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Gonioscopy part 2

The first part of the two-part article reviewed the indications and contraindications to performing gonioscopy, the optics of the procedure, and the types of goniolens. In this second part , Dr Michael E Johnson adopts a practical 'how to' approach to the technique and discusses the recording of observations. Common variations of normal anterior chamber angles and angle abnormalities that are seen in primary eye care will also be described .

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Preparation

Instruction

Patients need to be told why it is necessary to put a lens on their eye. As a suggestion of what to say: 'I want to look in the corners of the eye where its internal fluid drains. This is because problems with the drainage of fluid from the eye can cause glaucoma. The drain of the eye is hidden from view and to see it I need to put a lens on to the tear film, on the eye's surface'. Patients should be reassured that the eye will be numbed and so the procedure will not be painful, although they may have an awareness of gentle pressure or coldness. Some clinicians suggest that warming the goniolens improves tolerance. If a Goldmann-type lens is to be used then patients should also be warned that during the procedure coupling solution may dribble onto the face, and that this is not harmful.

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