Online Photo Diagnosis

May 2012 Contact Lens Spectrum

By Gregory W. DeNaeyer, OD, FAAO

This image shows the right of eye of a 78-year-old male who has exfoliative glaucoma of his right eye.

Exfoliation syndrome (pseudoexfoliation syndrome) is characterized by ring-like deposits on the anterior lens located at the pupillary margin secondary to exfoliative debris. Prevalence from the Framingham data for exfoliation syndrome was 1.8 percent.¹ Onset is usually not until the sixth decade and often presents unilaterally, but may eventually affect the other eye. Exfoliative debris can accumulate in the trabecular meshwork, causing it to appear more heavily pigmented and resulting in an increase in IOP for 50 percent of affected eyes.¹ It has been reported that exfoliation syndrome will convert to exfoliative glaucoma at a rate of 3.2 percent per year.² The differential diagnosis includes pigmentary dispersion, open angle glaucoma, and Fuch's heterochromatic iritocyclitis.

The featured patient has had a peripheral iridotomy and selective laser trabeculoplasty of his right eye. His eye pressure in both eyes has been well controlled with Cosopt (Merck) and Lumigan (Allergan).

References:

1. Pons ME, Roy H. Pseudoexfoliation Glaucoma. Medscape Reference. http://emedicine.medscape.com/article/1206366-overview. Accessed March 30, 2012.

2. Puska PM. Unilateral exfoliation syndrome: a conversion to bilateral exfoliation and to glaucoma: a prospective 10-year follow-up study. J Glaucoma 2002 11(6) 517-24.

3. Simmons ST, Cioffi GA, Gross, RL, et al. Glaucoma. San Francisco: American Academy of Ophthalmology; 2007:99-100.