Pigmentary Glaucoma Workup

Updated: Nov 12, 2021
  • Author: Lauren S Blieden, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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Imaging Studies

Ultrasound biomicroscopy (UBM) is useful in evaluating the iris configuration and the posterior chamber structures in patients with pigment dispersion syndrome (PDS) and pigmentary glaucoma (PG). [16] UBM may demonstrate a posterior iris insertion, [17] iris concavity, iridozonular contact, and extensive iridolenticular contact.

Anterior-segment optical coherence tomography (OCT) has been used to assess the parameters of the anterior chamber and angle dimensions in patients with pigmentary glaucoma. [18, 19]


Other Tests

As with the diagnosis and management of any glaucoma patient, the following are employed to confirm the diagnosis and monitor treatment:

Optic nerve imaging either with photos or Optical Coherence Tomography (OCT) to measure the retinal nerve fiber layer are used to detect changes in the nerve over time.

Visual field testing is routinely used to assess functional loss of peripheral vision that can affect a glaucoma patient.

Gonioscopy allows for the direct visualization of the trabecular meshwork using a prism or mirror applied to the surface of the eye during slit lamp examination. Gonioscopy helps the clinician confirm the diagnosis of pigment dispersion by visualizing excess pigment in the trabecular meshwork, along the iris surface, as well as the posteriorly concave iris root appearance seen in PDS.

Pachymetry, or central corneal thickness, is measured using ultrasound or OCT in all glaucoma patients. 


Histologic Findings

Pigment deposits visualized within trabecular endothelial cells on histology suggest phagocytosis. Trabecular endothelial cells can subsequently surpass their tolerance for phagocytizing pigment resulting in cell death. As endothelial cells continue to die, this leads to degeneration of the trabecular meshwork causing compaction of interlamellar spaces and results in reduced aqueous humor outflow.  [2]