Lens-less gonioscopy in buphthalmos

Light rays from an angle hit the cornea–air interface at an angle greater than the critical angle and thus are internally reflected. This necessitates need for special gonioscopy lenses.[1–3] In cases of buphthalmos with anterior chamber enlargement, a gaze-assisted attempt can be made for angle structure evaluation without the need for any gonioscopy lens because now the incident rays from the angle do not surpass the critical angle. The image [Fig. 1] was taken with a smartphone with flash on and the subject looking temporally. This smartphone-based image can be a useful teaching and documentation tool in pediatric glaucoma/large cornea cases. A coaxial illumination–visualization device like an indirect ophthalmoscope would suffice for this method of examination. A 20 diopter lens, used with an indirect ophthalmoscope, can be used here as a simple magnifying lens (held close to the eye) to better examine the angle structures. The technique of examination is limited to cooperative subjects with clear corneas.Figure 1: A buphthalmic eye showing prominent iris processesAuthors’ contributions AAB- Concept, Imaging. PP- manuscript preparation and editing. Declaration of patient consent The author 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 this 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 The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.