The iris abnormalities consisting of iridocorneal adhesions to Schwalbe's line and pupillary abnormalities suggest that PACD is a congenital disorder, perhaps a form of anterior chamber dysgenesis. The corneal stroma and Descemet membrane contain sheet-like opacities with clear intervening areas. These opacities are concentrated in the posterior stroma and are sometimes seen from limbus to limbus whereas in other cases they occur mostly peripherally. The cornea may be thinner than normal and somewhat flattened. There is little or no progression of the corneal opacification and vision varies widely. Glaucoma has not been reported.
Histological and EM studies have revealed some fracturing and disorganization of the posterior stromal lamellae and focal attenuation of the endothelium.