Pigmentary dispersion syndrome and suspected low tension pigmentary glaucoma

Recent evidence suggests that pigmentary dispersion syndrome is a result of the mechanical abrasion of the posterior iris surface and the anterior zonular fibers causing pigmentary release onto the ocular structures. Irreversible glaucomatous changes may be the result of the inability of the endothelial cells lining the trabecular beams to continue to phagocytize the release pigment. Glaucomatous field changes may occur despite low intraocular pressures and no clinically observable cupping. Visual field testing is indicated in any patient presenting with pigmentary dispersion syndrome since pressure spikes inducing nerve damage occur with stress, exercise, or prolonged mydriasis. Treatment may include miotics to prevent further abrasion rather than typical pressure-lowering medication.