Gonio 101

Tomek Wiraszka, PGY-4

Faculty: Dr. Brian Wong

Optics

Fig. 10.8 Optical principles of gonioscopy; n = refractive index; i = angle of incidence

Lenses- indirect
(Goldmann, Zeiss)

Indentation gonio in action

Fig. 10.12 Indentation gonioscopy in partial synechial angle clo

during indentation part of the angle becomes open (small arrow

Direct goniolenses for

surgery (Koeppe, Barkan,
Swan-Jacob)

g. 10.13 Koeppe goniolenses

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15.08.2

Normal angle anatomy

Angle

PAS

Van Herrick maneuver

Fig. 10.41 Primary angle-closure. (A) Closed angle; (B) van Heri
(Courtesy of L MacKeen fig. A; J Schuman, V Christopoulos, D D
Glaucoma, in Rapid Diagnosis in Ophthalmology, Mosby 2008

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Description

Grade

Comment

Full corneal
thickness +

Wide open

cornea
> x >1/4
cornea

Incapable of
closure

cornea

Should have
gonio

<1/4 cornea

Dangerously
narrow

Grading of angle

Shaeffer system
Grade 4 (3545) is the widest angle, characteristic of
myopia and aphakia, in which the ciliary body can be
visualized with ease.
Grade 3 (2535) is an open angle in which at least the
scleral spur can be identified.
Grade 2 (20) is a moderately narrow angle in which only the
trabeculum can be identified.
Grade 1 (10) is a very narrow angle in which only Schwalbe
line, and perhaps also the top of the trabeculum, can be
identified.
Slit angle is one in which there is no obvious iridocorneal
contact but no angle structures can be identified.
Grade 0 (0) is a closed angle due to iridocorneal contact
and is recognized by the inability to identify the apex of the
corneal wedge. Indentation gonioscopy will distinguish
appositional from synechial angle closure

Trauma

Fig. 21.14 Iris complications of blunt tr

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PXF

PDS

NVG

Fig. 10.52 Neovascular glaucoma. (A) Rubeosis iridis and angle-closure by PAS; (B) tiny capillary tufts on th

Secondary angle closure

Fig. 10.53 Secondary angle-closu

contact