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  • What Is Pseudoexfoliation Syndrome?

    Reviewed By J Kevin McKinney, MD
    Published Nov. 22, 2022

    Pseudoexfoliation syndrome (or PXF, also sometimes called Exfoliation Syndrome) is when tiny flakes of dandruff-like material build up in the body.

    These microscopic clumps of protein fibers are produced throughout the body and are found in the heart, kidneys, liver, lungs, and eye. But this material has only been proven to cause harm inside the eye, where it increases the risk for glaucoma. PXF also worsens cataracts and can make cataract surgery more difficult.

    Over time, this material can build up in the drainage angle, between the iris and cornea. This raises pressure inside the eye (called intraocular pressure, or IOP) and can damage the optic nerve. This is called pseudoexfoliation glaucoma (PXF glaucoma) and can lead to loss of vision.

    What Causes PXF?

    Doctors do not know for sure why people get PXF. Most think there are both genetic (passed down in families) and environmental causes (caused by something in the environment). PXF is rare in people younger than 50. This points to age-related changes in the tissues of the eye, which is true of many eye diseases.

    Who Is at Risk for Pseudoexfoliation?

    Anyone can get pseudoexfoliation (PXF), but it is more common in people:

    • of Northern European ancestry
    • who have family members with PXF glaucoma
    • aged 50 or older

    PXF is also more commonly found in women.

    It is possible, but not proven, that UV light exposure, high altitude, northern latitude and diet may play a role in developing PXF.

    What Are Symptoms of PXF?

    PXF glaucoma does not have any noticeable symptoms. High pressure inside the eye does not cause any pain, so patients can slowly lose vision without knowing it.

    How Is Pseudoexfoliation Diagnosed?

    An ophthalmologist can usually find signs of pseudoexfoliation (PXF) during a comprehensive eye exam. Tests they may do include:

    • A slit lamp exam. Your ophthalmologist uses the bright light and microscope of the slit lamp to look for tiny flakes of PXF material at the front of the eye (on the iris and lens).
    • Goniscopy. A gonioscopy lens is a small device that helps your doctor see the drainage angle. They can check if the drainage angle is blocked.
    • Measure intraocular pressure (IOP). A device called a tonometer will be used to check your IOP. If the pressure is too high, treatment may be needed to prevent damage to your optic nerve and loss of vision.
    • Dilation. Your doctor may use dilating eye drops to widen your pupils. This gives them a better view of the retina and the optic nerve in the back of the eye.

    How Is PXF Treated?

    If you have PXF, no treatment is needed unless you develop glaucoma. You do need to see your ophthalmologist at least once per year because of this risk of glaucoma. Depending on your level of risk, your ophthalmologist may want to see you more often.

    During follow-up exams, your ophthalmologist looks for signs of glaucoma. It’s important to go to every exam that is scheduled for you. If your doctor finds glaucoma early enough, you can save your vision.

    How Is Pseudoexfoliation Glaucoma Treated?

    Like most glaucomas, pseudoexfoliation glaucoma is treated by lowering the intraocular pressure. This helps prevent damage to the optic nerve. Treatment may include:

    • Eye drop medicine. Some eye drops reduce the amount of fluid made in the eye and other drops help it flow better out of the eye.
    • Laser surgery. Laser treatment of the drainage angle helps it drain more fluid from the eye.
    • Operating room surgery. Some glaucoma surgery is done in an operating room. It creates a new drainage channel for the fluid to leave the eye.