Pigment deposition of the more central aspect of the posterior lens capsule can be the first sign of pigmentary glaucoma or pigment deposition syndrome. This clinical presentation has been rarely reported. A search of published literature using PubMed and the Cochrane Registry revealed six cases with similar clinical presentation; however, they all described cases that had unilateral pigment deposits. Roberts et al. [
18], Lin et al. [
19], Turgut et al. [
20], and Nagarajaiah et al. [
21] described cases of unilateral pigment deposition on the posterior lens capsule without ocular trauma. Al-Mezaine [
22] described a case of pigment deposition after blunt ocular trauma. There is only one documented case of bilateral pigment deposition of the posterior lens capsule published by Canestraro et al. [
23]. The patient presented in this latter case study had optic nerve hypoplasia which made the assessment of the damage done by the glaucoma difficult. The hypothesized explanations of the etiology of pigment deposits of the posterior lens capsule are very similar across different authors. However, due to only a small number of reported cases, it is still too early to say that we understand the pathophysiological mechanisms behind this pathological finding. An intact anterior hyaloid face exhibits a firm annular adhesion to the posterior lens capsule at Wieger’s ligament [
24]. This forms a natural barrier which prevents pigment from traveling from the posterior chamber to the polar retrolental space. The pigmentation of the lens capsule is classically in the periphery in the shape of Scheie’s or Zentmayer’s line in pigment dispersion syndrome [
25‐
27]. This means that an anatomical anomaly or a defect in Wiegers ligament would have to be present and for the aqueous from the posterior chamber to be able to flow into the retrolental space [
18‐
20,
22]. Canestraro et al. [
23] proposed that anatomical changes due to the proximity of the posterior zonulae insertions and Wieger’s ligament are to be blamed.
The identification of pigment deposition of the posterior lens capsule is important especially if other signs of PDS are subtle. This is especially true if the patient has no transillumination defects or Krukenberg’s spindle. One could easily give the patient a diagnosis of primary open angle glaucoma; however, it has a different natural course and surgical treatment modalities from PG which makes it an important entity do diagnose correctly.