Pigment dispersion syndrome involves the abnormal release of pigment from the iris that is deposited throughout the eye. Some patients may develop pigmentary glaucoma. The mechanical abrasion theory proposes that iris defects allow iris pigment to enter the eye. The abiotrophy theory suggests there is a genetic component. Symptoms are typically absent early on but later include vision loss. Signs include pigment deposition in tissues like the cornea and trabecular meshwork. Treatment focuses on lowering intraocular pressure through medications, laser trabeculoplasty, or surgery if needed. About 25-50% of patients may progress to pigmentary glaucoma.

1. MARC P. JAPITANA MD
Department of Ophthalmology
CLMMRH

2. OVERVIEW
PIGMENT DISPERSION SYNDROME
– abnormal amounts of pigment are liberated from the
posterior surface of the iris
– pigments are deposited all throughout the anterior and
posterior chambers of the eye
PIGMENTARY GLAUCOMA
– a secondary glaucoma that develops among patients
with PDS

3. PATHOPHYSIOLOGY
 The Mechanical Abrasion Theory
 Abiotrophy Theory

4. MECHANICAL ABRASION THEORY
 proposed by D.G. Campbell
 proposed that people with PDS often exhibits iris
transillumination defects
 iris transillumination defects (slitlike defects) –
there was a corresponding packet of zonules
attached to it.

5. MECHANICAL ABRASION THEORY

6. MECHANICAL ABRASION THEORY

7. MECHANICAL ABRASION THEORY

9. ABIOTROPHY THEORY
 Abiotrophy is the premature degeneration of
cells or tissues, especially when it is due to
genetic defects
 PDS might have a heritable component –
GPDS1 gene mapped in chromosome 7
 microscopic findings of iris tissue

12. EPIDEMIOLOGY
 Diagnosed on second and third decade of life
 PDS is equally prevalent among men and
female, PG is more common among males
 More common among whites
 More common on myopic patients
 Genetic association is under study

13. SYMPTOMS
EARLY: usually no symptoms; some may
have blurred vision with jarring
exercise
LATER: loss of peripheral vision
VERY LATE: loss of central vision

14. SIGNS
 CORNEA
– KRUKENBERG SPINDLE – pigment deposited on the
corneal endothelium and phagocytosed in the endothelial
cells
– pigments do not cause visual symptoms
– pigments do not harm the endothelium

16. SIGNS
 IRIS
– develops defects in pigment epithelium of the iris that can be
seen through transillumination
– pigments deposited on the anterior surface can cause iris to
appear darker

19. SIGNS
 PUPILS
– change in the function of the pupil
– in asymmetric disease, larger pupil is found in the affected
eye
 ANTERIOR CHAMBER
– anterior chamber is usually deep

20. SIGNS
 IRIDOCORNEAL ANGLE
– open angle
– densed trabecular pigment
– backbowed iris
* gonioscopy is of importance to visualize the angle

23. SIGNS
 POSTERIOR CHAMBER
– pigments can accumulate at the junction of the lens and
posterior zonules
– SCHEIE STRIPE or ZENTMEYER LINES
– best examined in dilated pupils
– gonioscopy in of benefit

24. In Summary ...
 Classic triad of clinical signs of PDS
– Krukenberg spindle
– slitlike, radial, midperipheral iris transillumination
defects
– pigment deposition on the trabecular meshwork

25. TREATMENT
 Treated like POAG
 Cholinergic agonist drugs (Pilocarpine) –
induces miosis and lifts iris from the zonules
– not well tolerated by myopics
– may increase risk for developing retinal detachment
– pilocarpine Ocusert can be used to lessen side effects

26. TREATMENT
 Laser Trabeculoplasty may be beneficial in PG
 Laser Iridotomy – in PG patients with iris
backbowing
Not an ideal choice in the following patients
1. Patients with PDS with no Ocular Hypertension and may never
develop optic nerve damage
2. Patients with advanced glaucomatous damage taking multiple
medications

27. TREATMENT
 Trabeculectomy – if medical and laser therapy
fails
– increased risk for failure
– antimetabolites should be used with caution
– myopic males is at increased risk to develop hypotony
maculopathy

28. PROGNOSIS
 25 to 50% of patients with PDS will progress to
Pigmentary Glaucoma (PG)
 6 to 8% of patients with PDS & PG will develop
retinal detachment

29. THANK YOU!