Final answer:
The next appropriate step after finding an elevated IOP and notching during gonioscopy is to perform a fundoscopic examination to check for optic nerve damage indicative of glaucoma.
Step-by-step explanation:
If a patient has an incidental finding of intraocular pressure (IOP) of 26mmHg and gonioscopy shows all four structures with inferior notching, the next appropriate step would be to perform a fundoscopic examination. This is crucial to assess the optic nerve and to check for signs of glaucomatous damage. A fundoscopic examination can reveal if the elevated IOP has led to optic nerve head changes, such as cupping, which are indicative of glaucoma. Referring the patient to an ophthalmologist may follow if there is evidence of glaucoma or if the initial findings are inconclusive. Starting the patient on anti-glaucoma medication without proper diagnosis and evaluation could be premature. Repeating the measurement of IOP may also be necessary if there is a suspicion that the initial reading was not accurate.