Direct and indirect ophthalmoscopy in infants is always frustrating and frequently incomplete or impossible without general anesthesia. Infant gonioscopy is rarely even attempted with the child awake. A Koeppe type gonioscopic lens has been modified so that with its use these examinations may be accomplished in a high percentage of infants without subjecting them to general anesthesia.
This lens serves as an excellent lid separator, partially immobilizes the eye, optically dilates the pupil by 25%, and magnifies the angle structures by 40%. It increases the field of view of the fundus to approximately that seen by indirect ophthalmoscopy, thereby bringing more of the peripheral fundus into view and increasing the effective depth of focus of the direct ophthalmoscope. Most infant fundi can be viewed to the equator through an undilated pupil. Through a dilated pupil the more peripheral retina can be approached as readily as by indirect ophthalmoscopy. Should the
RICHARDSON KT, SHAFFER RN. Infant Ophthalmoscopy and Gonioscopy Without General Anesthesia. Arch Ophthalmol. 1965;73(1):55–57. doi:10.1001/archopht.1965.00970030057013
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