Glaucoma
Pseudoexfoliation Syndrome
Also known as: pseudoexfoliation, pseudoexfoliation syndrome, PXF, PEX, exfoliation syndrome, pseudoexfoliative glaucoma, flaky material lens capsule
Filed as: Routine
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
An age-related condition in which greyish-white fibrillar material is deposited on the anterior lens capsule, pupil margin and trabecular meshwork. It is the commonest identifiable cause of secondary open-angle glaucoma. Compared with primary open-angle glaucoma at the same pressure, pseudoexfoliative eyes tend to run higher IOP with wider diurnal swing and to progress faster, so the finding changes monitoring intent rather than simply adding a label. Frequently asymmetric or clinically unilateral. Zonular weakness is the other reason it matters: it raises the risk of lens subluxation and complicates cataract surgery, so the finding belongs in any pre-operative referral.
Recognition
Symptoms: what patients report
- Usually asymptomatic; found on routine examination
- Reduced vision if cataract or glaucomatous damage has developed
- No pain or redness in the uncomplicated syndrome
Signs: what the examination shows
- Greyish-white flaky material at the pupil margin
- Target or bullseye deposit on the anterior lens capsule, seen only after dilation
- Peripupillary iris transillumination (moth-eaten pattern)
- Pigment on the trabecular meshwork on gonioscopy, often with a Sampaolesi line
- Poorly dilating pupil
- Asymmetry between the eyes in IOP, deposits or disc appearance
- Phacodonesis or an unstable lens where zonular support is compromised
What OptoGuide™ covers for pseudoexfoliation syndrome
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Clinical Management Guidelines — College of Optometrists (guideline index)
- Light and electron microscopic features of preclinical pseudoexfoliation syndrome. Suwan Y, Kulnirandorn T, Schlötzer-Schrehardt U, et al. PloS One. 2023;18(3):e0282784.
- Pseudoexfoliation Syndrome-Clinical Characteristics of Most Common Cause of Secondary Glaucoma. Tomczyk-Socha M, Tomczak W, Winkler-Lach W, Turno-Kręcicka A. Journal of Clinical Medicine. 2023;12(10):3580.
- Glaucoma: Now and Beyond. Jayaram H, Kolko M, Friedman DS, Gazzard G. Lancet (London, England). 2023;402(10414):1788-1801.