4-Mirror Gonioscopy

Front 1

Unlike the 3-mirror, the 4-mirror sits _________, and thus you do not have a need for a fluid.

Back 1

only on the cornea

Front 2

The mirrors are angle at ___?

Back 2

64 degrees

Front 3

Can you use a fluid with
4-mirror if you want to?

Back 3

yes

Front 4

Name 3 types of 4-mirror.

Back 4

1-Zeiss
2-Posner
3-sussman

Front 5

The posner lens is made of ____ and has a ___ handle.

Back 5

plastic, fixed

Front 6

T of F: you must rotate the 4-mirror lens to see all 4 angles.

Back 6

false

Front 7

The small footplate allows you to perform ____ gonio.

Back 7

compression

Front 8

What is the purpose of compression gonio?

Back 8

To indent the central cornea to cause the aqueous in the anterior chamber to be pushed back over the peripheral iris. This will lower the IOP.

Front 9

If your patient has a PAS, upon compression gonio, will you be able to open up and see any more angle structures?

Back 9

no, the iris is stuck and will not budge.

Front 10

If compression WILL allow you to see deeper angle structures, then the patient has ______.

Back 10

primary acute angle closure.

Front 11

Will laser iridotomy help a patient with PAS.

Back 11

no

Front 12

Describe acute angle closure glaucoma.

Back 12

iris is stuck to the lens near the pupil. Fluid accumulates in the post. chamber and causes an iris bombe.

Front 13

The eye is ___ and ___ during an acute angle closure glaucoma attack.

Back 13

red, painful

Front 14

T of F: the patient may experience nausea and vomiting during an acute angle closure glaucoma attach.

Back 14

true, they also have reduced vision and may see haloes.

Front 15

What is an important step in the treatment of primary acute angle closure glaucoma? Why?

Back 15

compression gonio. this allows some fluid to drain to lower the dangerously high IOP>

Front 16

The 4-mirror is more/ or less stable over the eye than the 3-mirror.

Back 16

4-mirror is LESS stable than e-mirror

Front 17

Goldmann gonio lens provides a _____ view than the 4-mirror.

Back 17

clearer

Front 18

Would you perform gonio if you see hyphema during slit lamp.

Back 18

No!. You could cause a re-bleed.

Front 19

Would you perform gonio if your patient has a penetrating ocular injury?

Back 19

no.

Front 20

Would you perform gonio is your patient has a severe cornea trauma?

Back 20

no, (ie. chemical burns or abrasions)

Front 21

Would you perform gonio if the patient has an ocular surface infection?

Back 21

no

Front 22

For both 3-mirror and 4-mirror use _____ to numb the eye before gonio.

Back 22

0.5% proparacaine

Front 23

You can use ____ if you want to keep bubbles out.

Back 23

artificial tears

Front 24

The beam on the slit lamp should be oriented_____, ____ wide and ___ tall.

Back 24

vertically, 3mm, maximum height

Front 25

Mag for 4-mirror is _____?

Back 25

16x same as 3-mirror

Front 26

What is a lid speculum? Can you use if for gonio?

Back 26

a device that holds the eye lids open. yes

Front 27

The first angle to examine is the _____ angle. This means the light is placed over the ____ mirror.

Back 27

inferior angle, light on the Superior mirror first

Front 28

If you see a big glare on the view what can you do?

Back 28

move the light housing outward about 5-10 degrees.

Front 29

What is the only "thing" you will be rotating while doing gonio 4-mirror?

Back 29

rotate the light beam. Vertical beam for sup/inf angle. horizontal beam for nas/temp angle.

Front 30

For a better view, tilt the lens ____ the mirror.

Back 30

away from

Front 31

For a better view, have the patient look _____ the mirror.

Back 31

towards

Front 32

If you are looking at the inferior angle, tilt your lens ______?

Back 32

slightly down (away from mirror)

Front 33

For narrow angle, you can push on the edge of the lens in the ____ direction as the mirror you are looking in.

Back 33

same

Front 34

While looking at a narrow temporal angle, you can push on the edge of the lens over the _____ mirror.

Back 34

nasal

Front 35

Is it possible to use compression to break a fresh anterior synechia?

Back 35

yes

Front 36

What are 3 abnormalities that you may see when doing compression gonio?

Back 36

1-iridodialysis (a ripped away iris
2- foreign bodies
3- cyclodialysis (ciliary body is separated from sclera--this causes hypotony)

Front 37

What level disinfection is required for gonio lens?

Back 37

high-level

Front 38

What are 3 examples of high-level disinfectant substances?

