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78 Cards in this Set

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Unlike the 3-mirror, the 4-mirror sits _________, and thus you do not have a need for a fluid.
only on the cornea
The mirrors are angle at ___?
64 degrees
Can you use a fluid with
4-mirror if you want to?
yes
Name 3 types of 4-mirror.
1-Zeiss
2-Posner
3-sussman
The posner lens is made of ____ and has a ___ handle.
plastic, fixed
T of F: you must rotate the 4-mirror lens to see all 4 angles.
false
The small footplate allows you to perform ____ gonio.
compression
What is the purpose of compression gonio?
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.
If your patient has a PAS, upon compression gonio, will you be able to open up and see any more angle structures?
no, the iris is stuck and will not budge.
If compression WILL allow you to see deeper angle structures, then the patient has ______.
primary acute angle closure.
Will laser iridotomy help a patient with PAS.
no
Describe acute angle closure glaucoma.
iris is stuck to the lens near the pupil. Fluid accumulates in the post. chamber and causes an iris bombe.
The eye is ___ and ___ during an acute angle closure glaucoma attack.
red, painful
T of F: the patient may experience nausea and vomiting during an acute angle closure glaucoma attach.
true, they also have reduced vision and may see haloes.
What is an important step in the treatment of primary acute angle closure glaucoma? Why?
compression gonio. this allows some fluid to drain to lower the dangerously high IOP>
The 4-mirror is more/ or less stable over the eye than the 3-mirror.
4-mirror is LESS stable than e-mirror
Goldmann gonio lens provides a _____ view than the 4-mirror.
clearer
Would you perform gonio if you see hyphema during slit lamp.
No!. You could cause a re-bleed.
Would you perform gonio if your patient has a penetrating ocular injury?
no.
Would you perform gonio is your patient has a severe cornea trauma?
no, (ie. chemical burns or abrasions)
Would you perform gonio if the patient has an ocular surface infection?
no
For both 3-mirror and 4-mirror use _____ to numb the eye before gonio.
0.5% proparacaine
You can use ____ if you want to keep bubbles out.
artificial tears
The beam on the slit lamp should be oriented_____, ____ wide and ___ tall.
vertically, 3mm, maximum height
Mag for 4-mirror is _____?
16x same as 3-mirror
What is a lid speculum? Can you use if for gonio?
a device that holds the eye lids open. yes
The first angle to examine is the _____ angle. This means the light is placed over the ____ mirror.
inferior angle, light on the Superior mirror first
If you see a big glare on the view what can you do?
move the light housing outward about 5-10 degrees.
What is the only "thing" you will be rotating while doing gonio 4-mirror?
rotate the light beam. Vertical beam for sup/inf angle. horizontal beam for nas/temp angle.
For a better view, tilt the lens ____ the mirror.
away from
For a better view, have the patient look _____ the mirror.
towards
If you are looking at the inferior angle, tilt your lens ______?
slightly down (away from mirror)
For narrow angle, you can push on the edge of the lens in the ____ direction as the mirror you are looking in.
same
While looking at a narrow temporal angle, you can push on the edge of the lens over the _____ mirror.
nasal
Is it possible to use compression to break a fresh anterior synechia?
yes
What are 3 abnormalities that you may see when doing compression gonio?
1-iridodialysis (a ripped away iris
2- foreign bodies
3- cyclodialysis (ciliary body is separated from sclera--this causes hypotony)
What level disinfection is required for gonio lens?
high-level
What are 3 examples of high-level disinfectant substances?
1- 2% glutaraldehyde/20 minutes
2-3% H2O2/ 10 minutes
3- 1:10 bleach/15 minutes
Where do you put the bleach if you choose to use it?
in the little well/cup that touched the eye.
Do you turn the gonio lens on its side to soak it in glutaraldehde?
yes
Name 4 ways that the angle structures can be different from person to person.
1- congenital differences
2- pigment
3- width
4- iris processes
Does pigment increase with age?
yes
The wedge technique "point" directly to _____?
Schwalbe's line
What are 3 acquired individual differences in angle structures?
1-age
2- trauma
3-disease
What is the order (post to ant) of the angle structures?
CB, SS, TM,SL
Describe your light housing when performing the wedge technique.
optic section
Schwalbe's line is presisely where?
at the termination of decemet's membrane
The wedge looks like a __?
Y
T or F:The non-pigmented TM is anterior.
true
If you see a pinkish line, what are you looking at. What is it?
top of post. TM, Canal of Schlemm
The angle is at risk for closure if ______________.
if only half or less of the TM is visible in all quadrants.
The only angles you can check with the wedge technique are ___ and ___.
superior and inferior (due to light beam constraints)
When doing the wedge, what do you do with the light housing?
move it slowly to an angle of 20 degrees.
The bands of light forming the "Y" are on the corneal __ and __?
epithelium and endothelium
Should iris processes alarm you?
no, they are normal
The iris process connect the ___ to the ___?
peripheral iris, TM
Can iris processes elevate the IOP?
yes
_____ is a prominent anteriorly displaced Schwalbe's line. This occurs in 10-15% of normals
posterior embryotoxon
If you see NVI, should you rotate the gonio lens to see the entire 360 degrees?
yes, do this also to find a foreign body, looking at the PAS and angle recession
Where does NVI usually begin?
at the pupillary ruff (it could start at the angle though)
A blood vessel that crosses the SS is _____.
abnormal
What are the 3 characteristics of pigment dispersion syndrome?
1- iris transillumination
2-krukenburg's spindle
3-dense brown pigmentation of TM
DO people with pigment dispersion syndrome have an increased risk for glaucoma?
yes, by 50%
In angle recession, blunt trauma may tear the ___ from its insertion into the SS.
ciliary body
In angle recession, glaucoma may occur in ___ or ____.
month, years
Patients with angle recession will present with:
1-unilateral visual field loss
2- visual acuity loss
3-optic nerve head cupping
In angle recession, is it possible to to develop primary open angle glaucoma of the OTHER eye?
yes (WTF??)
NVI (the bad vessels) grow is a _____ direction, while "good" vessels are ___.
upwards, around
IN angle recession you will see ___ displaced iris which reveals a ____ CBB.
posterior, widened
Will a PAS occur as a result of angle recession?
yes, sadly but true
What is pseudoexfoliation syndrome?
material produced from the basement membrane of the ciliary epithelium, zonules and lens capsule: clogs up the TM.
Patients with pseudoexfiliation syndrome (PEFS) have ____ the risk for glaucoma.
6X
In PEFS, you will see ____ with the slit lamp.
You will also see __ with gonio.
white flaky material on pupillary margin and on anterior lens capsule.

irregular black pigment on the TM inferiorly
What is pathognomonic form PEFS? What is this?
Sampaolesi's line. THis is a scalloped band of pigment ANTERIOR to SL.
A ____ is the adhesion of peripheral iris to the corneal endothelium in the corneal periphery.
PAS
A PAS will cover up the ___?
TM
If a patient has a PAS with elevated IOP, they are said to have ________. (long title)
secondary angle closure without pupillary block
If you see a neoplasm in or near the angle, they have an _____?
angle tumor