Pseudoexfoliation Syndrome

The main problem with pseudoexfoliation is that there is a build-up of flaky material in the angle between the cornea and iris... Most people associate the term “exfoliation” with skin not with the eyes. When something exfoliates it scales off its surface in flakes or layers; we are most familiar with this happening on our arms or legs – after sunburn for example. So picture the shedding of flakes within the eye. This is known as pseudoexfoliation syndrome.

This condition is characterized by small dandruff-like flakes peeling off the outer layer of the lens within the eye. The material accumulates throughout the eye but most noticeably on the edge of the iris (the coloured part of your eye) and the lens. You cannot see the flakes with the naked eye – they are only visible with a slit-lamp microscope in your eye doctor’s office.

The main problem with pseudoexfoliation is that there is a build-up of flaky material in the angle between the cornea and iris which is known as the trabecular meshwork. This can clog the drainage system of the eye leading to open-angle glaucoma. Just as leaves block water from entering a sewer the flakes clog the drainage system and result in fluid backup. It is estimated that 40 - 60 percent of patients with pseudoexfoliation will end up developing open-angle glaucoma.

Typically pseudoexfoliation begins unilaterally (in one eye) but can become bilateral over time. Most patients remain asymptomatic until more advanced glaucoma develops – which is quite a problem since a patient with no symptoms does not know that anything is wrong. At the onset of the condition intraocular pressure is normal but over a short period of time a large percentage of patients develop very high pressure. As a result there may be some peripheral vision loss.

Patients with this condition are usually at least 60 years of age or older. It is most commonly seen in Scandinavians and people from northern latitudes. Pseudoexfoliation tends to go through phases of exacerbation and remission so routine assessment throughout the year is preferable. Otherwise treatment (if deemed necessary) is the same as for open-angle glaucoma. Response to a procedure called laser trabeculoplasty is usually quite good. This process involves energy being directly applied to the trabecular meshwork relieving the clog and increasing the fluid outflow from the eye thereby lowering intraocular pressure. Pseudoexfoliative glaucoma is more resistant to medical therapy (eyedrops) and has a poorer prognosis due to the higher intraocular pressure increased optic nerve damage and visual field defects. However if treated promptly with aggressive therapy it is possible to at least delay the onset or progression of glaucoma.