Pigmentary glaucoma special considerations?
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4 months ago
db • 50

Today I found that likely my glaucoma is pigmentary.

I would know if there are specific meds or supplements for pigmentary glaucoma. Any advice?

glaucoma pigment • 135 views
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4 months ago
david 3.2k

Dr. Robert Ritch found that many pigmentary glaucoma patients do very well on the eye drop medication dipivefrin (brand name Propine). However, it is one of those glaucoma medications that may be very difficult to find.

The following article says this medication is no longer available in the US:

Perioperative medications for preventing temporarily increased intraocular pressure after laser trabeculoplasty

It is possible that another similar drug would work as well, although Dr. Ritch favored this specific one above any others for pigmentary glaucoma.

It is interesting to note that dipivefrin is a prodrug of adrenaline. Dr. Ritch observed a trend (told to me in an unpublished conversation) in which pigmentary glaucoma is seen more frequently in type A personality individuals. (He also told me he saw it frequently in engineers, scientists, doctors and other highly intellectual professionals.) I know some of the earlier studies on type A personalities have been called into question more recently, but if I am right that there is an association between the type A personality type and being more adrenaline-driven, it seems interesting that a prodrug of adrenaline would be especially efficacious in many of these individuals. I think this is worth investigating further.

You may already have heard the advice about avoiding certain activities that can cause a "pigment storm." Jogging is frequently cited as such an activity. However, in casual conversations on FitEyes, many people with pigmentary glaucoma are able to engage in jogging without the IOP spike that would be associated with this large release of pigment.

The single most important bit of advice I can offer for anyone with pigmentary glaucoma is to buy or rent a tonometer and monitor your IOP according to one of the more detailed approaches described here:

What Are Examples of the Different Approaches to Home Eye Pressure Monitoring? | Ask FitEyes

For example, this one.

With pigmentary glaucoma, you should monitor your IOP frequently enough and with enough detail to learn what lifestyle factors put you at risk of sufficient pigment release to cause an IOP spike.

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For pigmentary glaucoma, look up Dr Ritch on pilocarpine.


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