Symptoms and Signs of Pseudoexfoliation Glaucoma
Publish date 06-03-2016

Symptoms and Signs of Pseudoexfoliation Glaucoma with exfoliation materials deposit on the lens © 2016 American Academy of Ophthalmology




Symptoms and Signs of Pseudoexfoliation Glaucoma


Symptoms of Pseudoexfoliation Glaucoma

1- Patients may be asymptomatic.

2- With chronic disease and with trabecular meshwork damage, high intraocular pressure can lead to pseudoexfoliation glaucoma with blurred of vision and or they may complain of decreased visual acuity secondary to cataract or glaucomatous visual field changes.

Signs of Pseudoexfoliation Glaucoma

Pseudoexfoliation syndrome can be diagnosed clinically by slit lamp.

1- It is usually bilateral diseases but asymmetrical.

2- Small tiny white material can be seen on the border or margin of the pupil.

3- On the anterior surface of lens capsule. It will form a characteristic ring in this area. This material will form a central disc in the center of the capsule followed be a clear zone which is also followed by a peripheral ring. The central clear zone is due to the movement of the iris over the lens capsule which will brush out the material from this area forming clear zone.

4- In transillumination test, there will be patchy atrophy on the papillary margin of the iris.




5- By gonioscopy, there will be increase of trabecular meshwork pigmentation specially in the inferior part of the eye.

6- By gonioscopy, the material can be seen deposited in abnormal location, which is anterior to the trabecular meshwork and this line is called Sampaolesi line.

7- In chronic disease, the IOP can be high when measured by tonometer which can lead to pseudoexfoliation glaucoma.

8- Other signs of glaucoma can be seen such as optic disc cupping, visual field defects.

9- Sometimes, Pseudoexfoliation materials can be deposited in the corneal endothelial cells and can be seen mainly in the inferior half of the cornea.

10- In Pseudoexfoliation, the zonules get weak and in slit lamp we can see that the lens and the iris are not stable and they move. This is called phacodonesis when lens is moving and iridodonesis when the iris is moving.

11- Pseudoexfoliation associated with iris ischemia or reducing blood flow to the iris. This will cause insufficient mydriasis in which the iris will not be fully diluted when mydriatic eye drops applied to the eye.