Gonioscopy is a biomicroscopic examination of the anterior chamber angle using a goniolens, essential due to the lack of transparency at the corneoscleral junction. There are two types: direct (for bedside use) and indirect (using a slit lamp), each allowing visualization of the angle structures via various gonioscopes. It aids in glaucoma classification, locating foreign bodies, and identifying tumors, but is contraindicated in cases of hyphaema or compromised cornea.

1. GONIOSCOPY Presented by
Karan kumar Satapathy (40)
Srikanta kumar Panda (85)
Guided by
Prof. Dr. Sujata Priyambada
Madam

2. WHAT IS GONIOSCOPY?
 It is a biomicroscopic examination of angle of anterior chamber (irido-
corneal angle) by using a device goniolens/ gonioscope/ gonioprism
WHY THE ANGLE OF ANTERIOR CHAMBER
CANNOT BE VISUALISE DIRECTLY?
 Lack of transparency of corneoscleral junction.
 Emergent light from angle structures undergo Total Internal Reflection at
Corneal surface

3. critical angle of cornea-air surface: 46º

4. TYPES:
Direct gonioscopy:
 Done in supine position
 Provides a direct view of the
angle
 Useful in bedridden patient,
anaesthetized patient, children
 E.g., Koeppe goniolens, Barkan
goniolens
Indirect gonioscopy:
 Done in sitting position on slit
lamp
 Provides a mirror image of the
opposite angle
 E.g. Zeiss 4 mirror gonioscope,
Posner 4 mirror gonioscope,
Goldmann single mirror
gonioscope

6. 1
MIRRO
R
2
MIRRORS
3
MIRROR
S
4
MIRROR
S

7. ANGLE STRUCTURE SEEN :
Posterior
 Ciliary body band
 Scleral Spur
 Trabecular Meshwork
 Schwalbe’s line
Anterior

9. GRADING
Scheie system
Based upon visibility
of number of
structures of the
angle.

10. GRADING
Shaffer system
The Shaffer system is based on angularity.
GRADE ANGLE CONFIGURATION STRUCTURES
VISIBLE
CHANCES OF CLOSURE
IV 35º-45º WIDEST ANGLE SL,TM,SS,CBB NIL
III 25º-35º OPEN ANGLE SL,TM,SS NIL
II 20º MODERATELY OPEN SL,TM POSSIBLE
I 10º VERY NARROW SL, anterior TM HIGHLY LIKELY
0 0º CLOSED NONE CLOSED

11. APPLICATION OF GONIOSCOPY:
Classification of Glaucoma
Localization of foreign bodies, abnormal blood vessels, tumors in angle
Demonstration of Peripheral Anterior Synechiae
Surgical aid in goniotomy
CONTRAINDICATION OF GONIOSCOPY:
Hyphaema
Compromised cornea (e.g., corneal ulcer)
Lacerated or perforated globe

12. Thank you