Pseudoexfoliation Syndrome and Open-Angle Glaucoma
Once thought to be an unusual form of open-angle glaucoma primarily associated with Scandinavian ancestry, we now know that exfoliation (or pseudoexfoliation) glaucoma constitutes a significant portion of most glaucoma practices in the world. This is an age-related systemic disorder that was initially described by Lindberg in 1917 1 when he observed small flecks of bluish-gray material on the pupillary border of many patients with chronic glaucoma. In 1925, Vogt 2 further characterized this disorder and felt that the particles were produced by the lens and was a form of capsular glaucoma. Dvorak-Theobald 3 introduced the nomenclature of pseudoexfoliation of the lens to differentiate this disorder from the rare true exfoliation that occurs from infrared damage in glassblowers (and in recent times, in some welders who do not wear eye protection). Therefore, both pseudoexfoliation and exfoliation usually refer to the same disorder. The presence of glaucoma distinguishes pseudoexfoliation glaucoma from pseudoex-foliation syndrome. In many locations, initial reports indicated that pseudoexfoliation was rare, but then, with more focused detection methods, a higher prevalence was subsequently observed. Several points are worth emphasizing: pseudoexfoliation open-angle glaucoma mimics primary open-angle glaucoma (POAG) in most, but not all, features and therefore may be underdetected or misdiagnosed. Recognition involves meticulous observation that includes the following (see Chapter 5): Careful attention to the crystalline lens on dilated slit-lamp examination The need to explain increased pigmentation observed on gonioscopy The observation of white flecks in the angle, on the lens, or on the zonules or ciliary processes (when visualized) The need to explain peripupillary iris transillumination defects.
