Pigment dispersion syndrome

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Pigment dispersion syndrome
Other namesPigmentary glaucoma
Schematic diagram of the human eye en.svg
The iris(cells) plays a role in this condition
Specialty Ophthalmology
Medication Latanaprost (eye drops)

Pigment dispersion syndrome (PDS) is an eye disorder that can lead to a form of glaucoma known as pigmentary glaucoma. It takes place when pigment cells slough off from the back of the iris and float around in the aqueous humor. Over time, these pigment cells can accumulate in the anterior chamber in such a way that they begin to clog the trabecular meshwork (the major site of aqueous humour drainage), which can in turn prevent the aqueous humour from draining and therefore increases the pressure inside the eye. [1] A common finding in PDS are central, vertical corneal endothelial pigment deposits, known as Krukenberg spindle. [2] With PDS, the intraocular pressure tends to spike at times and then can return to normal. Exercise has been shown to contribute to spikes in pressure as well. When the pressure is great enough to cause damage to the optic nerve, this is called pigmentary glaucoma. [1] As with all types of glaucoma, when damage happens to the optic nerve fibers, the vision loss that occurs is irreversible and painless.

Contents

Risk factors

This condition is rare, but occurs most often in Caucasians, particularly men, and the age of onset is relatively low: mid 20s to 40s. As the crystalline lens hardens with age, the lens zonules pull away from the iris and the syndrome lessens and stops. The main risk factor is nearsightedness. [1] Genetic factors may also play a part in the transition from syndrome to the glaucoma condition. [3]

Diagnosis

Diagnosis for pigment dispersion syndrome is made with characteristic slit lamp and gonioscopy findings. [4]

Management

There is no cure, but pigmentary glaucoma can be managed with eye drops or treated with simple surgeries. If caught early and monitored, chances of glaucoma are greatly reduced.

A 2016 Cochrane Review sought to determine the effectiveness of YAG laser iridotomy versus no laser iridotomy for pigment dispersion syndrome and pigmentary glaucoma, in 195 participants, across five studies. [5] No clear benefits in preventing loss of visual field were found for eyes treated with peripheral laser iridotomy. [5] There was weak evidence suggesting that laser iridotomy could be more effective in lowering intraocular pressure in eyes versus no treatment. [5]

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<span class="mw-page-title-main">Aqueous humour</span> Fluid in the anterior segment of the eye

The aqueous humour is a transparent water-like fluid similar to blood plasma, but containing low protein concentrations. It is secreted from the ciliary body, a structure supporting the lens of the eyeball. It fills both the anterior and the posterior chambers of the eye, and is not to be confused with the vitreous humour, which is located in the space between the lens and the retina, also known as the posterior cavity or vitreous chamber. Blood cannot normally enter the eyeball.

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<span class="mw-page-title-main">Posterior chamber of eyeball</span> Region of the eyeball between the iris and lens

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Pseudoexfoliation syndrome, often abbreviated as PEX and sometimes as PES or PXS, is an aging-related systemic disease manifesting itself primarily in the eyes which is characterized by the accumulation of microscopic granular amyloid-like protein fibers. Its cause is unknown, although there is speculation that there may be a genetic basis. It is more prevalent in women than men, and in persons past the age of seventy. Its prevalence in different human populations varies; for example, it is prevalent in Scandinavia. The buildup of protein clumps can block normal drainage of the eye fluid called the aqueous humor and can cause, in turn, a buildup of pressure leading to glaucoma and loss of vision. As worldwide populations become older because of shifts in demography, PEX may become a matter of greater concern.

<span class="mw-page-title-main">Secondary glaucoma</span>

Secondary glaucoma is a collection of progressive optic nerve disorders associated with a rise in intraocular pressure (IOP) which results in the loss of vision. In clinical settings, it is defined as the occurrence of IOP above 21 mmHg requiring the prescription of IOP-managing drugs. It can be broadly divided into two subtypes: secondary open-angle glaucoma and secondary angle-closure glaucoma, depending on the closure of the angle between the cornea and the iris. Principal causes of secondary glaucoma include optic nerve trauma or damage, eye disease, surgery, neovascularization, tumours and use of steroid and sulfa drugs. Risk factors for secondary glaucoma include uveitis, cataract surgery and also intraocular tumours. Common treatments are designed according to the type and the underlying causative condition, in addition to the consequent rise in IOP. These include drug therapy, the use of miotics, surgery or laser therapy.

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<span class="mw-page-title-main">Phacomorphic glaucoma</span> Disorder of the human eye

Phacomorphic glaucoma is an eye disease that can occur due to a neglected advanced cataract. In this, the mature cataractous lens cause secondary angle closure glaucoma. The presence of an asymmetric mature cataractous lens, shallow or closed anterior chamber angle, raised intraocular pressure (IOP) and other typical signs and symptoms of angle-closure glaucoma in the eye may lead to a diagnosis of phacomorphic glaucoma. Cataract surgery after initial IOP control with medication is the only treatment.

References

  1. 1 2 3 "Pigment-dispersion syndrome". National Institutes of Health. Retrieved October 7, 2018.
  2. Friedman, Neil J. (2021). The Massachusetts eye and ear infirmary illustrated manual of ophthalmology (Fifth ed.). St. Louis, Missouri. ISBN   9780323613323.{{cite book}}: CS1 maint: location missing publisher (link)
  3. Lascaratos G, Shah A, Garway-Heath DF (2013). "The genetics of pigment dispersion syndrome and pigmentary glaucoma". Surv Ophthalmol. 58 (2): 164–75. doi:10.1016/j.survophthal.2012.08.002. PMID   23218808.
  4. "Pigment Dispersion Syndrome Diagnosis". American Academy of Ophthalmology. 28 April 2018. Retrieved 18 November 2018.
  5. 1 2 3 Michelessi M, Lindsley K (2016). "Peripheral iridotomy for pigmentary glaucoma". Cochrane Database Syst Rev. 2 (9): CD005655. doi:10.1002/14651858.CD005655.PUB2. PMC   5032906 . PMID   26871761.