University of Iowa Health Care

Ophthalmology and Visual Sciences

EyeRounds.org

Pseudoexfoliation syndrome

Contributors: Jesse Vislisel, MD; Lucas Lenci, MD

Photographer(s): Brice Critser, CRA (fig. 1a, 2a,b, 6, 8); Tracy Aly, CRA (fig. 2c,d); Toni Venckus, CRA (fig. 7)

Pseudoexfoliation (PXF) syndrome is a condition in which fibrillar material is deposited in the anterior segment of the eye and other places throughout the body. It has complex inheritance, but is almost always associated with mutations in the LOXL1 gene. Individuals with this condition classically have exfoliative material visible along the pupillary margin and on the anterior lens capsule. The material on the lens capsule is often has a target-like appearance with distribution peripherally and centrally and an intervening clear space in the mid-periphery, presumably because the iris rubs the material off in this location as the pupil changes size. Other findings include "brown sugar" pigment in the trabecular meshwork, "moth-eaten" transillumination defects along the pupillary margin, and potentially zonular laxity which can lead to lens subluxation. It may be associated with open-angle glaucoma if the fibrillar material obstructs the trabecular meshwork and causes elevated intraocular pressure.

For more about pseudoexfoliation syndrome, read the related case report.


aDeposition of exfoliative material on the anterior lens capsule with intervening clear space bDeposition of exfoliative material on the anterior lens capsule with intervening clear space

Figure 1: Deposition of exfoliative material on the anterior lens capsule with intervening clear space. (higher resolution image of 1b not available)


a b
c d

Figure 2: Exfoliative material on the pupillary margin and anterior lens capsule.


aExfoliative material on an undilated pupillary margin bExfoliative material on an undilated pupillary margin

Figure 3: Exfoliative material on an undilated pupillary margin. (higher resolution image not available)


Pigment deposition within the trabecular meshwork and Sampaolesi line on gonioscopy

Figure 4: Pigment deposition within the trabecular meshwork and Sampaolesi line on gonioscopy. (higher resolution image not available)


Exfoliative material visible on the lens zonules.

Figure 5: Exfoliative material visible on the lens zonules. (higher resolution image not available)


Exfoliative material accumulating on the posterior capsular remnants after YAG laser posterior capsulotomy.

Figure 6: Exfoliative material accumulating on the posterior capsular remnants after YAG laser posterior capsulotomy.


Subluxated intraocular lens implant occurring spontaneously many years after cataract surgery. Fibrillar material is visible on the anterior capsule and along the pupillary margin. Subluxated intraocular lens implant occurring spontaneously many years after cataract surgery. Fibrillar material is visible on the anterior capsule and along the pupillary margin.

Figure 7: Subluxated intraocular lens implant occurring spontaneously many years after cataract surgery. Fibrillar material is visible on the anterior capsule and along the pupillary margin.


Contributed by Elizabeth Gauger, MD, August 13, 2012

Pseudoexfoliation syndrome Pseudoexfoliation syndrome

Figure 8: Inferiorly displaced posterior chamber intraocular lens located in the capsular bag. There is pseudoexfolation material on the visible superior zonules and pupillary margin.


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last updated: 06/29/2015