PIGMENT DISPERSION SYNDROME

Course overview

PIGMENT DISPERSION SYNDROME (PDS) IS A COMMON TYPE OF OPEN-ANGLE GLAUCOMA WHICH IS RELATIVELY UNDERDIAGNOSED. IT IS CHARACTERIZED BY THE SPONTANEOUS DISPERSION OF PIGMENT GRANULES FROM THE PIGMENT EPITHELIUM OF THE IRIS, WHICH GETS DEPOSITED IN THE ANTERIOR SEGMENT. IT IS A BILATERAL CONDITION THAT IS MORE COMMONLY ENCOUNTERED IN MYOPIC YOUNG MALES. SECONDARY PIGMENT DISPERSION CAN BE SEEN AFTER OCULAR TRAUMA, TUMORS OF THE IRIS, AND RUBBING THE IOL AGAINST THE SURFACE OF THE IRIS. SECONDARY PIGMENTARY GLAUCOMA (PG) IS ALSO COMMON AND CAN COEXIST. THE PATIENTS WITH PDS ARE USUALLY ASYMPTOMATIC, AND OCCASIONALLY PATIENTS MAY PRESENT WITH PAIN, REDNESS, EXTREME PHOTOPHOBIA, AND REDUCED VISUAL ACUITY. APPROXIMATELY 15% OF PATIENTS WITH PDS WILL CONVERT TO PG AFTER 15 YEARS. THE CLASSICAL CLINICAL FEATURES OF PDS INCLUDE CORNEAL EDEMA, KRUKENBERG SPINDLES, PIGMENTS IN THE ANTERIOR CHAMBER, CONCAVE IRIS CONFIGURATION, IRIS TRANSILLUMINATION DEFECTS, PIGMENTS ON THE ANTERIOR LENS SURFACE WITH SCHEIE STRIPE, AND ZENTMAYER RING OF PIGMENTS. THE POSTERIOR SEGMENT FEATURES CAN BE MYOPIC LATTICE DEGENERATION, PERIPHERAL RETINAL PIGMENTATION, OCCASIONALLY RETINAL DETACHMENT, AND GLAUCOMATOUS CUPPING, WHICH DEPENDS ON THE STAGE OF THE DISEASE. THE ESSENTIAL DIAGNOSTIC TOOLS FOR PDS ARE INTRAOCULAR PRESSURE ASSESSMENT, GONIOSCOPY, VISUAL FIELD, ANTERIOR SEGMENT OPTICAL COHERENCE TOMOGRAPHY (OCT), POSTERIOR SEGMENT OCT, POSTERIOR SEGMENT OCT ANGIOGRAPHY, AND ULTRASOUND BIOMICROSCOPY. THE RECOMMENDED MANAGEMENT OPTIONS ARE LIFESTYLE MODIFICATIONS, ANTIGLAUCOMA MEDICATIONS, LASER IRIDOTOMY, IRIDOPLASTY, AND FILTRATION SURGERY. THIS ACTIVITY HIGHLIGHTS THE ROLE OF THE INTERPROFESSIONAL TEAM IN THE EVALUATION AND MANAGEMENT OF PATIENTS WITH PIGMENT DISPERSION SYNDROME.