Secondary Open-Angle Glaucoma

Secondary Open-Angle Glaucoma

Jonathan S. Myers

Scott Fudemberg


Pigment dispersion syndrome (PDS) is a condition in which an abnormal amount of pigment is dislodged from the pigmented epithelium on the posterior surface of the iris and then deposited on various structures throughout the anterior segment. Obstruction of the trabecular meshwork by pigment, and subsequent damage to the meshwork, can lead to elevated intraocular pressure (IOP) and secondary open-angle glaucoma.


• PDS occurs most frequently in young (aged 20 to 45 years), myopic, Caucasian men.

• Approximately one-third of PDS patients go on to develop pigmentary glaucoma.


Campbell DG. Pigmentary dispersion and glaucoma: a new theory. Arch Ophthalmol. 1997;97:1667.

Gandolfi SA, Vecchi M. Effect of a YAG laser iridotomy on intraocular pressure in pigment dispersion syndrome. Ophthalmology. 1996;103:1693-1695.

FIGURE 13-1. Krukenberg spindle. A vertical endothelial deposition of pigment characteristic of pigment dispersion syndrome (PDS). It may slowly resolve when pigment shedding stops but may persist for many years or forever. Pattern of deposition is thought to be related to convection currents of aqueous within the eye.

FIGURE 13-2. Transillumination defects in pigment dispersion syndrome (PDS). Marked peripheral and mid-peripheral transillumination defects in PDS. Many patients may present with only several mild radial spoke-like defects.

FIGURE 13-3. Pigment dispersion syndrome, dense pigmentation, and Krukenberg spindle. Krukenberg spindle (foreground), heavily pigmented deep angle (background). Characteristic homogeneous dense pigmentation of trabecular meshwork.

FIGURE 13-4. Pigment dispersion syndrome, pigment deposition. Pathology specimen showing pigment deposition on trabecular meshwork and anterior to meshwork.

FIGURE 13-5. Pigment dispersion syndrome, pigment deposition. Pathology specimen showing pigment deposition within beams of trabecular meshwork.

FIGURE 13-6. Pigment dispersion syndrome, Zentmeyer line. Deposition of pigment near equator of lens, at insertion of lens zonular fibers. Variously referred to as Zentmeyer line or Scheie stripe.

FIGURE 13-7. Pigment dispersion syndrome (PDS), bowing of peripheral iris. A. Ultrasound biomicroscopy (UBM) of patient with PDS, showing backward-bowing peripheral iris in contact with lens surface. B. UBM of the same patient, following iridotomy, showing anterior relaxation of iris with reduced contact with lens.


Pseudoexfoliation syndrome (PXFS) is a systemic condition that can lead to secondary open-angle glaucoma. The characteristic flaky white pseudoexfoliation material, seen throughout the anterior segment, can obstruct the trabecular meshwork and has also been isolated in tissues throughout the body.

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May 4, 2019 | Posted by in OPHTHALMOLOGY | Comments Off on Secondary Open-Angle Glaucoma

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