An 85-year-old woman with a history of hypertension was referred to us for evaluation because of suspicious asymmetric optic nerve cupping. She was noted to have pseudoexfoliation material bilaterally. However, there was no evidence of glaucoma at presentation. She will be followed as a glaucoma suspect yearly. Pseudoexfoliation syndrome is found predominantly in the elderly and is three times more likely to affect women than men. Accumulation of pseudoexfoliation debris in the trabecular meshwork with subsequent accumulation of cellular debris and pigment can lead to a chronic increase in IOP.

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