOPY:
ADVANTAGES:
Straight on view
Variable angle of
visualisation
Panoramic
Angle recession-
comparison
DISADVANTAGES:
Inconvenient
Needs special
equipments
12. INDIRECT GONIOSCOPY
SUCTION TYPE OF
GONIOLENS
Use viscous fluid between
eye & the goniolens.they
provide better image and
require less control;
however are time
consuming & cumbersome
NON SUCTION TYPE
They are good for rapid
evaluation but image is
poor.excess pressure
causes corneal folds
whereas inadequate
pressure can cause entry
of air beneath goniolens
13. GONIOLENS USED IN INDIRECT
GONIOSCOPY
A) 4 MIRROR
B) 3 MIRROR
C) 2 & 1 MIRROR
14. FEATURES:
4 mirror lens: they allow quick examination of all 4
quadrants without any need for rotation of the
goniolens. Eg Zeis, Posner, Sussman.They are non
suction type
3 mirror lens: the D or arc shaped mirror is used for
angle examination, the other two help in viewing
peripheral retina.the central lens helps in macular
examination.the D shaped mirror should be first
placed at 12o’ clock position and eventually rotated
thrice to view the other 3 quadrants.eg. goldmann
2 & 1 mirror lens: they are used in patients with
small interpalpebral fissures.2 mirror lens need to be
rotated once for viewing all quadrants and 1 mirror
needs to be manipulated like the 3 mirror lens.
15. INDIRECT GONIOCOPY: SLIT
LAMP TECHNIQUE
GENERAL GUIDELINES:
Explain the procedure to the patient
Reassure the patient & ensure cooperation
Do an external examination first to rule out corneal abrasion, infection,
edema
Perform tonometry before gonioscopy
Use anaesthesia (4% lignocaine)
Pay attention to patient comfort
Pay attention to alignment by adequately supporting forearm (using an
elbow rest)
Perform examination in dark room
Examiner should use right hand to evaluate left eye & vice versa
Use suitable gonio lens. 3 mirror (suction type ) are best for starters
Disinfect lens prior & after every use
16. SLIT LAMP SETTINGS
10-25X magnification is used
Fairly short and narrow beam
Viewing & illumination arm in same axis.illumination
arm may be moved paraxially to view the temporal &
nasal recess
Focus light on the D shaped mirror
Avoid throwing light into the pupils
Magnification & illumination may be increased to view
finer details like blood vessels and foreign bodies
NOTE: Images are reversed but never crossed!!
17.
18. INDIRECT GONIOSCOPY
ADVANTAGES
* Quick, convenient
and hence preferred
by most
* No special
equipments required
* Allows differentiation
of appositional and
synaechial angle
closure
DISADVANTAGES
* Mirror images can
be confusing
* Inadvertant pressure
on cornea can lead
to (a) narrowing of
angle in goldmann 3
mirror lens (b)
opening of the angle
in 4 mirror lens
19. FACTORS INFLUENCING
FINDINGS IN GONIOSCOPY
PATIENT FACTORS OBSERVER BASED
Pupil size
Lens size
Patient’s cooperation
Entrapment of air between
goniolens & cornea
Excessive pressure causing
corneal folds
Unstable hands
Improper focussing
Lack of experience
20. CLEANING OF THE GONIO
LENS
Soaking in 1:10 bleach for 5-10 mins
Soaking in 2% glutaraldehyde
Rinsing with tap water
NOTE: Though good disinfectants
otherwise; avoid use of isopropyl alcohol
and hydrogen peroxide to rinse suction
type of lens because the weaken the seal
produced by coupling agents
22. ANGLE STRUCTURES
(a) IRIS :
* myopes – concave
* hypermetropes – convex
* abnormal covexity- pupillary block
* abnormal concavity-pigment dispersion
syndrome
* crypts – fuchs’
* abnormal last roll -plateau iris
(b) CILIARY BODY BAND :
*Iris inserts in its concave face
*its width increases in angle recession( scan
circumference), cyclodialysis( cleft seen)
23. (c) SCLERAL SPUR
It signifies the posterior border of trabecular meshwork,
attachment of ciliary body, & insertion of longitudinal
muscles of ciliary body.
