Which two glaucoma-related conditions involve pigment liberation in the anterior segment?

Which two glaucoma-related conditions involve pigment liberation in the anterior segment?

• A. Pigmentary glaucoma and pigment dispersion syndrome
• B. Angle-closure glaucoma and normal tension glaucoma
• C. Primary open-angle glaucoma and secondary glaucoma
• D. Pigmented keratitis and pigmentary keratopathy

Answer: (A)

Pigment liberation in the anterior segment occurs when pigment from the iris pigment epithelium is shed and floats into the aqueous, can coat the trabecular meshwork, and impede outflow. This is the hallmark of pigment dispersion syndrome, where pigment is released and circulated in the anterior chamber, often visible as Krukenberg spindle on the cornea, and may or may not produce high IOP. When that liberated pigment leads to sustained outflow obstruction and glaucomatous damage, the condition is pigmentary glaucoma. Other glaucoma conditions do not center on pigment release in the anterior chamber: angle-closure glaucoma arises from mechanical closure of the angle rather than pigment shedding; normal tension glaucoma is glaucomatous damage at normal IOP levels; primary open-angle and secondary glaucomas refer to other mechanisms of outflow resistance or secondary causes, not pigment dispersion; and keratitic conditions involving pigmentation affect the cornea rather than the aqueous outflow pathway.

Pigment liberation in the anterior segment occurs when pigment from the iris pigment epithelium is shed and floats into the aqueous, can coat the trabecular meshwork, and impede outflow. This is the hallmark of pigment dispersion syndrome, where pigment is released and circulated in the anterior chamber, often visible as Krukenberg spindle on the cornea, and may or may not produce high IOP. When that liberated pigment leads to sustained outflow obstruction and glaucomatous damage, the condition is pigmentary glaucoma.

Other glaucoma conditions do not center on pigment release in the anterior chamber: angle-closure glaucoma arises from mechanical closure of the angle rather than pigment shedding; normal tension glaucoma is glaucomatous damage at normal IOP levels; primary open-angle and secondary glaucomas refer to other mechanisms of outflow resistance or secondary causes, not pigment dispersion; and keratitic conditions involving pigmentation affect the cornea rather than the aqueous outflow pathway.