Gonioscopy in ophthalmology

Modern ophthalmology uses various diagnostic methods to accurately identify and localize eye diseases.Gonioscopy is considered one of the most accurate methods in determining violations of the organs of vision.

Method definition

Gonioscopy allows you to inspect the front of the eye with special lenses.This study allows us to identify some pathologies that are not determined by other diagnostic methods. They can be crucial in the diagnosis of certain diseases, one of which is glaucoma. To carry out this diagnostic procedure, a special device called a gonioscope or a gonioscopic lens is used.

Determination of the angle between the cornea and the iris and its examination allows us to identify at an early stage the occurrence of glaucoma and other dangerous diseases. With gonioscopy, you can find a solder between the iris and the cornea.

Do not abandon the diagnostic procedures, if they are insisted by an ophthalmologist.

Types of procedure

Gonioscopy, depending on the design of the optical device (lens), is divided into two types:

• direct gonioscopy;
• indirect gonioscopy.

In domestic ophthalmology, basically, four types of lenses are used:

• straight lens Keppe;
• gonioscope Krasnova;
• the Goldmann lens;
• gonioscope of Van-Boinningen.

The Keppe lens is placed directly on the cornea, pretreated with a special lubricant.In the ophthalmologic procedure using the Keppe lens, it is required that the patient lie horizontally, which limits the possibility of using a slit lamp.

Keppe's lens

The compact Krasnov gonioscope is a spherical prism with one reflecting edge. It is used together with a slit lamp. Such an instrument is usually equipped with eye clinics of polyclinics.

The Goldman lens allows for stereoscopic examination of the fundus and anterior chamber of the eye.The presence of three mirrors, which are located at different angles, allow you to explore the peripheral parts of the retina. The Goldman's lens does not rest on the cornea, but is located at some distance, and the gap is filled with a special lubricant.

The Van-Boinningen gonioscope is a prismatic design with four mirrors, which provides a study of the entire periphery of the retina.Mirrors are made on the basis of silver spraying, providing a reflective coefficient of up to 98%. Such coatings are not damaged by coherent radiation, therefore gonioscopes of this type are widely used to control laser operations.

Van-Boiningen gonioscope

The application of the gonioscope allows not only to examine the anterior chamber of the eye and all areas of the retina, but also to carry out such microsurgical operations as goniotomy and goniopuncture.

Goniotomy is a surgical intervention in the structure of the iris-corneal angle.The essence of the operation is to perform a miniature scalpel incision at a certain point. This procedure is indicated for congenital glaucoma and should be performed at an early age. In this case, a positive result is achieved in 75% of patients. In adulthood, such an operation is ineffective. During the surgical intervention, the gonioscope is superimposed on the cornea of ​​the eye and control is made through it, during the course of the operation.

Goniopuncture is indicated at the older age, when the goniototomy no longer yields the desired result. Nevertheless, the results of goniopuncture depend on the age of the patient. The earlier it will be held, the more chances of success. In this operation, not a cut is performed, but a puncture at one point of the sclera. The surgical instrument is introduced during the control with the help of a gonioscope.

Goniopuncture

In order to identify the child's congenital glaucoma and immediately proceed to treatment, visit the eye department within 1-2 months after birth.

Indications for diagnosis

Gonioscopy is considered a very important and accurate method of diagnosis.It is shown in the following cases:

• glaucoma;
• congenital pathologies of the eye;
• postoperative control;
• diagnosis of neoplasm;
• hit foreign body.

Glaucoma is characterized by changes in the angle of the anterior chamber of the eye, which can be detected only by gonioscopy.After carrying out antiglaukomatoznyh operations, the surgeon should control the outflow of intraocular fluid. When a tumor appears in the root of the iris, gonioscopy allows you to determine the boundaries of the tumor and decide on the question of surgical intervention. When a foreign body enters the visual organ, a visual inspection and, in some cases, an X-ray examination are required. If glass, plastic or aluminum particles fall into the eye, the X-ray will not show anything. Gonioscopy will help you pinpoint the location of the injury and identify the presence of foreign objects.

The process of antiglaucomatous operation in front of eyes

Gonioscopy is well tolerated by patients, as it does not cause painful sensations.There is only a slight discomfort from touching the cornea of ​​an alien object.However, some contraindications to the application of this procedure are available. Gonioscopy can not be performed with the following diseases:

• conjunctivitis;
• keratitis;
• corneal ulcers.

In addition, the procedure is not performed for patients who are under the influence of alcohol or drugs and a mental patient in the phase of aggression.The patient's allergic reaction to medications used during the procedure can also lead to the refusal of the medication.

Possible edema of the epithelium is not a contraindication to use, but it should be removed or reduced by instillation of a solution of glucose or glycerin.

Solution of glucose

Particularly dangerous for certain eye injuries are the smallest pieces of glass. They are very difficult to detect and in some cases they do not cause trouble.

Process of procedure

Before the gonioscopy, the ophthalmologist tells the patient in detail how the procedure will be performed. This will relieve some nervous tension of the patient.Then the following actions are sequentially performed:

1. The anterior surface of goniolinase is sterilized by special means.
2. Lubricant is applied to the working surface of the lens
3. An anesthetic is buried in the conjunctival region of the eye.
4. On the cornea is applied goniolinza.
5. Slit lamp is being adjusted to get a good view.
6. Using goniolinza, a detailed inspection is performed.
7. After the procedure is completed, the lens is carefully removed.
8. Antimicrobials are injected into the conjunctival area.

Conducting gonioscopy

Restrictions after surgery

After the gonioscopy, no restrictions are applied, but after the goniotomy and goniopuncture restrictions, of course, there are. First of all, it concerns the limitation of physical exertion.You can not lift and carry heavy objects, engage in any moving games and sports activities.In the first two weeks you can not visit the sauna, sauna and swimming pool.

If there is no possibility of completely giving up smoking, at least reduce the number of cigarettes consumed.You can not drink alcoholic beverages. The fact is that nicotine causes a vasospasm, which leads to an increase in blood pressure, which is very dangerous for the operated eye.

Postoperative period

After conducting goniotomy and goniopuncture, you must lie in bed for at least 24 hours.You need to get up as often as possible and do not bend over. It is not recommended for 4-5 days to use atropine and other drugs that can cause a dilated pupil. After these eye surgeries, there is rarely a prolonged inflammation, but the doctor usually prescribes antimicrobial droplets. Small hemorrhages resolve within 3-4 days. In the postoperative period, you need to follow a rational diet. Especially useful are vegetables, fruits and nuts. Beef and pork is better to replace the meat of poultry or fish.

Atropine - drops with relaxing effect

Acute, salty and pickled foods should be completely excluded from the diet. Meat is better to cook, but not fry.

results

In assessing the results of gonioscopy, the following are the main criteria:

• The angle between the cornea and the iris;
• Possible synechia.

The width of the angle determines the amount of fluid outflow.A large angle provides good drainage, while a too small angle makes it difficult to drain through the drainage system and can cause acute glaucoma.

Classification of the width of the angle between the cornea and the iris

Synechia or iris adhesions with surrounding tissues can lead to inflammatory processes in the structures of the eye.

Early diagnosis and timely treatment is a guarantee of vision recovery.

Video

conclusions

Glaucoma is one of the most common eye diseases. Very often there is congenital or hereditary glaucoma. To establish an accurate diagnosis and determine the type of disease, gonioscopy is used, which in most cases is the only method of diagnosis in case of neglected cases, but primary will always be tonometry - measurement of intraocular pressure.If there are unpleasant sensations in the eye or after an injury, you should immediately visit an ophthalmologist.