Scleral spur might be obscured by
* Iris processes
* iris bombe
* Peripheral anterior synechiae
*Pigments
(d)TRABECULAR MESHWORK
• Most of the aqueous flow is through the posterior TM.it has
intracellular pigment that increases with age.it is identified by
the schwalbe’s line anteriorly & blood in schlemm’s canal and
scleral spur posteriorly
24. (e) SCHWALBE’S LINE
It is the peripheral termination of the Descemet’s
membrane. It is the landmark for identification of TM in
narrow angles.
pigmentation might be seen (sampaolesi’s line).
NOTE:
a) Vessels in angle: this are normally found as well.it might be
the major circle of iridis or radial arteies in iris stroma.
The never cross scleral spur.
b) Pigmentation normally is more defined in the inferior
quadrant….excessive pigmentation in the superior
quadrant is suggestive of some pathology
26. SPAETH SYSTEM OF
CLASSIFICATION (1971)
MAJOR FEATURES STUDIED HERE:
A) Level of insertion of the root of iris
B) Width of the angular recess
C) Configuration of peripheral iris
D) Trabecular meshwork pigmentation
29. LEVEL OF INSERTION OF ROOT
OF IRIS
GRADES:
A) Anterior to schwalbe’s line
B) Behind the schwalbe’s line
C) On the scleral spur
D) Behind the scleral spur deep to
ciliary body face
E) Extremely deep (post ciliary body
band)
31. WIDTH OF THE ANGLE
RECESS
It is estimated by a tangential line from
iris to trabecular meshwork as is
expressed in degrees
Slit
10 degrees
20 degrees
30 degrees
40 degrees
NARROW
WIDE
33. CONFIGURATION OF THE
PERIPHERAL IRIS
It is recorded as
A) Q - queer: anteriorly concave
eg.. High myopes & pigment dispersion syndrome
B) R - regular: anteriorly flat
eg.. Myopes and aphakic
C) S - steep: anteriorly convex
its usually normal; however exaggerated convexity is seen
in hyperopes
PLATEAU IRIS: A flat iris configuration with a peripheral
convex hump in close relation to trabecular meshwork seen
in normal phakic eyes often mimicking narrow angle
34. PIGMENTATION IN THE
POSTERIOR MESHWORK AT 12
O’ CLOCK POSITION
0 - No pigmentation
1 - Trace pigmentation
2 - Mild pigmentation
3 - Moderate pigmentation
4 - Heavy pigmentation
CAUSES OF HEAVY PIGMENTATION:
a)pigment dispersion syndrome
b) pseudoexfoliation syndrome
c) traumatic & uveitic glaucoma
35. OVER THE HILL GONIOSCOPY
Done when the patient
apparently seems to have a
convex / steep iris
configuration or
visualisation of angle
structures is difficult.
Patient hereby is asked to
look in the direction of the
mirror
Alternatively tilt the
goniolens away from the
observation mirror
This helps assessing angle
recess over convex iris
36. INDENTATION ( compression)
GONIOSCOPY
In addition, the spaeth classification also uses the
findings of indentation gonioscopy to distinguish
apposition and synechial angle closure.
The examiner describes the iris insertion as first seen
and then after indentation.
It is usually done in cases with STEEP IRIS
configuration where identification of angle structures
is difficult
The technique involves a routine assessment of all
quadrants following which if an angle is found to be
narrow, each quadrant is reevaluated using a narrow
slit beam( to prevent miosis &artifactual opening of
angle) & pressure is applied in the centre of the eye
37. This helps in deepening of the angular
recess caused by bowing back of peripheral
iris along with stretching of limbal scleral
ring and straightening of angular recess.
