Pigmentary glaucoma goes hand in hand with pigment dispersion syndrome. People with this condition flake pigment from their eyes, and sometimes, that pigment accumulates and blocks drainage ducts. When that happens, glaucoma sets in. (Learn more)

There are two types of glaucoma: open-angle glaucoma and angle-closure glaucoma (also called narrow-angle glaucoma). Pigmentary glaucoma is an open-angle form of the condition. (Learn more)

Pigmentary glaucoma is most common in young, nearsighted males. Symptoms are subtle, and they include haloes around lights. (Learn more)

Treatment aims to reduce pressure, not keep pigment in place. Eye drops and surgeries are often used to help preserve sight. The condition tends to fade with age, but lost eyesight can't be restored. Treatment is critical. (Learn more)

Researchers are hard at work to find new therapies for pigmentary glaucoma. Recently, studies uncovered a genetic link to the condition. That could result in treatment innovations in time. (Learn more)

What Is Pigmentary Glaucoma?

close up focus on an eye

There are multiple forms of glaucoma, and all involve pressure. When your eye can't process fluids properly and they build up within the eye, the optic nerve can be damaged. That can result in vision loss.

Glaucoma can stem from many triggers. Pigmentary glaucoma originates in the colored part of your eye, known as the iris.

Whether your eyes are blue, green, or brown, they owe that color to pigment granules within the eye. Those bits of shade should stay in place no matter what you do. But in some people, those pigment bits break away and collect within the eye. Sometimes, they are harmless debris, but they can band together and do damage.

In some people, those pigment bits clump together. The eye attempts to flush out the blockage through drainage channels. But if the pigment block is big enough, the eye can stop draining altogether.

Your eye continues to create fluid, even if none is moving out. Pressure begins to rise as fluid builds up with nowhere to go. That pressure can squeeze the optic nerve, and sometimes, it damages that critical pathway. Vision loss results.

If pigment blocks fluid processing, pigmentary glaucoma is an appropriate diagnosis.

Terminology Recap: Open-Angle Glaucoma & Angle-Closure Glaucoma

glaucoma

As we mentioned, many forms of glaucoma exist. They can be split into two groups based on how the disease progresses.

The Glaucoma Research Foundation explains that there are two main glaucoma types.

  • Open-angle glaucoma: Drainage canals leading out of the eye close slowly, and pressure begins to rise. The issue starts small, and it's very easy to ignore. Without treatment, permanent vision loss can result.
  • Angle-closure glaucoma: This is a less common form of glaucoma, and it's characterized by a sudden block of the drainage canals. Symptoms are noticeable right away.

The University of Arizona says that pigmentary glaucoma is an open-angle form of the disease. That means symptoms start small, and in some cases, they could be ignored altogether.

Risk Factors for Pigmentary Glaucoma

The pigment within your eyes should stay put. But for some people, eye structures are irregular, and that allows color to flake away.

Your iris should be curved outward, as is the shape of your eye. In some people, the iris is flat or concave. Each time you squint, blink, or move your eye, the unusual iris rubs on other parts of the eye. In time, bits of the iris can flake away under the pressure. This is known as pigment dispersion syndrome.

The BrightFocus Foundation says you could be at risk for pigment dispersion syndrome if you:

  • Are male.
  • Have nearsightedness (myopia).
  • Are between 20 and 40 years old.
  • Have a family history of the disorder.

Your eye doctor can spot the condition during a standard eye exam. Spots of color may appear in unusual places. When doctors use a slit lamp to check your iris, they'll see spots that have no pigment at all.

You can have pigment dispersion syndrome without glaucoma. In fact, the BrightFocus Foundation says just 30 to 35 percent of people with the syndrome develop glaucoma.

Symptoms of glaucoma are subtle. In the beginning, says University of Iowa Health Care, you may notice:

  • Blurry vision.
  • Haloes around lights.
  • Headaches.
  • Nausea or vomiting.

These symptoms may worsen when you're engaged in impact sports like basketball or soccer.

In time, these symptoms can worsen. You may then notice difficulty with your vision, including gaps in your visual field.

There is no specific pigmentary glaucoma timeline. Your disease will progress at a clip dictated by your pigment loss. Some people develop serious problems within months, and in others, it can take years.

Treatment Options for Pigmentary Glaucoma

man using eyedrop

The goal of therapy isn't to keep pigment where it belongs. Instead, professionals use treatments to lower the pressure in your eye.

The Glaucoma Research Foundation says it's very difficult to stop pigment loss in the eye. But doctors have many methods they can use to reduce eye pressure.

Your doctor might use:

  • Eye drops. These medications reduce eye pressure, and you can use them at home.
  • Pupil constrictors. These medications keep your eye closed tight so structures won't rub together.
  • Laser surgery. Your doctor uses precise tools to help the eye drain effectively so pigment won't build up. Your doctor can also use lasers to amend the shape of the iris so it won't rub on surrounding structures.

It's critical to get care for pigmentary glaucoma, as the vision loss you experience won't ever come back. But time could help to improve the disease.

The American Academy of Ophthalmology explains that pigment loss may stop as people get older. Aging eyes don’t move as much as their younger counterparts, so less friction occurs. Your eyes may also change shape as you age, so the iris is farther from irritating neighbors.

Future Treatment Options

It might be discouraging to hear that there is no cure (aside from age) for pigmentary glaucoma. But researchers are hard at work on solutions, and recent discoveries hold a great deal of promise.

In 2019, researchers discovered a gene that could be responsible for pigmentary glaucoma. They hope that this discovery could help them to develop therapies that could halt the disease in vulnerable people, long before it begins. Gene identification could also help people pinpoint risks, so they can take preventive steps to reduce eye pressure before vision loss sets in.

These therapies won't be sitting in your doctor's office in the near future. Researchers need time to develop therapies and test them. But this exciting discovery could help future generations to preserve their sight, even when they're living with a serious condition.

In the interim, if you've been diagnosed with pigmentary glaucoma, work with your doctor and follow your treatment plan carefully. That's the best way to ensure that you don't experience permanent vision loss.

 

References

Types of Glaucoma. (October 2017). Glaucoma Research Foundation.

Glaucoma, Pigment Dispersion Syndrome. The University of Arizona Health Sciences.

Pigment Dispersion Syndrome and Pigmentary Glaucoma. (October 2019). Glaucoma Research Foundation.

Pigmentary Glaucoma and Pigment Dispersion Syndrome. (September 2015). BrightFocus Foundation.

Pigmentary Glaucoma: 24-Year-Old Male with Episodic Haloes Around Lights and Blurry Vision. (February 2014). University of Iowa Health Care.

Pigmentary Glaucoma: Answers to Your Questions. (April 2018). Glaucoma Research Foundation.

Pearls for Care in Pigmentary Glaucoma. (May 2015). EyeWorld.

Pigmentary Glaucoma. American Academy of Ophthalmology.

Scientists First to Pinpoint a Cause of Pigmentary Glaucoma. (January 2019). Medical Xpress.