Pigment dispersion syndrome is a condition that causes the pigment, or the color in your eyes, to rub off and float around. This can be caused by the iris rubbing against the lens. It occurs in less than 2.5% of the American population

Pigment dispersion syndrome (PDS) is more common in people who are nearsighted and those with a family history of the condition. Close to a third of the time, pigment dispersion syndrome can lead to pigmentary glaucoma. This occurs when the pigment builds up and creates drainage issues in your eyes, which can cause damage to the optic nerve.

If pigment dispersion syndrome is not causing any symptoms, you will need to be monitored regularly with annual eye exams. However, no further treatment is necessary.

When pigment dispersion syndrome turns into pigmentary glaucoma, steps need to be taken to regulate your eye pressure. This often involves the use of medications like eye drops, surgery, or laser surgery.

Pigment Dispersion Syndrome

Your iris is the colored part of your eye that contains the pigment, which is what gives your eyes their color. With pigment dispersion syndrome, the pigment at the back of your iris rubs off and then moves freely around your eye. Much of the time, this does not affect your vision or lead to further problems.

The pigment can get trapped in the drainage pathway of your eyes and build up there, however. This raises the pressure in your eye, which can damage your optic nerve and lead to pigmentary glaucoma.

Causes of Pigment Dispersion Syndrome

There is a genetic component to pigmentary dispersion syndrome. If you have a family history of this condition, you are more likely to have it as well.

People with PDS are also more likely to have a concave iris. This means the iris bends backward instead of forward. This can increase its contact with the lens and make it more likely for the pigment granules to flake off.

When you have pigment dispersion syndrome, everyday use of your eyes, including reading and blinking, can cause the pigment to rub off. Another possible cause of PDS is vigorous exercise, which can lead to more rubbing of the iris on the lens and a greater release of pigment from the iris.

People who are nearsighted (myopic) are more likely to have PDS. This is likely because people with myopia often have deeper anterior chambers than those without it, which can make the iris and the lens rub together more easily.

Risk Factors for Pigment Dispersion Syndrome

Aside from being nearsighted and having a family history for PDS, there are other potential risk factors for the condition, such as:

  • Gender.
    Pigment dispersion syndrome impacts men and women at equal rates, but men have triple the risk for developing pigmentary glaucoma with PDS.
  • Race.
    Caucasians are more likely to have PDS than people of other races.
  • Age.
    PDS is most common in people in their 20s and 30s. It is less common in people over 50.
  • Eye structure differences.
    Just as deep anterior chambers and concave irises can increase the risk for PDS, so can flat corneas.

Pigment Dispersion Syndrome & Glaucoma

Pigment dispersion syndrome frequently does not cause any symptoms or have many long-term side effects. However, it can increase the risk for secondary glaucoma in the form of pigmentary glaucoma. Glaucoma is one of the leading causes of blindness in the world, and it is caused by damage to the optic nerve.

Pigmentary dispersion syndrome can cause pigment granules to build up in the drainage channel of the eye, which then causes the fluid to be unable to drain properly. A buildup of aqueous humor, or the fluid in your eye, raises your intraocular eye pressure (IOP), which then puts strain on your optic nerve. This can damage the optic nerve and cause glaucoma.

Pigmentary glaucoma differs from the more common open-angle glaucoma in that it occurs at a much younger age on average. Glaucoma is a serious condition that requires medical intervention to prevent further vision loss.

Treatment Options

Pigmentary dispersion syndrome is usually diagnosed through a routine eye exam. Often, you will not experience any symptoms. As long as the pressure in your eye remains in the normal range, you do not need any specialized treatment.

It is important to continue with annual eye exams. Your ophthalmologist will measure your eye’s pressure and ensure that PDS has not progressed to pigmentary glaucoma.

There is no cure for glaucoma. Once vision is lost, there is no getting it back. It is essential to get treatment for pigmentary glaucoma to preserve your sight.

Early signs of pigmentary glaucoma, aside from raised IOP, can cause blank spots to occur in your vision. Let your eye doctor know of any changes in your sight.

  • Medications: Treatment options typically include prescription eye drops. These medicines help your eyes drain fluid properly or reduce the amount of fluid that is produced in an effort to regulate your IOP. Eye drops will need to be placed straight into your eyes, often several times per day, to keep the pressure down.
  • Surgery: Once PDS has progressed to pigmentary glaucoma, additional treatments include laser and traditional surgeries. Surgery for pigmentary glaucoma can include laser or traditional trabeculectomy. It can alter your drainage angle to help the aqueous humor drain better, or insert a drainage tube or glaucoma drainage device. 
  • Laser iridotomy: A laser iridotomy is often beneficial in people with pigmentary glaucoma brought on by PDS. It makes a small hole in the iris to help flatten it. This can reduce the amount of pigment that will then float around the eye, which in turn helps to keep IOP down. This treatment is most effective in the early stages of pigmentary glaucoma. It is not as effective once optic nerve damage is more significant.

Treatments for pigmentary dispersion syndrome are typically only necessary once pigmentary glaucoma is a factor. Work with your ophthalmologist to determine the best ways to keep your eye pressure regulated and minimize the damage to your optic nerve.

Treatments for glaucoma are aimed at preserving and maintaining vision, keeping IOP at healthy levels, and minimizing damage to your optic nerve.

References

Molecular Genetics of Pigment Dispersion Syndrome and Pigmentary Glaucoma: New Insights Into Mechanisms. (2018). Genetics in Ophthalmology.

Pigment-Dispersion Syndrome. (May 2016). National Center for Advancing Translational Sciences (NCATS) Genetic and Rare Disease Information Center (GARD).

Glaucoma. (2013). Emory and Rimion’s Principles and Practice of Medical Genetics.

Pigment Dispersion Syndrome Symptoms and Risk. (April 2020). American Academy of Ophthalmology (AAO).

What Is Pigment Dispersion Syndrome? (April 2020). American Academy of Ophthalmology (AAO).

Do Not Let Glaucoma Steal Your Sight! (December 2018). Centers for Disease Control and Prevention (CDC).

Pigment Dispersion Syndrome Diagnosis and Treatment. (April 2020). American Academy of Ophthalmology (AAO).

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