Abstract: Pigment dispersion syndrome (PDS) represents a distinct clinical entity characterized by the release of pigment granules from the iris pigment epithelium, leading to dispersion throughout the anterior segment of the eye. This article offers a comprehensive review of PDS, encompassing its underlying mechanisms, clinical manifestations, diagnostic criteria, treatment strategies, and recent advancements. By delving into the complexities of PDS, ophthalmologists can refine their approach to patient care and optimize outcomes in this condition.

Introduction: Pigment dispersion syndrome poses diagnostic and therapeutic challenges in ophthalmology, often masquerading as other ocular conditions such as glaucoma. Understanding the pathophysiology and clinical features of PDS is essential for accurate diagnosis and appropriate management.

Pathophysiology: Pigment dispersion in PDS occurs due to mechanical rubbing of the iris against the lens zonules, leading to disruption of the iris pigment epithelium and liberation of pigment granules into the aqueous humor. These pigment granules can subsequently accumulate in the trabecular meshwork, causing obstruction of aqueous outflow and elevation of intraocular pressure (IOP).

Clinical Manifestations: Patients with PDS may present with characteristic signs such as Krukenberg spindle, transillumination defects of the iris, and trabecular meshwork pigmentation on gonioscopy. Additionally, individuals with PDS may be at increased risk of developing secondary glaucoma, particularly pigmentary glaucoma, due to trabecular meshwork obstruction.

Diagnostic Criteria: Diagnosis of PDS requires a thorough ocular examination, including assessment of iris morphology, gonioscopy to evaluate the angle structures, and measurement of IOP. Ancillary tests such as optic nerve imaging with optical coherence tomography (OCT) and visual field testing may aid in identifying signs of glaucomatous optic neuropathy.

Management Strategies: Management of PDS aims to reduce the risk of progression to secondary glaucoma while addressing symptoms and optimizing visual function. Treatment modalities may include topical medications to lower IOP, laser peripheral iridotomy (LPI) to relieve iris-lens contact, and lifestyle modifications to minimize mechanical trauma to the iris.

Recent Advances: Recent innovations in PDS management focus on improving diagnostic accuracy, enhancing treatment efficacy, and preventing progression to secondary glaucoma. Advancements such as anterior segment imaging with ultrasound biomicroscopy (UBM) and anterior segment optical coherence tomography (AS-OCT) offer insights into iris morphology and angle structures, aiding in early detection and monitoring of PDS-related changes.

Conclusion: Pigment dispersion syndrome presents unique challenges in ophthalmology, requiring a multidisciplinary approach to diagnosis and management. By staying informed about the latest research and innovations in PDS, ophthalmologists can optimize patient outcomes and improve quality of life for individuals affected by this condition.

For further reading and reference:

• American Academy of Ophthalmology – Pigment Dispersion Syndrome: https://www.aao.org/eye-health/diseases/pigment-dispersion-syndrome
• Glaucoma Research Foundation – Pigment Dispersion Syndrome: https://www.glaucoma.org/glaucoma/pigment-dispersion-syndrome.php
• National Eye Institute – Glaucoma: https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/glaucoma