|Pseudoexfoliation syndrome demonstrating the three identifiable
zones on the anterior lens capsule. Note in the second picture (taken
from a different patient) the white flaky material deposits on the pupillary
- More commonly unilateral although in about one third of cases,
it presents bilaterally.
- Affects elderly patients with coexisting cataract.
- Clinical features:
- Symptoms: usually asymptomatic
- Gray-white fibrillar material deposited on the surface of
structures in the anterior chamber of the eye
- The deposits produce three identifiable zones on the anterior
lens capsule and are best seen when the pupil is dilated:
- The translucent material deposit in the pupillary area
which is quite faint and easily missed, outlined by dandruff-like
- More dense deposits of granular material at the peripheral
- Clear intermediate zone, which is attributed to the
posterior iris rubbing against the anterior lens capsule
- The PXE material deposits on the zonules and ciliary processes
may be associated with zonular weakness and lead to lens subluxation
or zonular dialysis during cataract surgery
- Increased pigment deposition at Schwalbe's line (i.e. Sampaolesi's
- Deposits of flaky PXE material in the angle may compromise aqueous
outflow and result in secondary glaucoma.
- Open angle glaucoma is more common in patients with PXE (than in
normal population) and may be more resistant to medical therapy.
- Regular follow-up of patients (including those with normal
intraocular pressures and optic discs)
- Topical and/or systemic anti-glaucoma medications are initially
used to treat patients with increased intraocular pressure
- Surgical treatment (including laser trabeculoplasty and filtration
surgery) may be indicated for glaucoma resistant to medical therapy
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