Pigmentary glaucoma Symptoms, Causes, Risk Factors, Diagnosis, Treatment & Prevention

Pigmentary Glaucoma

introduction

What is Pigmentary Glaucoma?

Pigmentary glaucoma is a type of secondary open angle glaucoma characterised by pigmentation of the trabecular meshwork, iris transillumination defects and pigments along the corneal endothelium. Individuals with the same findings who do not demonstrate optic nerve damage and/or visual field loss are classified as Pigment dispersion syndrome even if intraocular pressure is elevated.

Symptoms of Pigmentary glaucoma

  • Early – Asymptomatic 
  • Later – Loss of peripheral vision
  • Advanced – Loss of central vision
  • Episodes of haloes and blurry vision due to increased intraocular pressure brought about by vigorous exercise or dark exposure

Causes of Pigmentary glaucoma

  • Concave iris contour. 
  • Rubbing of the posterior iris surface against the anterior lens zonules.
  • Disruption of iris pigment epithelial cells
  • Release of pigment granules
  • Temporary  increase in  IOP overwhelming  the trabecular meshwork & decreased outflow
  • Overtime, pathological changes in trabecular meshwork lead to chronic increased IOP and secondary glaucoma 

Pigmentary glaucoma Risk Factors

  • Males in 30 years age group
  • Myopia
  • Concave iris and posterior iris insertion
  • Flat corneas
  • Family history
prevention

Pigmentary glaucoma Prevention

  • Avoiding vigorous and  jarring exercise
  • Regular periodic eye examination if there are signs of  pigment dispersion syndrome.

Pigmentary glaucoma Diagnosis 

Usually diagnosed on slit lamp and fundus examination by an ophthalmologist  along with the measurement of IOP and confirmed after undergoing the approximate test for glaucoma including Gonioscopy,Automated perimetry,pachymetry  and OCT of RNFL and ONH.

Pigmentary glaucoma Treatment

  • Topical anti glaucoma medication
  • Laser PI
  • Laser trabeculoplasty
  • Anti glaucoma filtering surgery
  • Glaucoma valve surgery
  • Cyclodestruction of the ciliary body (last resort)

 

Written by: Dr. Prathiba Surender – Head – Clinical Services, Adyar

FAQ

What is pigmentary glaucoma?

Pigmentary glaucoma is a type of secondary open angle glaucoma characterized by increased  pigmentation in the trabecular mesh work,  iris transillumination defects and pigments on the back of the corneal endothelium 

It is treated by antiglaucoma medication, laser and surgery. 

Long standing pigment dispersion causes structural damage to the trabecular mesh work which obstructs the aqueous outflow leading to increased IOP and glaucoma

Exercise has known to cause increase in pigment dispersion, thereby increasing the blockage in the trabecular mesh work and increasing the IOP

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