Back 38

1- 2% glutaraldehyde/20 minutes
2-3% H2O2/ 10 minutes
3- 1:10 bleach/15 minutes

Front 39

Where do you put the bleach if you choose to use it?

Back 39

in the little well/cup that touched the eye.

Front 40

Do you turn the gonio lens on its side to soak it in glutaraldehde?

Back 40

yes

Front 41

Name 4 ways that the angle structures can be different from person to person.

Back 41

1- congenital differences
2- pigment
3- width
4- iris processes

Front 42

Does pigment increase with age?

Back 42

yes

Front 43

The wedge technique "point" directly to _____?

Back 43

Schwalbe's line

Front 44

What are 3 acquired individual differences in angle structures?

Back 44

1-age
2- trauma
3-disease

Front 45

What is the order (post to ant) of the angle structures?

Back 45

CB, SS, TM,SL

Front 46

Describe your light housing when performing the wedge technique.

Back 46

optic section

Front 47

Schwalbe's line is presisely where?

Back 47

at the termination of decemet's membrane

Front 48

The wedge looks like a __?

Back 48

Y

Front 49

T or F:The non-pigmented TM is anterior.

Back 49

true

Front 50

If you see a pinkish line, what are you looking at. What is it?

Back 50

top of post. TM, Canal of Schlemm

Front 51

The angle is at risk for closure if ______________.

Back 51

if only half or less of the TM is visible in all quadrants.

Front 52

The only angles you can check with the wedge technique are ___ and ___.

Back 52

superior and inferior (due to light beam constraints)

Front 53

When doing the wedge, what do you do with the light housing?

Back 53

move it slowly to an angle of 20 degrees.

Front 54

The bands of light forming the "Y" are on the corneal __ and __?

Back 54

epithelium and endothelium

Front 55

Should iris processes alarm you?

Back 55

no, they are normal

Front 56

The iris process connect the ___ to the ___?

Back 56

peripheral iris, TM

Front 57

Can iris processes elevate the IOP?

Back 57

yes

Front 58

_____ is a prominent anteriorly displaced Schwalbe's line. This occurs in 10-15% of normals

Back 58

posterior embryotoxon

Front 59

If you see NVI, should you rotate the gonio lens to see the entire 360 degrees?

Back 59

yes, do this also to find a foreign body, looking at the PAS and angle recession

Front 60

Where does NVI usually begin?

Back 60

at the pupillary ruff (it could start at the angle though)

Front 61

A blood vessel that crosses the SS is _____.

Back 61

abnormal

Front 62

What are the 3 characteristics of pigment dispersion syndrome?

Back 62

1- iris transillumination
2-krukenburg's spindle
3-dense brown pigmentation of TM

Front 63

DO people with pigment dispersion syndrome have an increased risk for glaucoma?

Back 63

yes, by 50%

Front 64

In angle recession, blunt trauma may tear the ___ from its insertion into the SS.

Back 64

ciliary body

Front 65

In angle recession, glaucoma may occur in ___ or ____.

Back 65

month, years

Front 66

Patients with angle recession will present with:

Back 66

1-unilateral visual field loss
2- visual acuity loss
3-optic nerve head cupping

Front 67

In angle recession, is it possible to to develop primary open angle glaucoma of the OTHER eye?

Back 67

yes (WTF??)

Front 68

NVI (the bad vessels) grow is a _____ direction, while "good" vessels are ___.

Back 68

upwards, around

Front 69

IN angle recession you will see ___ displaced iris which reveals a ____ CBB.

Back 69

posterior, widened

Front 70

Will a PAS occur as a result of angle recession?

Back 70

yes, sadly but true

Front 71

What is pseudoexfoliation syndrome?

Back 71

material produced from the basement membrane of the ciliary epithelium, zonules and lens capsule: clogs up the TM.

Front 72

Patients with pseudoexfiliation syndrome (PEFS) have ____ the risk for glaucoma.

Back 72

6X

Front 73

In PEFS, you will see ____ with the slit lamp.
You will also see __ with gonio.

Back 73

white flaky material on pupillary margin and on anterior lens capsule.

irregular black pigment on the TM inferiorly

Front 74

What is pathognomonic form PEFS? What is this?

Back 74

Sampaolesi's line. THis is a scalloped band of pigment ANTERIOR to SL.

Front 75

A ____ is the adhesion of peripheral iris to the corneal endothelium in the corneal periphery.

Back 75

PAS

Front 76

A PAS will cover up the ___?

Back 76

TM

Front 77

If a patient has a PAS with elevated IOP, they are said to have ________. (long title)

Back 77

secondary angle closure without pupillary block

Front 78

If you see a neoplasm in or near the angle, they have an _____?

Back 78

angle tumor