Gonioscopic

Gonioscopic refers to anything related to gonioscopy, a ophthalmic examination used to visualize the iridocorneal angle where aqueous humor drains from the eye. The term is applied to procedures, findings, or techniques that involve inspecting the anterior chamber angle to assess its anatomy and openness.

The examination is typically performed with the patient seated at a slit lamp. After instilling topical anesthesia, a sterile contact lens or goniolens is placed on the cornea with a coupling fluid. The examiner uses slit-lamp illumination to view the angle structures through the lens, rotating the lens to assess all quadrants (superior, inferior, nasal, temporal). Indentation gonioscopy may be employed to evaluate angle dynamics by applying gentle corneal pressure, helping distinguish appositional closure from synechial closure. Modern practice often uses multiple-mirror lenses (eg, four- or three-mirror lenses) to obtain a comprehensive view.

Indications include evaluation of suspected or known glaucoma, assessment of angle anatomy before procedures, and investigation of occludable or narrow angles, pigment dispersion, angle recession, neovascularization, or peripheral anterior synechiae. Findings are commonly graded using systems such as Shaffer or Spaeth, which describe angle width and configuration but do not substitute for clinical judgment.

Limitations include patient cooperation, corneal clarity, and lens comfort. Proper technique and sterile preparation reduce risks such as corneal abrasions. Gonioscopic examination remains a core tool in glaucoma diagnosis and management, providing essential information about the angle that cannot be obtained from standard anterior segment examination alone.