Journal article
Pigment Dispersion Syndrome/Pigmentary Glaucoma: Challenges in Diagnosis and Management
Optometry (Saint Louis, Mo.), Vol.83(6), pp.237-243
01 Jun 2012
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Abstract
Background: Pigment dispersion syndrome (PDS) refers to a bilateral pathological deposition of pigment onto the intraocular tissues of the anterior segment. The pigment is liberated from the iris by the mechanical rubbing of the posterior iris surface againstthe lens zonules. The released pigment follows the flow of aqueous and ultimately accumulates in the trabecular meshwork (TM). Pigmentary glaucoma (PG) is a potential sequela. Although PDS and PG predominantly occur in young, myopic white males, these conditions do affect the black population. However, the clinical presentation of PDS in blacks is variable and may confound the diagnosis.
Case Reports: Two patients with PDS are discussed. The first was a 28-year-old white male who indicated that he manifested blurred vision and brow ache whenever he underwent long, vigorous runs. Examination revealed a dense, vertical band of endothelial pigment on both corneae, iris transillumination defects in both eyes, and dense, 360 degree pigment on the TM of both eyes. At the time of presentation, the IOPs were not elevated, and there was no evidence of glaucoma. However, IOPs were found to be elevated when measured after the patient had engaged in a long run. Since the patient indicated that he would continue to engage in long runs and would persist in vigorous exercise, he was considered to be at risk for the development of PG. Various options were presented, and the patient finally opted for peripheral iridotomies. The patient has remained symptom-free for several years.
The second patient was a 65 year-old black male who presented for a second opinion regarding a diagnosis of normal tension glaucoma. He manifested some of the stigmata of PDS. However, gonioscopy revealed greater pigment in the superior angle than the inferior angle, a sign that pigment deposition had occurred many years earlier. The pigment dispersion process was deemed to be inactive. The IOPs measured 14 mmHg OU. The optic nerves revealed large, vertically elongated cups. The visual fields revealed glaucomatous defects. Inactive PG was diagnosed, and no treatment was instituted. The patient has been followed for several years with no increase in IOPs and no progression of optic nerve head cupping or visual field defects.
Conclusions: Diagnosing PDS and preventing consequent PDG in a young white patient involves careful, intuitive diagnostic testing and a step-wise approach to control IOP. Older black patients with subtle stigmata of PDS and burned-out PG may present with findings that masquerade as normal tension glaucoma and can be diagnostic challenges.
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Details
- Title
- Pigment Dispersion Syndrome/Pigmentary Glaucoma: Challenges in Diagnosis and Management
- Creators
- Bernard H. Blaustein - Salus UniversityJohn Mark Snyder
- Publication Details
- Optometry (Saint Louis, Mo.), Vol.83(6), pp.237-243
- Publisher
- Amer Optometric Assn Inc
- Number of pages
- 7
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- [Retired Faculty]; Pennsylvania College of Optometry (PCO)
- Identifiers
- 991022004633404721
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- Ophthalmology