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

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

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