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# Pseudoexfoliation syndrome and glaucoma

Flaky white material builds up in the front of the eye with age, clogging the drain and weakening the lens supports. It causes a severe glaucoma.

Updated Nov 12, 2026

On this page

- The basics What it is
- Who gets it
- Causes
- Risk factors
- Pathophysiology
- In ophthalmology

- Clinical Symptoms and signs
- Red flags
- Diagnosis
- Differential diagnosis
- Complications
- Prognosis

- Treatment Goal of treatment
- Treatment

- Study Test yourself

- Connections Connections

## What it is

An age-related disorder in which a fibrillar, flaky white material is produced and deposited on the lens capsule, pupil margin, [drainage angle](https://durgical.com/en/anatomy/iridocorneal-angle/) and other tissues. It is the most common identifiable cause of secondary open-angle glaucoma, which tends to have higher and more variable pressures than primary glaucoma. It also weakens the zonules, making cataract surgery riskier.

See it in 3D

- [Lens](https://durgical.com/en/anatomy/lens/)
- [Iris](https://durgical.com/en/anatomy/iris/)
- [Ciliary body](https://durgical.com/en/anatomy/ciliary-body/)
- [Cornea](https://durgical.com/en/anatomy/cornea/)

## Who gets it

Increases with age, usually after 60; frequency varies widely between populations and is high in some (for example Nordic countries); often one eye first.

## Causes

- Genetic predisposition (variants of the LOXL1 gene)
- Ageing
- Environmental factors (latitude, ultraviolet exposure)

## Risk factors

- Age over 60
- Family history
- Some ethnic and geographic backgrounds

## Pathophysiology

Abnormal extracellular matrix material accumulates; it is rubbed off the lens by the moving [iris](https://durgical.com/en/anatomy/iris/), releasing pigment and debris that clog the trabecular meshwork and raise pressure. The same material weakens the zonules and the iris dilates poorly.

## Symptoms and signs

- None until glaucoma or cataract develops
- Gradual peripheral field loss in advanced glaucoma

## Red flags

- Very high pressure
- Lens subluxation
- Asymmetric glaucoma with rapid progression

## Diagnosis

**Clinical**
Dilated slit lamp examination shows a target-like pattern of white material on the anterior [lens](https://durgical.com/en/anatomy/lens/) capsule; poor dilation and transillumination defects at the pupil margin.

**Tests**
Tonometry, gonioscopy (heavy angle pigmentation), [optic disc](https://durgical.com/en/anatomy/optic-disc/) and field assessment.

**Imaging**
OCT of the nerve fibre layer to follow glaucoma.

## Differential diagnosis

- Pigment dispersion syndrome
- True exfoliation (heat-related capsular delamination)
- Primary open-angle glaucoma

## Goal of treatment

Control the eye pressure and plan cataract surgery safely.

## Treatment

**Medical**
Pressure-lowering drops.

**Procedure**
Laser trabeculoplasty, often effective in this condition.

**Surgical**
Glaucoma surgery when pressure is not controlled; cataract surgery with measures to support weak zonules.

## Complications

- Glaucoma with rapid visual field loss
- Lens subluxation or dislocation
- Complications of cataract surgery
- Central retinal vein occlusion

## Prognosis

Glaucoma is more aggressive than primary open-angle glaucoma but controllable with timely treatment.

## Test yourself

Think of the answer, then tap the question to see it.

## Where is pseudoexfoliation material best seen?

On the anterior lens capsule after dilating the pupil.

## Why is cataract surgery riskier in pseudoexfoliation?

Because the zonules are weak and the pupil dilates poorly.

## Which gene is linked to pseudoexfoliation?

LOXL1.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/conditions/pseudoexfoliation-syndrome-and-glaucoma/)

## In ophthalmology

- [Gonioscopy: looking into the drainage angle](https://durgical.com/en/ophthalmology/gonioscopy-looking-into-the-drainage-angle/)

## Connections

## Related conditions 3

- [Open-angle glaucoma](https://durgical.com/en/conditions/open-angle-glaucoma/)
- [Cataract](https://durgical.com/en/conditions/cataract/)
- [Acute angle-closure glaucoma](https://durgical.com/en/conditions/acute-angle-closure-glaucoma/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Pseudoexfoliation Syndrome and Glaucoma](https://www.ncbi.nlm.nih.gov/books/NBK574522/) (StatPearls Publishing (NCBI Bookshelf), 2023).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/conditions/pseudoexfoliation-syndrome-and-glaucoma/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/pseudoexfoliation-syndrome-and-glaucoma/