Ohp Ii Mt 1 Packet 1

Front 1

T/F - Hyphema is a contraindication for gonio

Back 1

True

Front 2

T/F - Refractive surgery is not a contraindication for gonio.

Back 2

False - particularly recent refractive surgeries are a contraindication

Front 3

Besides looking at the anterior chamber angles, what else is gonioscopy used for?

Back 3

- Retinal 3-mirror eval
- Laser trabeculoplasty
- Compression gonioscopy: break angle closure attack, eval synechiae

Front 4

What is the direct method of gonioscopy?

Back 4

Koeppe lens - direct viewing w/ light source and viewing microscope

Front 5

What is the indirect method of gonioscopy?

Back 5

Employ mirrors mounted into a contact lens

Front 6

The Sussmann lens is a (#) mirror lens with (a handle/no handle)

Back 6

4-mirror, no handle

Front 7

The Posner lens is a (#) mirror lens with (a handle/no handle)

Back 7

4 mirror w/ stick handle

Front 8

The Zeiss gonio lens is a (#) mirror lens with (a handle/no handle)

Back 8

4 mirror w/ Unger holding fork

Front 9

T/F - The 3-mirror goniolens has better optics vs 4-mirror.

Back 9

True

Front 10

Which gonio lens is better for blepharospasm - 3 or 4 mirror?

Back 10

3 mirror (sticks to eye better)

Front 11

T/F - You can use a 3-mirror lens for compression gonioscopy.

Back 11

False - can use only 4 mirror

Front 12

T/F - The 4-mirror goniolens is less traumatic to the eye vs the 3-mirror.

Back 12

True

Front 13

T/F - The 4-mirror goniolens requires the same amount of fluid as the 3-mirror

Back 13

False - little or no fluid req'd for 4-mirror

Front 14

T/F - The 3-mirror goniolens requires more dexterity to manipulate vs the 4-mirror.

Back 14

False - 4-mirror req more dexterity

Front 15

How do you assess peripheral anterior synechiae (PAS) in indentation gonioscopy?

Back 15

Push on eye w/ 4-mirror and see if the PAS still sticks.

Front 16

T/F - Indentation gonioscopy can lower the IOP.

Back 16

TRUE - in the case of breaking an angle closure attack!

Front 17

Wrinkles on the posterior cornea during gonio is a sign of...

Back 17

either pushing too hard or deliberate indentation gonioscopy

Front 18

Your 70-year old patient has a bowed out iris because he has a thicker crystalline lens. You want to eval the inferior angle but your view is limited. How do you look into that angle?

Back 18

Tilt or slide the lens inferiorly (toward the angle being viewed) OR have the patient look up (look into the mirror).

Front 19

The Hruby lens in the Goldmann 3-mirror lens involves a __D power with an (inverted/upright) image.

Back 19

64D, upright

Front 20

Apical mirror = __°
Peripheral mirror = __°
Equatorial mirror = __°
Also name the shapes of each mirror.

Back 20

A = 59°, Bullet
P = 67°, Square
E = 73°, Trapezoid

Front 21

What features can you view with the apical, peripheral, and equatorial mirrors?

Back 21

A = Angle, Ora
P = Peripheral retina
E = Equatorial retina

Front 22

Name the order of the structures seen in the AC angle, starting from center to peripheral.

Back 22

Iris, Ciliary body, Scleral spur, Trabecular meshwork (pigmented, nonpigmented), Scwhalbe's line

Front 23

The ciliary body is __mm wide. Wider may indicate _____.

Back 23

0.5, angle recession

Front 24

What is the fibrous ring that attaches the CB to the TM?

Back 24

Scleral spur

Front 25

T/F - The nonpigmented trabecular meshwork is the filtering portion of the angle.

Back 25

False - the PIGMENTED TM is the filtering portion

Front 26

What is more posterior, the pigmented or nonpigmented TM?

Back 26

Pigmented is more Posterior (nonpigmented more anterior)

Front 27

You see a reddish tinge in Schlemm's Canal after you push really hard on your patient's eye with your goniolens. Within which AC angle structure do you see this reddish tint?

Back 27

Within the trabecular meshwork (remember the drainage of the aqueous goes thru the TM and into Schlemm's canal)

Front 28

T/F - TM pigmentation does not occur until puberty.

Back 28

True

Front 29

T/F - TM pigmentation decreases with pregnancy.

Back 29

False - incr w/ pregnancy

Front 30

T/F - TM pigment increases w/ age.

Back 30

True

Front 31

T/F - TM pigment increases with iris colors.

Back 31

True (whatever this means...just look at pg 4, 1st packet???)

Front 32

If you see pigment on the iris, SS, and CB, you would grade the pigmentation...

Back 32

4+

Front 33

A grade zero TM pigmentation indicates...

Back 33

granular, fine, gray color

Front 34

The termination of Descemet's is marked by this AC angle structure.

