Pigmentary glaucoma is an eye condition in which color from the iris spreads to other parts of the eye. This color, or pigment, builds up in the eye’s tissues, preventing fluid from draining. In some people, this results in damage to the optic nerve.

Not everyone who has this extra pigment will develop glaucoma. For some, the pigment buildup does not cause symptoms. When it does, the condition can lead to vision loss if left untreated.

Globally, more than 70 million people experience glaucoma in one of its forms. Pigmentary glaucoma makes up between 1 and 1.5% of glaucoma cases in the Western world.

Read on to learn more about pigmentary glaucoma, including how it develops, the symptoms, treatments, and whether it is safe to exercise.

A person undergoing an eye exam with a doctor.Share on Pinterest
FG Trade/Getty Images

Pigmentary glaucoma occurs when pigment from the iris, which is the colored part of the eye surrounding the pupil, disperses to other parts of the eye.

The condition begins with pigment dispersion syndrome. This is when the rear surface of the iris releases pigment into other structures of the eye. If this continues for a long time, pigment builds up in the spongy tissue of the eye. This makes the tissue less effective at draining fluid.

As fluid accumulates, pressure inside the eye can increase and damage the optic nerve. This is pigmentary glaucoma.

According to estimates, there is a 35–50% chance of people with pigment dispersion syndrome later developing pigmentary glaucoma. Another name for the condition is glaucomatous optic neuropathy.

Pigmentary glaucoma can become serious if a person does not receive treatment. Treatment does not cure the condition. However, it can reduce the symptoms and prevent the condition from worsening.

With early and appropriate treatment, some people can experience a reversal of their symptoms, such as pigment distribution and raised eye pressure.

While it is relatively rare for a person to go blind due to pigmentary glaucoma, it is possible. A person can increase their chances of preserving their sight by keeping follow-up appointments with their doctor.

Pigmentary glaucoma does not always cause symptoms. If it does, the signs a doctor may notice during an eye exam include:

  • a Krukenberg spindle, which is a line of pigment that appears on the clear surface of the eye
  • a ring of tiny slit-like marks on the iris that let light through
  • scattered and dense brownish pigmentation of the anterior chamber angle, which is located between the cornea and iris

If these signs occur alongside increased pressure in the eye, a person may have pigmentary glaucoma.

Late in the disease, pigmentary glaucoma may affect vision, causing a loss of central vision. High amounts of pigment dispersal may also cause spikes in eye pressure and swelling of the cornea, which may result in short-term:

  • eye pain
  • eye redness
  • blurry vision
  • seeing halos around lights
  • headaches that get worse with exercise, head movements, prolonged reading, or blinking
  • sensitivity to light

Pigmentary glaucoma results from pigment dispersion syndrome, which happens due to mechanical friction between the iris and lens of the eye.

Scientists are not sure why this happens in some people but not others. However, they believe genetics may play a role. Some researchers have suggested that the genes relating to lighter eye colors could be linked to a higher risk of developing pigmentary glaucoma.

People with severely concave irises are also more likely to release pigment than people with flat or convex irises. People with nearsightedness, or myopia, have a higher chance of developing pigmentary glaucoma, too.

Pigmentary glaucoma can begin sooner than other forms of glaucoma, with most diagnoses occurring between a person’s third to fifth decades of life.

Doctors treat pigmentary glaucoma in a similar way as primary open-angle glaucoma. They may prescribe medications to reduce pressure in the eye, such as:

  • topical prostaglandins
  • beta-blockers
  • carbonic anhydrase inhibitors
  • alpha-adrenergic agonists

In some cases, doctors may recommend surgery or laser treatment to help the eye drain fluid. One option is a laser trabeculoplasty, which involves using a laser to stimulate the eye’s drainage tissue to better drain fluid and lower pressure in the eye.

Another laser treatment, known as laser peripheral iridotomy, involves flattening the iris to make it less concave, which reduces friction between the iris and other structures.

However, previous studies on this procedure have shown that it does not help in cases where a person has elevated eye pressure, so the procedure is controversial as an option for pigmentary glaucoma.

There is some evidence that exercise may increase pigment dispersion in people with pigmentary glaucoma. However, it is unclear if this always increases pressure inside the eye or whether it is always detrimental. So far, many studies on this have been case studies, focusing on only a few individuals.

Additionally, research has not confirmed whether it is the intensity of the exercise or the duration of the activity that matters most for people with glaucoma.

People should discuss whether it is safe for them to exercise with a doctor. They will have an idea of the relative saferty based on the person’s eye health and pressure.

In general, though, experts advise against forms of exercise that elevate internal eye pressure, such as:

  • swimming with goggles, which can raise intraocular pressure to damaging levels
  • scuba diving, due to increases in intraocular pressure during descent and ascent
  • bungee jumping, because having the head pointing downward and the force of the impact at the end of the cord may increase intraocular pressure
  • activities that involve being upside down or holding breath, such as certain yoga poses and lifting weights

Pigmentary glaucoma is not a life threatening condition. However, it can alter a person’s activities, lifestyle, or, potentially, their vision.

With prompt treatment, some people may find the symptoms get better, so people who have concerns about their symptoms should speak with a doctor as soon as they can.

Pigmentary glaucoma is a type of optic nerve damage that can occur due to pigment dispersion syndrome. This is when pigment from the iris of the eye leaks into other structures, reducing how well the eye can drain fluid. Over time, this can increase pressure in the eye and affect vision.

Not everyone experiences or notices symptoms of this condition. Visible signs may include a ring of tiny slit-like marks of the iris that let light through or a line of pigment on the cornea known as a Krukenberg spindle.

Early diagnosis and treatment is important, as pigmentary glaucoma can progress if left untreated.