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 Table of Contents  
Year : 2023  |  Volume : 3  |  Issue : 1  |  Page : 198-199

Gonioscopy: The third eye of an ophthalmologist

Department of Ophthalmology, AIIMS, Jodhpur, Rajasthan, India

Date of Submission26-Jun-2022
Date of Acceptance21-Sep-2022
Date of Web Publication20-Jan-2023

Correspondence Address:
Nikhil Agrawal
Room No 3116 AIIMS Academic Block, AIIMS, Jodhpur, Rajasthan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_1531_22

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Keywords: Gonioscopy, Foreign body, Angles

How to cite this article:
Agrawal N, Shakrawal J, Singh KJ, Ranawat A, Bhatnagar K, Meena S, Tandon M. Gonioscopy: The third eye of an ophthalmologist. Indian J Ophthalmol Case Rep 2023;3:198-9

How to cite this URL:
Agrawal N, Shakrawal J, Singh KJ, Ranawat A, Bhatnagar K, Meena S, Tandon M. Gonioscopy: The third eye of an ophthalmologist. Indian J Ophthalmol Case Rep [serial online] 2023 [cited 2023 Jun 1];3:198-9. Available from: https://www.ijoreports.in/text.asp?2023/3/1/198/368149

A 42-two-year-old male—a laborer by occupation—presented with chief complaints of foreign body sensation and conjunctival redness in the right eye. A month ago, the patient underwent ocular trauma while working at the construction site. He consulted a nearby vision center. The patient was managed conservatively on an antibiotic and steroid combination for four weeks but was later referred to a higher center due to persistent congestion. On examination, his visual acuity was 20/20 in both eyes, but there was the presence of mild conjunctival congestion in the right eye. Intraocular pressure was 14 mmHg in both eyes. On slit-lamp evaluation, a self-sealed corneal perforation of 1.5 mm was noted in the right eye; Seidel's test was negative and the anterior chamber showed occasional cells and a solid creamy white lesion at the 6 o'clock position [Figure 1]a. Anterior segment examination of the left eye was within normal limits. Fundus examination was also unremarkable in both eyes. X-ray orbit showed the presence of a foreign body [Figure 1]. However, the exact location could not be determined. Therefore, a gonioscopy of the right eye was performed, which revealed a suspicious foreign body lodged in the inferior angle [Figure 1]b. The findings were confirmed on anterior segment optical coherence tomography (ASOCT) [Figure 1]c. On surgical exploration, a metallic foreign body of 2.5 mm in largest diameter was retrieved from the inferior angle [Figure 1]e.
Figure 1: (a) Solid, creamy, white mass lesion at 6 o'clock position (arrow) and self-sealed corneal perforation (arrowhead) seen on slit-lamp evaluation. (b) Foreign body seen in inferior angles on gonioscopy. (c) Foreign body visualized on anterior segment OCT (arrow). (d) Foreign body detected on X-ray (arrow). (e) Intraoperative photograph of metallic foreign body retrieved from the angle

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  Discussion Top

Penetrating ocular trauma is a potentially vision-threatening injury, and retained intraocular foreign bodies often pose a significant challenge to the treating ophthalmologist.[1],[2] If undetected, they may present with persistent or recurrent inflammation in the eye. Our case is unique as the foreign body was diagnosed only after one month with the help of gonioscopy.[3],[4]

Besides, radiological investigations like X-ray, ancillary investigations, gonioscopy, ultrasound biomicroscopy, and ASOCT should be done in suspected cases to rule out any retained foreign bodies in angles. These tests not only aid in diagnosing metallic and non-metallic foreign bodies but are also helpful in determining their exact location. However, among them also, gonioscopy is the cheapest and most readily available investigation.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Ali NAM, Buscombe CP, Jones DH. Intraocular foreign body in the anterior cham ber angle of the eye-a 30-year-old 'emergency'. Oxf Med Case Reports 2021;2021:omab032. doi: 10.1093/omcr/omab032.  Back to cited text no. 1
Davidson RS, Sivalingam A. A metallic foreign body presenting in the anterior chamber angle. CLAO J 2002;28:9-11.  Back to cited text no. 2
Graffi S, Tiosano B, Ben Cnaan R, Bahir J, Naftali M. Foreign body embedded in anterior chamber angle. Case Rep Ophthalmol Med 2012;2012:631728. doi: 10.1155/2012/631728.  Back to cited text no. 3
Yeniad B, Beginoglu M, Ozgun C. Missed intraocular foreign body masquerading as intraocular inflammation: Two cases. Int Ophthalmol 2010;30:713-6.  Back to cited text no. 4


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