Back 34

Schwalbe's line

Front 35

What AC angle structure marks the anterior limit of the angle wall?

Back 35

Schwalbe's line

Front 36

What is Sampaolesi's line? Where in the AC angle is it typically seen?

Back 36

A wavy line of pigment seen in exfoliation patients, typically in inferior angle

Front 37

Your patient has an anteriorly displaced Schwalbe's line - what is this and what percent have it?

Back 37

Posterior embryotoxon, 15%

Front 38

The Van Herrick angle assesses the ratio of ___ to ___.

Back 38

Width of peripheral AC to width of cornea

Front 39

An angle of __:__ warrants gonioscopy in some cases.

Back 39

1/4:1

Front 40

Name the most posterior structure visible on Grade 4 of the Becker-Schaffer gonioscopy grading scale.

Back 40

Ciliary body

Front 41

Name the most posterior structure visible on Grade 3 of the Becker-Schaffer gonioscopy grading scale.

Back 41

Scleral spur

Front 42

Name the most posterior structure visible on Grade 2 of the Becker-Schaffer gonioscopy grading scale.

Back 42

Anterior TM

Front 43

Name the most posterior structure visible on Grade 1 of the Becker-Schaffer gonioscopy grading scale.

Back 43

Anterior TM/Schwalbe's line

Front 44

Name the most posterior structure visible on Grade 0 of the Becker-Schaffer gonioscopy grading scale.

Back 44

No visible structures

Front 45

TM without iris bow involves a (slight/moderate/high) risk of angle closure.

Back 45

slight

Front 46

What four characteristics must be recorded for angle assessment?

Back 46

- Most posterior structure
- Grade of TM pigment
- Iris approach (flat, moderate, bowed)
- Any angle anomalies

Front 47

What are the two ways that a gonio lens can be removed?

Back 47

- Pt looks up and blink
- Pt looks nasal and put pressure at edge of lens thru lower lid

Front 48

T/F - Irrigation after use of goniosol is optional.

Back 48

False - must irrigate eye well after using goniosol

Front 49

If your view thru the goniolens is steamy, what's going on?

Back 49

no fluid in lens

Front 50

For gonioscopy, what diagnoses are required for billing purposes?

Back 50

- Narrow angles
- Glaucoma suspect
- Glaucoma

Front 51

T/F - Angle closure occurs with a mid-dilated pupil.

Back 51

True

Front 52

T/F - A large corneal diameter is a risk factor for angle closure.

Back 52

False - small diameter

Front 53

Risk for angle closure = __mm central AC depth

Back 53

1.8

Front 54

T/F - Short axial length is a risk factor for angle closure

Back 54

True

Front 55

What is the "classic triad" for pigment dispersion syndrome?

Back 55

1) Krukenberg's spindle
2) Mid peripheral iris transillumination defects
3) Dense pigment in TM

Front 56

In pigment dispersion syndrome, Krukenberg's spindle is __mm in width, __mm in height.

Back 56

1-2mm, 3-6 mm

Front 57

Pigment on anterior segment structures (iris, peripheral lens) from pigment dispersion syndrome is called...

Back 57

Scheie's or Zentmeyer's line

Front 58

Pigment showering after dilation is a sign of...

Back 58

pigment dispersion syndrome

Front 59

T/F - IOP almost always increases in pigment dispersion syndrome.

Back 59

False - may or may not be elevated

Front 60

T/F - Sampaolesi's line is a normal sign and is not found in pigment dispersion syndrome.

Back 60

False - it IS found in pigment dispersion syndrome

Front 61

What happens to the ciliary body in angle recession? What does it look like in gonioscopy?

Back 61

CB gets torn open, thus CBB appears wide

Front 62

T/F - Previous intraocular surgery can cause periph anterior synechiae.

Back 62

True

Front 63

T/F - Chronic or intermittent angle closure can cause periph anterior synechiae

Back 63

True

Front 64

T/F - Uveitis is not a cause of periph anterior synechiae.

Back 64

False - uveitis does caues PAS

Front 65

T/F - Neovascularization of the iris can cause hyphema in an older patient.

Back 65

True

Front 66

Name the three causes of iris neo mentioned.

Back 66

DM, carotid disease, Hx of vein occlusion

Front 67

T/F - Iris neo involves BVs crossing over scleral spur

Back 67

True

Front 68

Which angle is the last to seal in angle closure during iris neo?

Back 68

Inferior angle

Front 69

How long can an angle closure take with iris neo?

Back 69

days, weeks, months

Front 70

What is the DDx of blood in Schlemm's canal?

Back 70

- Excessive pressure from gonio lens
- Incr episcleral venous pressure - look for engorged EVP (cavernous sinus fistula, thyroid dz, sturge-weber)
- Low IOP

Front 71

T/F - SLOCT allows assement of angles thru an opaque cornea

Back 71

True

Front 72

The image you see in fundus biomicroscopy is (inverted/upright) and (not reversed/reversed)?

Back 72

inverted, reversed