Following this one can see structures not
visible earlier or confirm the presence of
peripheral anterior synechiae
If inappropriate pressure is applied, corneal
folds can distort the view
NOTE: Compession gonioscopy isn’t
effective when the IOP is beyond 40 mmHg
as this limits expansion of scleral limbal ring
40. GONIOSCOPY FLOW
DIAGRAM
Scleral spur visible?
NO
DO INDENTATION
GONIOSCOPY
SYNECHIAE (+)
PRIMARY SYNECHIAL ANGLE
CLOSURE
NO SYNECHIAE, RAISED IOP-
PRIMARY APPOSITIONAL
ANGLE CLOSURE
NO SYNECHIAE,NORMAL IOP-
PRIMARY ANGLE CLOSURE
SUSPECT
YES
OPEN ANGLE
41. OTHER ABNORMALITIES IN
ANGLE
Besides abnormalities in angle configuration,
gonioscopy also helps us detect :
A) Peripheral anterior synechiae
B) Neovascularisation of the angle
C) Affects of trauma on angle
D) Specific angle features as in - fuch’s
heterochromatic iridocyclitis, pseudoexfoliation
syndrome, plateau iris etc
E) Tumours of the anterior segment like ciliary body
cysts
F) foreign bodies /silicone oil globules in the angle
G) Early detection of KF Ring
42. IRIS CYST AS SEEN IN (A) SLIT LAMP AND (B)
GONIOSCOPY
48. DISTINGUISHING NORMAL VESSELS
FROM NEOVASCULARISATION OF
THE ANGLE
NORMAL VESSELS
NEOVASCULARISATION OF
THE ANGLE
Radial in orientation
Thick and dull red
Non branching in nature
Do not cross the scleral
spur
Fine and irregular
Bright red
Arborising
Cross the scleral spur
50. POSSIBLE AFFECTS OF TRAUMA
ON ANGLE
ANGLE PECESSION – It is characterised by
a widely visible ciliary body band due to
tear between longitudinal and circular ciliary
muscle fibres. should be followed up
regularly .
CYCLODIALYSIS –disincertion of ciliary
body band from scleral spur, characterised
by deep angle & decreased IOP ; shows a
white band on gonioscopy
INTRAOCULAR FOREIGN BODY
LODGED IN THE ANGLE
LODGED BLOOD CLOTS
53. SPECIFIC ANGLE
CHARACTERISTICS
FUCH’S HETEROCHROMATIC
IRIDOCYCLITIS: Fine fragile vessels
PSEUDOEXFOLIATION SYNDROME:
Sampaolesi’s line & heavily pigmented
trabecular meshwork
PIGMENT DISPERSION SYNDROME:
Abnormal posterior bowing of iris
PLATEU IRIS: Flat configuration iris with
peripheral hump mimicking narrow angle
RAISED EPISCLERALVENOUS PRESSURE
:uniform linear reddish hue (blood in
schlemm’s canal)
54. DIAGRAMATIC
REPRESENTATION
This is the most clinically
useful method of
recording gonioscopic
findings.
Firstly abbreviation for
most posteriorly visible
structure viz.. Ciliary
body(CB), scleral spur(SS),
trabecular meshwork(TM),
schwalbe’s line(SL)
Grading of pigmentation in
each quadrant
Configuration of the iris
Any abnormality in the
angle
56. SUMMARY : KEY POINTS
It is obvious that various angle grades merge
into one another, so the usefulness of any
classification system depends on the skill of
the observer in judging which angles are
potentially or actually occluded &
identifying features of secondary glaucoma
Though simplified to a single grade, the
experienced clinician’s assessment of angle’s
risk for closure takes into account the 3 D
aspects of the angle anatomy, such as level of
iris insertion and peripheral iris
configuration.
57. KEY POINTS …..CONTINUED
Gonioscopy is very much an acquired art ;
and its optimal utilisation requires
considerable personal experience.
Awareness of the sources of error and
proper interpretation of findings results in
shorter learning curve.
Proper long term management of glaucoma
requires gonioscopy at appropriate intervals
because the condition of the angle is not
static throughout life !!