A New Clinical Form of Heterochromia of the Iris with Pigmentation of the Sclera and Pigmentary Glaucoma.

THE significance of pigmentation of the anterior segment of the eye in the development of glaucoma, especially in the area of the trabecula of the chamber angle, has been studied by many authors. von Hippel (1901) considered that glaucoma was due to obstruction of the chamber angle with pigment (Hanssen, 1923). Levinsohn (1908) microscopically established infiltration ofthe chamber angle by pigmented granules. The corneal pigment spindle (Krukenberg, 1899a, b), as well as pigmentations of the anterior surface of the iris, anterior capsule of the lens, zonular fibres, vitreous body, and chamber fluid, were all included in the analysis of the symptomatology of pigmentary glaucoma. Among the older authors, Koeppe (1916a, b), in his clinical and microscopic findings, stressed the importance of pigmentation in the anterior sector of the eye in the development of glaucoma. In cases in which the intra-ocular pressure was not yet increased, he used the term preglaucomatous condition. Other authors who contributed to the study of this problem include Kraupa (1917), Hanssen (1923), Koby (1927), and Vogt (1930). Sugar (1940) mentioned finding pigment in the chamber angle in a case of chronic glaucoma. Sugar and Barbour (1949) described the clinical picture of pigmentary glaucoma. Later authors included Calhoun (1953), Bick (1957), Malbran (1957), Scheie and Fleischhauer (1958), and van Beuningen (1959). It is thought that the following cases of heterochromia of the iris represent a certain link with pigmentary glaucoma: