PREVENTION OF BLINKING ALTERS IRIS CONFIGURATION IN PIGMENT DISPERSION SYNDROME AND IN NORMAL EYES

Purpose: To examine the effect of blinking on iris configuration and a queous humor distribution between the posterior and anterior chambers in eyes with pigment dispersion syndrome compared with healthy eyes. M ethods: High-resolution, anterior segment ultrasound biomicroscopy was performed on ten eyes of ten patients with untreated pigment dispersi on syndrome and on ten control subjects. Patients were scanned continu ously for 15 minutes or until the maximal change in iris configuration occurred. During this time, the eyelids were held open mechanically, and blinking was prevented. Eyes then were rescanned immediately after blinking. Results: Initial iris configuration was concave in all eyes with pigment dispersion syndrome, whereas in control eyes it was conc ave in four eyes, planar in four eyes, and convex in two eyes. Iridozo nular contact occurred in eyes with pigment dispersion syndrome only. Iridolenticular contact was greater in eyes with pigment dispersion sy ndrome than in control eyes. Analysis of covariance controlling for ag e, sex, and refractive error showed pigment dispersion syndrome to be a significant predictor of increased iris concavity. During continuous scanning, the mean change in iris position, from most concave to most convex, and mean time to the maximal change in iris configuration wer e greater for eyes with pigment dispersion syndrome than in control ey es and were related to the degree of initial iris concavity only (anal ysis of covariance). In six eyes with pigment dispersion syndrome, the eye cup was removed, normal blinking was permitted, and the eye was r escanned. The iris resumed a concave configuration in all eyes. Conclu sion: Increased iris concavity in pigment dispersion syndrome appears to be related to increased iridolenticular contact. This creates an an atomic configuration that predisposes to reverse pupillary block. The accumulation of aqueous humor in the posterior chamber, when blinking is prevented, alters iris position in pigment dispersion syndrome and in healthy eyes and increases iridozonular and iridociliary-process di stances while minimizing iridolenticular contact. Normal blinking appe ars to create transient vector forces which promote aqueous humor flow from the posterior to anterior chamber.