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Investigations for Glaucoma

  1. Provocative Tests:
    1. For PACG
      1. Mydriatic test: Rise in IOP of >8mmHg after instillation of tropicamide.
      2. Dark Room test: Patient in dark room for 60-90 min. If > 8 mmHg rise in IOP; test is     +ve.
      3. Prone test: Rise in IOP > 8mm after prone position.
      4. Dark room prone test: Combined test of Dark room test + Prone test.
      5. Mydriatic Miotic test: Pilocarpine test: 10% phenylephrine and 2% pilocarpine - causes
      6. Mid dilated pupil and max pupillary block.
    2. For poag:
      Water Drinking Test.
  2. Measurement of IOP


Self tonometer : Rebound tonometer ( I- care )

Contact lenses for 24 hr IOP monitoring : Kragerfisher

  1. Gonioscopy: Visualization of angle ancctures

Angle Structures On Gonioscopy
(From Anterior Posterior)

  1. Schwalbes' line
  2. Non-pigmented trabecular meshwork
  3. Pigmented trabecular meshwork
  4. Scleral spur
  5.  Ciliary body band
  6. Root of iris

Two types:

  1. Indirect - Goldman, Zeiss
  2. Direct - Keoppe lens (used in goniotomy)



Combined kinetic and static: Goldmann Perimeter.

Campimetry: Central visual field evaluation (Central 300).




Other methods of ONH Evaluation -

  • Monophotography and stereophotography of ONH.
  • Confocal scanning laser topography and nerve fibre layer analyzer.
  • GDX [Glaucoma diagnostic) and HRT [Heidelberg retinal tomograph]
  • OCT can also be used for retinal nerve fiber [RNFL] analysis.

F. Investigations in children


  1. Tonometry                               
  2. Corneal diameter measurement
  3. Gonioscopy (Koeppe)                       
  4. Ophthalmoscopy
  5. Axial length measurement

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