Pigmentary Glaucoma

What is Pigmentary Glaucoma?

Pigmentary glaucoma is classified as a secondary open-angle glaucoma, which means the drainage angle is open. However, a clog doesn’t allow eye fluid to drain consistently. 

A slight fluctuation in drainage rate leads to eye pressure spikes, permanently damaging the optic nerve. Pigment dispersion syndrome leads to glaucoma 30% of the time. 

While men and women develop PDS at the same rate, men develop pigmentary glaucoma at three times the rate as women.⁴ Pigmentary glaucoma affects younger people more than primary open-angle glaucoma.

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Pigmentary Glaucoma

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Dangers of Pigmentary Glaucoma

Those who develop glaucoma, or pigmentary glaucoma, are at risk of long-term vision problems.

These problems include:

• Vision loss
• Optic nerve damage
• Retinal detachment

Treatment can slow the disease’s progression. However, the optic nerve damage and vision loss are permanent.

Symptoms of Pigmentary Glaucoma

Because intraocular pressure tends to gradually increase over time, early stages of pigmentary glaucoma typically don’t have any symptoms. This is why glaucoma has also been called the “silent thief of sight.”

This is the progression of pigmentary glaucoma’s warning signs:

• Blind spots. Commonly in your peripheral vision (side vision)
• Changes to central vision. As the disease progresses, your visual acuity (distance vision) is affected
• Redness and halos around lights. Warning signs of pigment dispersion syndrome and glaucoma.

What is Pigment Dispersion Syndrome? 

Pigment dispersion syndrome (PDS) is a rare eye condition. It’s characterized by the spontaneous dispersion of pigment deposits or granules from the iris pigment epithelium (IPE).

These granules fall into the posterior iris surface or the back of your iris (the colored part of your eye). This can disturb aqueous humor fluid, which helps maintain eye pressure, by clogging the drainage system and trabecular meshwork (where eye fluid drains out). 

This results in elevated intraocular pressure (IOP). Increased IOP can lead to glaucoma.

Pigment Dispersion Syndrome Symptoms

Those with PDS typically don’t have any symptoms. Some people may have blurry vision or see halos around light or after exercise. 

Many people with PDS also have myopia (nearsightedness). PDS can lead to pigmentary glaucoma as pigment granules accumulate in the eye’s drainage system. 

Who is at Risk of Developing Pigmentary Glaucoma?

While primary glaucoma typically affects people over 60, pigmentary glaucoma is prevalent in younger, middle-aged adults. Common risk factors for PDS and pigmentary glaucoma include:

• Male
• Caucasian
• Nearsightedness (myopia)
• Family history of PDS
• People with flat corneas (transparent outer layer of the eye)

Pigmentary Glaucoma and Vigorous Exercise

Vigorous exercises are associated with PDS and pigmentary glaucoma. This is because some exercises’ strenuous movements and jarring motions can cause pigment granules to flake off the iris and into the eye fluid.

These exercises include:

• Jogging
• Basketball
• Combat sports
• Weight lifting
• Sit-ups and pull-ups

Some aerobic exercises such as biking, swimming, and walking promote lower intraocular pressure. This is because it improves blood flow to the brain and eyes. 

If you have PDS, consult an eye doctor before exercising. Before exercising, you can also take medications that lower eye pressure to prevent pressure spikes. 

Diagnosing Pigmentary Glaucoma

Because pigmentary glaucoma doesn’t have symptoms, getting an annual eye exam is important. This can detect early signs of glaucoma and other eye conditions.

An ophthalmologist diagnoses pigmentary glaucoma during an eye exam. They will look for evidence of pigment fragments in the drainage angle and check intraocular pressure. 

Optic nerve damage will be assessed by looking at the back of the eye. Vision field tests look for blind spots in the peripheral vision (side vision), and visual acuity tests screen for central and distance vision changes.  

Pigmentary Glaucoma Treatment

Lowering eye pressure is the first line of treatment for people diagnosed with pigmentary glaucoma. Medicated eye drops are the gold standard in reducing intraocular pressure, such as:

• Prostaglandins
• Timoptic
• Brimonidine
• Xalatan

Antiglaucoma miotics, including pilocarpine, contract the pupils. These eye drops help: 

• Reduce friction between the iris and lens
• Reduce eye pressure
• Promote the flow of aqueous humor (eye fluid)

Do You Need Surgery for Pigmentary Glaucoma?

If medication alone is ineffective at reducing and maintaining normal eye pressure, laser treatment and traditional filtration surgery may be necessary.

Options include: 

• Selective laser trabeculoplasty. Opens up the drainage angle to promote the outflow of fluid
• Laser iridotomy. Creates a small hole in the iris to move fluid out of the eye
• Trabeculectomy. Creates a bleb (reservoir) to capture fluid and decrease IOP
• Tube shunt surgery. Implants a hollow tube called a shunt to divert fluid into a reservoir and away from the eye

Pigmentary Dispersion Syndrome Treatment

PDS treatment varies depending on how it affects your eye pressure. If you have PDS with normal or slightly elevated IOP, there is a low risk for optic nerve damage. Because of this, you won’t need treatment other than seeing your ophthalmologist once a year.

However, PDS with elevated IOP has a greater risk of optic nerve damage. You’ll need eyedrops or laser therapy to lower your IOP.

Summary

Pigmentary glaucoma is a result of pigment dispersion syndrome. This occurs when pigment granules flake off the iris, affecting aqueous humor flow.

This disruption clogs your eye’s drainage system and trabecular meshwork, leading to intraocular pressure elevation (IOP). An elevated IOP causes damage to the optic nerve and causes pigmentary glaucoma. 

Pigmentary glaucoma can cause permanent damage, resulting in vision loss. Treatment starts with medicated eye drops to reduce eye pressure. However, if that’s ineffective, you may need laser treatment or traditional filtration glaucoma surgery.