Pseudexfoliation

Pseudexfoliation is a condition characterized by the deposition of flaky, dandruff-like material on various ocular structures. This material is an abnormal protein aggregate. The most commonly affected areas include the anterior lens capsule, the iris, and the trabecular meshwork. It is often bilateral, though it can be asymmetric.

The exact cause of pseudexfoliation is not fully understood, but it is thought to involve a systemic connective tissue abnormality. Genetic factors may play a role, and the condition is more prevalent in certain ethnic groups. Age is also a significant risk factor, with it being more common in individuals over 50. Environmental factors are also being investigated.

Clinically, pseudexfoliation can lead to several complications. It is a major risk factor for the development of pseudoexfoliation glaucoma, a type of open-angle glaucoma caused by obstruction of the trabecular meshwork by the exfoliative material. This can lead to increased intraocular pressure and optic nerve damage. Cataract formation is also accelerated in eyes with pseudexfoliation, and surgery to remove the cataract can be more challenging due to zonular weakness, the fibers that hold the lens in place.

Diagnosis is typically made during an eye examination, where the characteristic deposits can be observed. Dilating the pupil often makes the deposits more visible on the lens capsule and iris. Management focuses on monitoring intraocular pressure, treating glaucoma if present, and timely cataract surgery when indicated. Early detection and management are crucial to preserve vision.