Procedure for Performing Gonioscopy - A Comprehensive Guide

Introduction

Gonioscopy is a specialized eye examination that allows doctors to view the angle of the eye, which is critical for diagnosing certain eye conditions and diseases. Understanding the detailed procedure is essential for both ophthalmologists and patients. This guide will walk you through each step involved in performing a gonioscopy.

Step-by-Step Procedure for Gonioscopy

Telling the Patient and Obtaining Informed Consent Explain the indications for the test, ensuring the patient understands why the gonioscopy is necessary. Obtain written consent from the patient, ensuring they are fully aware of the procedure and any associated risks. Cleaning and Disinfecting the Gonioscopy Lens Clean and disinfect the gonioscopy lens to ensure hygiene and clear vision. Fill the gonioscopy lens with a viscous coupling solution, ensuring not to create any bubbles that could interfere with the view. Anesthesizing the Eyes Apply anesthetic drops to both eyes to ensure the patient is comfortable during the examination. Aligning the Biomicroscope Systems Set up the illumination and observation systems of the biomicroscope. Adjust the magnification to 1 and set the rheostat to low or medium intensity. Pull the biomicroscope towards yourself for better visibility. Inserting the Gonioscopy Lens Move the microscope to a side or rotate the lens holder to insert the lens. Instruct the patient to look up and gently insert the lens. Ask the patient to slowly look straight ahead while you wipe off any excess solution. Handling the Gonioscopy Lens Hold the lens with your left hand when examining the right eye and vice versa. Using the Vertical Parallelopiped Beam Use a vertical parallelopiped beam that is 1-3 mm wide, adjusting the light intensity to a moderate level to avoid pupil constriction. Starting the Examination Begin with the thumbnail mirror in the 12 o'clock position to view the inferior angle first. The inferior quadrant is usually the widest and most pigmented, making it easier to identify the structures. Identify the prominent pigmented posterior structures, such as the Ciliary Body (CB) band, and recognize the adjacent angle structures moving from posterior to anterior. Identifying Structures in Narrow Angle Use the focal line technique to locate the Schwalbe's line if the CB band is not visible in a narrow angle. Use a bright optic section at a 20-degree angle with the mirror in the 12 o'clock position. Observing Other Angles Rotate the lens by 90 degrees to observe the nasal or temporal angle with one hand maintaining contact with the eye and the other hand for rotation. Systematic Examination Examine all quadrants through a 360-degree rotation in a systematic manner. Removing the Lens Remove the lens by simply releasing it from the cornea after completing all necessary observations.

Closure

Performing gonioscopy requires meticulous attention to detail and adherence to strict procedures. By following the steps outlined in this guide, eye care professionals can ensure accurate and thorough examinations of the eye angle. If you are a patient seeking a gonioscopy, understanding these steps can help you better prepare for the procedure and what to expect.