Oman Journal of Ophthalmology

CLINICAL IMAGE
Year
: 2010  |  Volume : 3  |  Issue : 1  |  Page : 36--37

Pigment dispersion syndrome: An atypical presentation


S Bhallil, AI. Benatyia, B El--Mahjoubi, O El-Abdouni, H Tahri 
 Department of Ophthalmology, University Hospital, Hassan II Fez, Morocco

Correspondence Address:
S Bhallil
BP 2830 fès principale 300 00 fez
Morocco




How to cite this article:
Bhallil S, AI. Benatyia, El--Mahjoubi B, El-Abdouni O, Tahri H. Pigment dispersion syndrome: An atypical presentation.Oman J Ophthalmol 2010;3:36-37


How to cite this URL:
Bhallil S, AI. Benatyia, El--Mahjoubi B, El-Abdouni O, Tahri H. Pigment dispersion syndrome: An atypical presentation. Oman J Ophthalmol [serial online] 2010 [cited 2022 May 27 ];3:36-37
Available from: https://www.ojoonline.org/text.asp?2010/3/1/36/60022


Full Text

Pigment dispersion syndrome (PDS) occurs most commonly in middle-aged myopic patients and is characterized by concentric iris pigmentation, iris transillumination defects, backbowing, Krukenberg spindle, and dense pigment deposits in the trabecular meshwork. [1] It can lead to elevated intraocular pressure (IOP) and glaucoma. [1] We describe a case of atypical PDS in a 30-year-old man with hypermetropia of +2.5 diopters.

A 30-year-old man presented with asymmetric pigment dispersion resulting in pigmentary glaucoma in the right eye. There was no family history of glaucoma. On examination, the patient's uncorrected visual acuity was 20/25 in the right eye (OD) and 20/20 in the left eye (OS). Refraction revealed hypermetropia of +2.5 diopters. Intraocular pressure was 38 mmHg OD and 16 OS. Both corneas were clear. Corneal pachymetry was 520 µm OD and 530 µm OS. Slit-lamp examination revealed Krukenberg spindle [Figure 1] with concentric iris pigmentation [Figure 2]. We noted absence of iris transillumination defects. Gonioscopy revealed heavy pigmentation of the trabecular meshwork [Figure 3]. The optic disk appearances and visual fields were within normal limits.

PDS results from iridozonular friction and some possible contribution from iridociliary process contact with resultant liberation of pigment from the posterior iris. In majority of the patients with PDS, there is a concave approach of the iris as it inserts into the anterior chamber angle. [1],[2] The cause of this concavity remains unclear. [1] The liberated pigment accumulates on the corneal endothelium, the front surface and the circumferential furrows of the iris, the posterior lens capsule and lens zonules within the trabecular meshwork. This pigment dispersion is mainly due to aqueous convection currents. [1],[2] When aqueous outflow is affected and intraocular pressure rises, nerve damage may ensue. This process is known as pigmentary glaucoma (PG). Pigment dispersion syndrome has been found most commonly in patients between the ages of 30 and 50 years. [3] Myopia is frequently associated with pigment dispersion syndrome with a mean myopic correction of-3.9 diopters. [3] Hypermetropia with PDS has been rarely reported. [4]

The risk of developing pigmentary glaucoma from pigment dispersion syndrome is about 10% in most series. Young, myopic men were most likely to have pigmentary glaucoma. [3] An IOP greater than 21 mmHg at initial examination is usually associated with an increased risk of conversion. [3] Possibly due to a thicker iris stroma, the iris transillumination defects will rarely be present in patients of African descent. [1] If medical (Beta-adrenergic antagonists, Parasympathomimetics, Alpha-adrenergic agonists, Carbonic anhydrase inhibitor, Prostaglandin analogs) and laser (Laser trabeculoplasty, Laser iridectomy) therapy fail to control the IOP in PG, then glaucoma-filtering surgery is an option. [ 1]

References

1Sowka J. Pigment dispersion syndrome and pigmentary glaucoma. Optometry 2004;75:115-22.
2Grassi MA, Alward WL, Verdick RL, Langlow EP, Kwon YH. Atypical pigment dispersion syndrome in a child. Am J Ophthalmol 2004;137:753-6.
3Siddiqui Y, Ten Hulzen RD, Cameron JD, Hodge DO, Johnson DH. What is the risk of developing pigmentary glaucoma from pigment dispersion syndrome? Am J Ophthalmol 2003;135:794-9.
4Linnér E. The association of ocular hypertension with the exfoliation syndrome, the pigmentary dispersion syndrome and myopia. Surv Ophthalmol 1980;25:145-7.