Pigmentary Glaucoma with Retinochoroidal Pigmentation

Pigmentary glaucoma (PG) is considered as an entity within the spectrum of secondary open angle glaucomas. The condition usually starts in the third or fourth decades of life with disruption of the iris pigment epithelium. The released pigment granules deposit on anterior segment structures such as the corneal endothelium, trabecular meshwork and lens/zonules. This stage is known as primary pigment dispersion syndrome (PPDS). Genetic studies have shown it to be an autosomal dominant disorder with incomplete penetrance. A susceptibility locus for PPDS has also been identified on chromosome 7q35‐q36.[1,2] Over a period of time, intraocular pressure (IOP) may increase due to progressive trabecular meshwork dysfunction, which may manifest as ocular hypertension or lead to PG. The probability of PPDS converting to PG is reported to be 10% at 5 years and 15% after 15 years of diagnosis.[3] Sivaraman et al have cited the probability of progression from PPDS to PG at 10‐50%.[4] Significant diagnostic signs for PPDS/PG are limited to the anterior segment. The classic triad of PPDS is the presence of Krukenberg spindles (KS), transillumination Pigmentary Glaucoma with Retinochoroidal Pigmentation