Glaucoma
Pigment Dispersion Syndrome
Also known as: pigment dispersion, pigment dispersion syndrome, PDS, pigmentary glaucoma, Krukenberg spindle, iris transillumination defects, pigmentary dispersion
Filed as: Routine
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
Pigment liberated from the posterior iris surface is deposited on the corneal endothelium, iris and trabecular meshwork. It characteristically affects younger myopic adults, which is the opposite demographic to most glaucoma suspects and part of why it is missed. A proportion convert to pigmentary glaucoma. The mechanism is mechanical — a concave peripheral iris chafing against the lens zonules — so pupillary movement and exercise can liberate a shower of pigment and produce a transient pressure spike with blur or haloes. Because these patients are myopic, peripheral retinal assessment belongs in the same examination.
Recognition
Symptoms: what patients report
- Usually asymptomatic
- Blur or haloes after exercise or in dim conditions, when the pupil moves
- Symptoms that resolve spontaneously over hours
Signs: what the examination shows
- Krukenberg spindle — a vertical band of pigment on the corneal endothelium
- Mid-peripheral radial or spoke-like iris transillumination defects, seen on retroillumination
- Dense, even trabecular pigmentation through 360 degrees on gonioscopy
- Deep anterior chamber with a concave peripheral iris
- Intraocular pressure that may be normal between spikes
- Myopic refraction in a younger adult
What OptoGuide™ covers for pigment dispersion syndrome
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Clinical Management Guidelines — College of Optometrists (guideline index)
- Pigment Dispersion Syndrome and Its Implications for Glaucoma. Bustamante-Arias A, Ruiz-Lozano RE, Carlos Alvarez-Guzman J, Gonzalez-Godinez S, Rodriguez-Garcia A. Survey of Ophthalmology. 2021 Sep-Oct;66(5):743-760.
- Pigment dispersion syndrome and pigmentary glaucoma: overview and racial disparities. Pang R, Labisi SA, Wang N. Graefe's Archive for Clinical and Experimental Ophthalmology = Albrecht Von Graefes Archiv Fur Klinische Un
- Characteristics of pigmentary glaucoma in Japanese individuals. Yamashita T, Shiihara H, Terasaki H, et al. PloS One. 2022;17(6):e0268864.