Pigmentary Glaucoma: The Metaphor of The Bathroom Sink

A bathroom sink is a good way to illustrate the mechanics of pigmentary glaucoma. Just as the sink drain can become clogged by hair toothpaste and assorted debris the drainage mechanism in the front of the eye can become clogged by the mechanical blockage of pigment cells that have come loose from the iris (the visible tissue that gives your eye color).

Under normal circumstances pigment is not shed inside the eye at least not in large amounts. In certain young usually male near-sighted individuals the iris is bowed backward more than normal causing it to rub up against the tissues that hold the lens in place. This rubbing back and forth causes the pigment cells on the iris to become dislodged and sloughed off into the currents of the clear fluid (aqueous) that circulate in the front of the eye.

These freely floating pigment cells now tend to settle like dust particles on the various tissues inside the eye. The problem arises when they drift to the eye s drainage mechanism. Like the hair in the sink drain the pigment cells can block the flow of fluid from the eye. This can lead to an increase of eye pressure.

Pigmentary glaucoma is usually found in both eyes and appears between the ages of 20 and 40. This type of glaucoma has been found to have an association with the presence of near-sightedness and occurs more frequently in males than in females.

Pigment release - not always a problem

If your doctor finds that you have excess pigment cells that are being sloughed from your iris you are not necessarily headed for glaucoma.

Another condition associated with pigment release is Pigmentary Dispersion Syndrome (PDS). With PDS there is the same type of characteristic pigmentary release but the eye pressures appear to be within normal limits. Many patients with PDS however will go on to develop pigmentary glaucoma with time so your doctor will most likely monitor you closely.

Pigmentary glaucoma can be treated with medications designed to both lower the eye pressure and also to pull the abnormally bowed iris forward hopefully to minimize the dislodging of pigment cells. Whether you are treated or not close monitoring is necessar.