Current concepts in pigmentary glaucoma

Since its initial description over 50 years ago as a rare clinical entity, pigmentary glaucoma has become recognized as one of the most common forms of secondary open-angle glaucoma. Pigmentary glaucoma affects a much younger patient population than most other forms of open-angle glaucoma, and has a predilection for Caucasian males with myopia. Hallmarks of this disease include midperipheral iris transillumination defects, Krukenberg spindles and a heavily pigmented trabecular meshwork. The mechanism of pigment dispersion appears to be a rubbing between iris pigment epithelium and packets of lens zonules, possibly associated with an inherent abnormality of the pigment epithelium, and the mechanism of aqueous outflow obstruction is believed to involve accumulation of the pigment granules in the trabecular meshwork, followed by denudation, collapse, and sclerosis of the trabecular beams. Current management includes standard antiglaucoma drugs, laser trabeculoplasty, and filtering surgery, although research suggests the possibility of earlier intervention with medication or surgery to arrest the pigment dispersion and reverse or prevent the secondary glaucoma.