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What is Pseudoexfoliation Glaucoma?

By H. Colledge
Updated May 17, 2024
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Pseudoexfoliation glaucoma is an eye disorder found in people who have a condition known as pseudoexfoliation syndrome. In pseudoexfoliation syndrome, strands of protein accumulate in tissues throughout the body, including the eye. Inside the eye, flakes of protein substance are deposited around the colored part of the eye, or iris, and throughout the structures at the front of the eyeball. Around the edge of the iris, fluid from within the eye normally drains out through a filter called the trabecular meshwork, and in pseudoexfoliation glaucoma this becomes clogged with protein strands. As fluid is prevented from leaving the eye, the pressure inside the eyeball, known as the intraocular pressure, increases, giving rise to the condition called glaucoma.

The risk of developing pseudoexfoliation glaucoma increases with age, and it is rarely seen in people younger than 50 years old. Although the condition is associated with pseudoexfoliation syndrome, only around a third of people who have the syndrome go on to develop the glaucoma. Women are more likely to develop it than men. Factors which increase the chance of having pseudoexfoliation glaucoma include being exposed to ultraviolet light and living in the north or at high altitude.

Pseudoexfoliation glaucoma tends to occur in only one eye at first, but may go on to involve both eyes. There may be no symptoms, and the condition may be discovered after a raised intraocular pressure is noted during an eye examination. This raised pressure, or ocular hypertension, is a problem, because it can damage the optic nerve supplying the eye, leading to loss of vision. When the affected eye is examined using a special microscope, called a slit-lamp, a flaky, white substance is seen forming a ring around the edge of the pupil. Sometimes, a typical bullseye pattern is seen, consisting of three rings.

Treatment options for pseudoexfoliation glaucoma include the use of medications to lower the pressure inside the eye and prevent the disease from progressing. Techniques such as argon laser trabeculoplasty are used in cases where drugs fail to work. In argon laser trabeculoplasty, a laser is used to burn small holes which increase the drainage of fluid from the eye, lowering the pressure inside. If such methods are unsuccessful, what is known as trabeculectomy surgery is sometimes used, where a special drainage hole is created to allow fluid to pass out of the eye. Early detection is important, and people with pseudoexfoliation syndrome are given yearly eye tests to check for signs of glaucoma.

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