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91 Cards in this Set
- Front
- Back
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what are you examining with gonio?
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the anterior chamber
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The ant. chamber angle is the filter and exit point for what?
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aqueous humor
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what physiological process affects the risk for glaucoma? What is the state of the angle which causes concern?
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dilation, the narrowness of the angle.
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Would you perform gonio after noticing a small angle when doing the Van Herrick technique?
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of course!
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Would you do gonio if the patient has a history of angle closure?
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yes
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Would you do gonio to rule out ischemic NVI? What could you rule out?
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yes, rule out uncontrolled diabetes and vein occlusion
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Would you do gonio to assess a peripheral anterior synechia?
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yes
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Name 5 others reasons to perform gonio.
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1-suspect glaucoma
2- evidence of NVI 3- evidence of neoplasms in AC or on iris behind limbus 4- evidence of inflammation or trauma 5- evidence of degenerative conditions of the anterior segment. |
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What structure of the eye prevents you from seeing the angle with just using the slit lamp?
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the opaque white nature of the limbal cornea.
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What quantifies the anterior chamber angle?
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anatomical zone b/t the iris root and descemet's membrane.
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What is the critical angle of total reflection dependent on?
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the refractive indices on either side of the interface.
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How does the design of the gonio lens enable you to view the angle. (long answer)
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the gonio lens involves placing a concave surface against the cornea-- this eliminates the cornea as a refracting surface. The obliquely inclined mirrors allow observation of the anterior chamber structures.
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What amazing and super talented man designed the gonio lens we use today?
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Goldmann
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any small difference in curvature b/t the lens and the cornea is minimized by a ______ b/t the 2 surfaces.
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fluid
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What distinguishes the various gonio lenses?
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the diameter of their contact surface.
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Small gonio lenses have a diameter of___? Large is____?
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<10 mm, >13 mm
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What do large lenses require?
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require an interface solution (used to mask the air/cornea interface difference)
(Large=Liquid) |
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What is the name of the 3-mirror?
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Goldmann
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What are 3 names of 4-mirror lenses?
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1- Posner
2- Zeiss 3- Sussman |
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What is the name of a single high plus lens?
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Koeppe
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Describe a direct lens system.
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this uses a high convex lens to view the AC. (no mirrors)
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Describe an indirect lens system.
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this uses mirrors + a slit lamp for AC evaluation.
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Goldmann contains 3 ______mirrors and is thus
a(n) ________ system? |
internal mirrors, indirect
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A D-shaped mirror is used to view the______?
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AC angle
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The trapezoid mirror is used to view the _____?
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mid-peripheral retina
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The cylindrical mirror is used to view the ____?
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ora seratta
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Goldmann 3-mirror requires the use of____?
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a viscous gel
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How many of the 3 mirrors is used to evaluated the angle?
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only 1
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The center lens may be used to get a _____ view of the post. pole.
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magnified
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Does the Koeppe gonio lens have mirrors?
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No!!
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The Koeppe is a ____ view of the angle?
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direct
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How many diopters is the koeppe gonio lens?
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50D
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Compare the mag of the koeppe to the mag of ziess and goldmann.
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The koeppe gives a Lower mag.(~1/2) As a result the field of view is doubled and has less distortion.
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When using the koeppe, do you need a slit lamp?
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No, patient lies down, face up.
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Does the koeppe lens require a viscous solution?
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yes
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When using the koeppe lens the clincian views the angle _____ of where he is located.
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opposite
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What are 2 gonio lens that require a viscous solution?
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1-goldmann
2-koeppe (any lens that has a large corneal contact area) |
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What are 2 choices of viscous solutions?
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1- goniosol
2- celluvisc |
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what is an advantage of using goniosol? a disadvantage?
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advantage= better view, less bubble formation
disadvantage= allergic RXN to the preservative BAK |
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What is an advantage of using celluvisc? disadvantage?
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advantage= less corneal disruption
disadvantage= greater frequency of bubble formation. |
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What are the needed supplies when performing goldmann 3-mirror? (5)
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1- lens
2- soap, water, saline, and 2% glutaraldehyde 3-anesthetic 4-methylcellulose sol'n 5-slit lamp |
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What will you use to numb the patient while doing gonio?
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0.5% proparacaine
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what mag do you use for goldmann gonio?
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16X
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What size beam for goldmann gonio? ______wide and ____ tall?
