Correct Answer: C
This patient presents with pigment dispersion syndrome (PDS), a secondary open-angle glaucoma. PDS is characterized by homogeneous pigmentation of the trabecular meshwork, iris transillumination defects, and pigment along the corneal endothelium, yielding characteristic Krukenberg spindles. PDS presents with a peripheral concave iris which causes the iris to shave against the zonules when it constricts/dilates leading to a release of pigment granules from the pigment epithelial cell membrane. This pathophysiology acutely leads to a transient increase in IOP with lack of optic nerve damage or permanent visual field loss. If left untreated, PDS can cause chronic elevation of IOP and ultimately open-angle glaucoma. Myopia, increased C/D ratio, and a peripheral concave iris is often present in patients with PDS. PDS is also most often diagnosed in middle-aged males and commonly exacerbated by exercises in which IOP is increased. PDS is a secondary open-angle glaucoma, so a narrow angle on gonioscopy is not expected.
Source: EyeWiki, Iowa Eye Rounds
