Trabecular meshwork pigmentation is a manifestation of the clinical diagnosis of pigmentary glaucoma. Pigmentary glaucoma is a secondary open-angle glaucoma caused by pigmentation of the anterior segment of the eye. What should we do to prevent it in our daily lives? Follow-up Patients need to be followed up regularly for clinical examination and, if necessary, appropriate treatment. The conventional treatment for PG is usually medication first, followed by laser treatment, and finally surgery is considered. Clinical observation Patients with early PDS/PG should be carefully examined at least once every six months for the number of iris transillumination defects and to observe the iris morphology. Whenever possible, data on the degree of pigmentation in different areas of the eye should be recorded to leave a base for later dynamic observation. boys-Smith-type iris keratoscopes with pigmentation scales are useful tools. During the course of the disease, assessment of trabecular meshwork damage is based primarily on intraocular pressure. If IOP rises, trabecular meshwork damage increases; conversely, a decrease in IOP may indicate that pigment dispersion has ceased and that the trabecular meshwork has not been irreversibly damaged. Normal function is restored with a reduction of cytochrome in the trabecular meshwork. If pigment dispersion ceases and trabecular function does not improve, irreversible damage to the trabecular meshwork may occur, resulting in secondary chronic open-angle glaucoma. Optic disc damage, visual field defects Due to long-term PG causes the same optic disc damage seen in chronic open-angle glaucoma. Of note is that most PG patients have combined myopia and therefore may have specific myopic ocular features. The optic disc in myopic eyes may be more susceptible to damage from elevated IOP than in orthoptic or hyperopic eyes. Therefore, this group of patients requires more frequent examinations. In addition, it may be more difficult to assess glaucomatous optic disc damage in myopic eyes than in normal eyes. Therefore, the optic disc needs to be examined more carefully in myopic eyes, which are more susceptible to paracentral or even central vision loss than orthoptic and hyperopic eyes. Medication In mild cases, the use of adrenergic beta-blockers or sympathomimetic drugs may be sufficient; in many severe cases, pupil-reducing drugs may be added. If topical medication is not tolerated or fails to control IOP, oral carbonic anhydrase inhibitors may be administered.