The Exfoliation Syndrome: A Continuing Challenge

Exfoliation syndrome is characterized clinically by the presence of whitish granular and dandruff-like deposits on the anterior capsule of the lens, as well as on the pupillary border of the iris. It occurs worldwide, but there is significant variation in the prevalence among different populations. Despite first being recognized over a century ago, the exact nature of exfoliation material and the pathogenesis of the disease remain unknown. Most current theories suggest a metabolic or degenerative process. Although exfoliation material can be found in various organs throughout the body, the only definite pathologic manifestations are in the eye. Glaucoma is the most important sequela of exfoliation syndrome, and it is renowned as being more aggressive, unpredictable, and difficult to control than primary open-angle glaucoma. Exfoliation patients are also at risk of complications from cataract surgery related to loss of zonular integrity. Treatment of exfoliation glaucoma is similar to treatment for primary open-angle glaucoma. However, more frequent monitoring is usually indicated.