Narrow Angle on Cholinergic

Sometimes the iris is bowed forward making visualization of the iridocorneal angle quite challenging. In many of these eyes the angle is open but the iris bowing obscures the view (Figure 1). This was a bigger problem when cholinergic agents, such as pilocarpine, were commonly used. One can have the patient look into the examining mirror or tip the lens towards the angle being examined to look over the hill and into the angle. In general, if one can readily see over the hill and into the angle without indenting, the angle is not occludable.

In this patient using pilocarpine the angle looks closed. However, when the patient looks into the mirror we can see over the hill and into the angle.