Pigment Dispersion Syndrome

Question 1

What is PDS?

Answer 1

Liberation of pigment from the iris with subsequent accumulation on anterior segment structures.

Question 2

Etiology

Answer 2

Posterior bowing (concave) of midperipheral iris with the iris epithelium rubbing the zonules. Possibly due to increased AC pressure relative to PC pressure.

Question 3

Demographics of PDS

Answer 3

Occurs between ages 20-50 years
Caucasian men
Myopes

Question 4

PDS is associated with 15% of __ cases

Answer 4

Lattice degeneration

Question 5

Unilateral or bilateral?

Answer 5

Bilateral

Question 6

Symptoms

Answer 6

Can be asymptomatic
Blurred vision, eye pain, halos around lights after exercise or pupillary dilation. ( can cause pigment release with acute elevation of IOP)

Question 7

Signs of PDS

Answer 7

Posterior bowing of midperipheral iris (concave)
AC appears deep

Midperipheral, spoke-like iris TIDs

Pigment deposition:

• TM
• Schwalbe’s line. Sampaolesi line.
• Vertical band on K endothelium (krukenberg spindle)
• Posterior equatorial lens surface (zentmayer or scheie line)
• AC
• Anterior iris surface
• Anterior hyaloid face (vitreous)
• Ciliary body
• Zonules

Question 8

Krukenberg spindle

Answer 8

Vertical band of pigment deposition on K endothelium.

Question 9

zentmayer or scheie line

Answer 9

Pigment deposition on posterior equatorial lens surface

Question 10

Pathognomonic for PDS

Answer 10

zentmayer or scheie line

Pigment deposition on posterior equatorial lens surface

Question 11

Complications of PDS

Answer 11

Secondary open angle glaucoma. Pigment may obstruct the TM and prevent outflow.

Question 12

When can large fluctuations in IOP occur?

Answer 12

Exercise.

Question 13

Risk of developing glaucoma is __% at 5 years and __% at 15 years

Answer 13

10%, 15%