Pigment deposition on the posterior surface of the central cornea indicates which condition?

• A. Corneal dystrophy
• B. Pigmentary glaucoma
• C. Keratitis
• D. Cataract

Answer: (B)

Pigment dispersion from the iris can shed pigment that deposits on the posterior (endothelial) surface of the cornea. This pattern is a classic clue to pigment dispersion syndrome, which, when pigment blocks the trabecular meshwork and raises intraocular pressure, becomes pigmentary glaucoma. The key idea is that pigment on the corneal endothelium reflects pigment being released inside the eye and circulating to the drainage angle; if outflow is impeded and pressure increases, glaucoma can develop.

Other conditions don’t typically present with pigment specifically lining the posterior corneal surface. Corneal dystrophy involves structural changes and opacities in the cornea itself, keratitis is an inflammatory process, and cataracts are opacities of the lens, not pigment on the corneal endothelium.