03/11/2023
Pseudoexfoliation:
▪️Pseudoexfoliation syndrome (PXS) is an important ocular manifestation of a systemic disorder and is the commonest cause of secondary open-angle glaucoma.
▪️Not all patients with PXS will develop glaucoma and there is no reliable method of determining which patients with the condition will subsequently develop optic disc damage.
▪️ Clinical features:
➖Cornea: Pseudoexfoliative material may be deposited on the endothelium and scattered pigment deposits are common. A vertical (Krukenberg) spindle may rarely form, similar to that seen in pigment dispersion syndrome. Endothelial cell abnormality, such as low density, is more common than average.
➖Anterior chamber: Pseudoexfoliative material particles are sometimes seen. Mild aqueous flare from an impaired blood aqueous barrier is common.
➖Iris: Granular pseudoexfoliative material deposits, pupillary ruff loss and patchy transillumination defects at the pupillary margin.
➖Lens: The anterior lens capsule typically shows a central disc and a radially indented peripheral layer of pseudoexfoliative material, separated by a clear zone maintained by pupillary abrasion. Peripheral capsular deposition is often visible only with pupillary dilatation. Deposits may be flaky, with scrolled edges. Cataract is more common in an eye with pseudoexfoliative material, probably because of reduced ascorbate levels in the aqueous. Phacodonesis (lens instability) due to zonular weakness may be present, but spontaneous subluxation is rare.
➖Anterior chamber angle.
○ Patchy trabecular and Schwalbe line hyperpigmentation is common, especially inferiorly.
○ A Sampaolesi line, which is an irregular band of pigment running on or anterior to the Schwalbe line, is commonly seen. It is not pathognomonic and can be found in pigment dispersion syndrome.
○ Dandruff-like pseudoexfoliative material deposits may be seen.
○ There is an increased risk of angle closure probably because of zonular laxity.
Credit: Ophthalmology-Notes AndOphthalmology-Notes And Synopses