Pseudoexfoliation syndrome

The iris and the lens contain dandruff-like flakes. The flakes on the lens are arranged in a bull eye fashion with an 
intermediate clear zone. The corneal endothelium shows pigment deposition. On retroillumination, the iris shows 
peripupillary iris transillumination. The condition is usually bilateral.

Look for:

  • trabeculectomy 
  • fundus for optic disc cupping (glaucoma caused by pseudoexfoliation syndrome is also termed capsular 

  • glaucoma)
  • lens subluxation or phacodonesis. As the eye is usually dilated for examination, iridodonesis is 

  • usually not apparent if there is lens subluxation.

1. What is the risk of glaucoma in pseudoexfoliation syndrome?

2. What may you see on gonioscopy?

3. What is the source of the flakes seen in this condition?

4. What is the risk of cataract extraction in this patient?

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