Secondary Open-Angle Glaucomas
Neil T. Choplin, Carlo E. Traverso in Atlas of Glaucoma, 2014
Approximately one-third of patients with pigment dispersion syndrome will go on, over a period of years, to develop pigmentary glaucoma. Treatment of pigmentary glaucoma includes the full spectrum of pharmacological, laser, and surgical modalities. Miotics work well to lower pressures both by opening the trabecular meshwork and by pulling the iris away from zonular fibers, reducing pigment release. However, many of these young patients are intolerant of miosis-induced headaches and blurred vision. Longer-release preparations, such as pilogel and ocuserts, reduce these symptoms adequately for some patients. These patients are also at increased risk for retinal detachment with miotics. For these reasons, many clinicians start with aqueous suppressants, such as beta-blockers, alpha-agonists, and carbonic anhydrase inhibitors. Prostaglandin analogs can also be effective.
Differential Diagnosis of Viral-Induced Anterior Uveitis
Published in Ocular Immunology and Inflammation, 2018
Lia Judice Relvas, Laure Caspers, Soon-Phaik Chee, Manfred Zierhut, François Willermain
Sectoral iris atrophy of VZV and HSV typically involve the pigment epithelium, leading to iris transillumination, whereas the iris atrophy in FUS is diffuse and tends to be anterior stromal and consequently can induce heterochromia. Pigment dispersion syndrome and bilateral acute iris transillumination can also present with such a picture and should be thus included in the differential diagnosis. CMV AU may be associated with a more patchy stromal iris atrophy, retaining a round pupil but may also frequently present without any iris lesions (Figure 3). Fuchs uveitis may present with a diffuse atrophy that may lead to diffuse fine iris transillumination in some cases. Focal iris stromal hemorrhage may be seen in HSV/VZV uveitis and severe HSV or VZV AU may even present with hyphema, albeit rarely, and needs to be differentiated from spontaneous hyphema which may be occasionally seen in FUS often associated to RV.
Transient vision loss: a neuro-ophthalmic approach to localizing the diagnosis
Published in Expert Review of Ophthalmology, 2018
Helen Chung, Jodie M. Burton, Fiona E. Costello
The anterior segment examination is also crucial to the diagnosis of pigment dispersion syndrome, which is characterized by mid-peripheral iris transillumination defects, vertically oriented pigment dusting on the corneal endothelium (Krukenberg spindle), and heavy pigmentation of the trabecular meshwork on gonioscopy [11]. A shallow anterior chamber could predispose an individual to angle closure attacks; if suspected based on Van Herick grading of the peripheral anterior chamber depth (anterior chamber <1/4 corneal thickness), formal gonioscopy should be performed to check for occludable angles [12]. Uveitis-glaucoma-hyphema (UGH) syndrome has been reported to cause TVL due to recurrent hyphemas. This is classically thought of as a late complication of cataract surgery in which the intraocular lens abrades the iris. Ocular signs that may be observed include irregular iris transillumination defects, hyphema, and anterior chamber reaction [13]. Finally, ocular ischemic syndrome can manifest in the anterior segment as arcus senilis of the contralateral eye or neovascularization of the iris or angle in the ipsilateral eye [6].
Bilateral Acute Depigmentation of Iris (BADI) Post COVID Infection following Systemic Moxifloxacin Therapy
Published in Ocular Immunology and Inflammation, 2023
Gazal Patnaik, Wadke Vidya Arunkumar, Mihir Lagvankar
Although BADI is a benign, self-limiting disorder, it needs to be differentiated with other potential severe clinical entities. Herpetic iridocyclitis is commonly associated with keratic precipitates and sectoral or diffuse iris atrophy. Pigment dispersion syndrome (PDS) is more commonly seen in young myopic males with a concave iris configuration. ASOCT and gonioscopy in our patient has ruled out any iris transillumination and iris concavity. SARS – CoV2 has been associated with various ocular manifestations.5 A temporal association with an interval of 2–3 months post acute infection has also been strongly reported, as seen in our case as well.6 To the best of our knowledge, BADI has never been associated with the novel virus yet. BAIT has been reported with the COVID infection, however, there was no association with the fluoroquinolones in that case.7 Various differentials need to be excluded so as to avoid unnecessary long term medical management with topical corticosteroids or toxic systemic antiviral medications or anti-glaucoma medications.8 Treatment with topical corticosteroids could also increase the risk of raised IOP, which may lead to secondary open angle glaucoma.
Related Knowledge Centers
- Eye
- Glaucoma
- Iris Pigment Epithelium
- Iris
- Aqueous Humour
- Trabecular Meshwork
- Krukenberg'S Spindle
- Intraocular Pressure
- Optic Nerve
- Zonule of Zinn