Pseudoexfoliation Syndrome and Pigment Dispersion Syndrome i
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Pseudoexfoliation syndrome (PXS) and pigment dispersion syndrome (PDS) are two of the commonest disorders to produce secondary open-angle glaucoma through trabecular meshwork blockage. Each is a defined clinical entity, and while genetics likely play a significant role in the pathogenesis of both, the specific genes involved appear to be distinct. There is surprisingly little published in the literature regarding the coexistence of PDS and PXS in the same patient. We present the intriguing case of a patient who developed PDS in one eye and PXS in the other. This unusual case acts as a platform for an interesting discussion of the genomics of PXS and PDS.

Case Report
A 77-year-old Caucasian female presented to the glaucoma services at the Mater Misericordiae Hospital in 2007 for assessment of her anterior segment findings, first noted by an optometrist. She was a moderate myope, and best corrected visual acuity on the Snellen chart was 6/6 in both eyes with spectacle correction. Examination of her right eye revealed typical corneal Krukenberg spindle, pigment cells in the anterior chamber, and peripheral iris transillumination defects (fig. 1a–c). On gonioscopy, the iridocorneal angle was wide open with a heavily pigmented trabecular meshwork (TM) visible. Examination of the left anterior segment was unremarkable – with a clear cornea, no cells in the anterior chamber, and no iris transillumination defects seen. Iridocorneal angles were open on gonioscopy, with lesser pigmentation of the TM of the left than the right eye. IOP was 16 mm Hg on the right and 14 mm Hg on the left. Fundal examination revealed healthy looking tilted optic discs bilaterally, and normal macula, retina, and retinal vasculature. A diagnosis was made of right PDS, no treatment was indicated at this stage, and the patient was followed up on an annual basis.