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wide parallelopiped, ~4mm wide, and maximum height.
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What angle should your light housing be when doing goldmann gonio?
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0 degrees
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The Koeppe is a ____ view of the angle?
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direct
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How many diopters is the koeppe gonio lens?
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50D
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Compare the mag of the koeppe to the mag of ziess and goldmann.
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The koeppe gives a Lower mag.(~1/2) As a result the field of view is doubled and has less distortion.
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When using the koeppe, do you need a slit lamp?
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No, patient lies down, face up.
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Does the koeppe lens require a viscous solution?
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yes
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When using the koeppe lens the clincian views the angle _____ of where he is located.
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opposite
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What are 2 gonio lens that require a viscous solution?
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1-goldmann
2-koeppe (any lens that has a large corneal contact area) |
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What are 2 choices of viscous solutions?
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1- goniosol
2- celluvisc |
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what is an advantage of using goniosol? a disadvantage?
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advantage= better view, less bubble formation
disadvantage= allergic RXN to the preservative BAK |
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What is an advantage of using celluvisc? disadvantage?
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advantage= less corneal disruption
disadvantage= greater frequency of bubble formation. |
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What are the needed supplies when performing goldmann 3-mirror? (5)
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1- lens
2- soap, water, saline, and 2% glutaraldehyde 3-anesthetic 4-methylcellulose sol'n 5-slit lamp |
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What will you use to numb the patient while doing gonio?
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0.5% proparacaine
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what mag do you use for goldmann gonio?
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16X
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What size beam for goldmann gonio? ______wide and ____ tall?
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wide parallelopiped, ~4mm wide, and maximum height.
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What angle should your light housing be when doing goldmann gonio?
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0 degrees
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What solution do you use to soak the gonio lens?
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2% glutaraldehyde
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The D-shaped mirror will be located ______ when on the eye.
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superiorly
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The angle is viewed ____ from the mirror.
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180 degrees
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If the mirror is at the 12:00 position, the angle viewed is at _____?
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6:00
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With the gonio lens in place, in which direction will you push the slit lamp(in, or out?) to bring the structures into focus?
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push in towards the patient.
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You must _____ the lens to view all of the angles.
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rotate
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The light beam must be ______ to the flat surface of the "D".
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perpendicular
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To view lateral angles, the slit beam should be rotated to the ______ position.
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horizontal
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T or F: It is best to forcefully pull the lens off of the cornea when you are done.
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False--this will cause corneal trauma!
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T or F: There is no need to perform a parallelopiped scan of the cornea after gonio.
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False! You must do this, and you may need to use a FL strip.
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What has happened if you see stippling over the entire cornea when you are scanning?
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Patient had a reaction to goniosol
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What has happened if you see patchy puntate staining?
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patient RXN to proparacaine.
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Describe the procedure for cleaning the gonio lens.
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1- 2% glutaraldehyde soak for 20 minutes
2- sterile saline rinse 3- dry with a lint free tissue or cotton towel 4- replace in lens container |
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What is the best choice for performing gonio if you have to take fundus photos?
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use celluvisc (instead of goniosol), this will prevent the possibility of corneal rxns. Better yet, use a 4 mirror lens (b/c it does not require a solution)
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To get deeper into the angle, have the patient _____?
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look toward the mirror slightly.
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T or F: Always check IOP BEFORE gonio.
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true
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What are the 3 things a clinician needs to examine when doing gonio?
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1- the openness of the angle
2- are the structures healthy? 3- anything unusual? |
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What is the last iris roll?
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Fuchs roll
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What is the most posterior AC angle structure?
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the CBB ( ciliary body band )
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What color is the CBB?
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grayish brown-white
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What does the CBB play a role in?
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aqueous production
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The CBB is broader ___ and ____?
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inferiorly, temporally
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What structure comes after the CBB?
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the SS (scleral spur)
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What color is the SS?
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thin whitish band
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What does the SS represent?
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the continuation of the sclera into the anterior chamber
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where is the SS?
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b/t the ciliary body and the TM
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What structure comes after the SS?
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The TM!
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The TM is like a ____? What does it do?
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sieve, it drains the aqueous from the anterior chamber.
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What color is the TM? What might you see in here?
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translucent gray. pigment
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Where will most of the pigment be within the TM? why?
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the posterior portion, b/c it is the filtering point
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T or F: darker eyes will have more pigment in the TM than lighter eyes.
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true
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