The corneal wedge is a useful technique to identify the trabecular meshwork in eyes that are either nonpigmented or excessively pigmented. In these situations it can be challenging to tell where the trabecular meshwork begins. The most common use for the corneal wedge is in young patients where the trabecular meshwork has not yet developed any pigmentation. It can be difficult to determine whether one is looking at a wide-open and nonpigmented angle or a totally closed angle where one is looking at the internal cornea.
The corneal wedge can be explained by the first video clip. The slit beam is made very thin and bright. It is offset from the oculars. Through the gonioscopy lens the light beam will be seen to travel across the iris and the angle. Where it travels across the cornea one will notice two lines, one sharp and bright line that is contiguous with the line that travels across the iris and trabecular structures and another line that is broader and fuzzier on the outside of the cornea. If one follows the outside line from the cornea towards the angle it will continue until the cornea ends. It then illuminates the curved interface between the cornea and sclera at the limbus and joins the brighter inner beam at Schwalbe’s line.
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