Diagnosis and management of pigmentary glaucoma

Pigment dispersion syndrome and pigmentary glaucoma affect typically young, myopic persons. Iridozonular contact causes pigment dispersion and obstruction of the trabecular meshwork. Accumulation of pigment may result in transient elevation of intraocular pressure or irreparable damage to the meshwork accompanied by uncontrolled glaucoma. In the reviewed publications the transition from pigment dispersion syndrome to pigmentary glaucoma was found to be 20%. The main risk factors for the transition were ocular hypertension and myopia. Dapiprazole, an alpha-adrenergic blocking agent, was found to be effective in treating pigmentary glaucoma and in preventing pressure spikes after exercise. Dapiprazole causes miosis without affecting accommodation. Yttrium aluminum garnet laser iridotomy reduced the incidence of ocular hypertension in pigment dispersion syndrome, although the effect was less pronounced in persons older than 40 years of age. Lattice degeneration was found in 33.3% of the eyes with pigment dispersion syndrome.