PDS - Reverse Pigmentation

This patient was being evaluated for normal tension glaucoma at age 59. On examination, he has intraocular pressures of 12 mmHg OD and 14 mmHg OS. He has trans illumination defects of the iris and marked angle pigmentation. Note that his pigmentation is more striking superiorly than inferiorly. Dr. Robert Ritch makes the point that people who are clearing the pigmentation from their angles often have this reverse pigmentation - where there is more pigment above them below. It is not uncommon to see this in patients who are being evaluated for normal tension glaucoma. They probably have had elevated intraocular pressures when they were young adults.