PIGMENTARY GLAUCOMA

Pigmentary GLC is caused secondary to pigment dispersion syndrome (PDS).
              PDS is an uncommon bilateral condition characterized by pieces of iris pigment that is deposited in various structures of               the anterior segment, such as the endothelium of the cornea, the trabecular meshwork, and the anterior lens.
              PDS is caused by shedding of pigment, resulting from the mechanical rubbing between the posterior pigment layer of the               iris and the anterior surface of the zonular fibrils.

Pigmentary GLC: Accumulation of pigment may result in an elevation of IOP or irreparable damage to the meshwork that can be accompanied by uncontrollable GLC.
              - 20% of the people that display PDS also get Pigmentary GLC.
              - PDS and Pigmentary GLC mostly affects young, myopic people. Typically it is found more in myopic men in their 30’s               to 50’s.

CLASSIFICATIONS:
Stage 0: Iris chafing and/or Krukenberg’s spindle and angle pigmentation
Stage 1: Iris chafing, Krukenberg’s spindle and/or pigment granules on the iris and /or pigment on the anterior lens capsule in the       undilated pupillary zone, and angle hyperpigmentation.
Stage 2: Iris chafing, pigment granules on the corneal endothelium and/or on the iris and/or the anterior lens capsule in the       undilated pupillary zone, angle pigmentation as in stage 1, IOP higher than 21mmHg, and normal visual fields.
Stage 3: Visual field defects, which represent the diagnosis of pigmentary

GLC. TREATMENTS
Medical:
     - Drugs that constrict the pupil and tighten the peripheral iris decrease iridozonular rubbing and help take away the pigment        from accumulating in the meshwork.
     - Dapiprazole is an alpha-adrenergic blocking agent that acts on the iris dilator muscle without knocking out accommodation. ¨               The clearing of the trabecular meshwork takes about 3 months.
              Side effects: Foreign body sensation and ocular redness. ¨
Laser:
      - Treat with YAG laser Iridotomy.
              This helps prevent ocular hypertension.

RETINAL ASSOCIATIONS: PDS is closely associated with retinal degenerations.

REFERENCES:
1. Kanski, Clinical Ophthalmology. Pg. 259
2. Lehto, and Vesti. Current Opinion in Ophthalmology, 1998.

The classifications were taken verbatim from the article listed above.