Exfoliation Glaucoma

Whitish flakes resembling dandruff appear on the anterior lens capsule during midlife, often accompanied by pigment.  It is a progressive disorder in all aspects and once established does not regress.  The condition is often asymmetrical and even unilateral, at least in some stages.  This fibrillar material is deposited throughout the anterior chamber including the trabecular meshwork where it blocks the outflow mechanism leading to glaucoma.  The latter is often severe and difficult to control.  It is claimed that the risk of glaucoma is 6 times greater among such patients compared with individuals who do not have exfoliation.  Cataract prevalence is higher among patients with exfoliation and those with cataracts have a higher prevalence of exfoliation.  Dilation is often difficult in such patients and operative complications such as capsular rupture, lens mobility, and vitreous loss are greater.  Posterior synechiae are more frequent in exfoliation patients.  Pupillary block and angle closure glaucoma are additional glaucoma risks.

The majority of evidence suggests that the source of the exfoliation material is the extracellular matrix of ocular structures including the lens epithelium, iris pigment epithelium and the non-pigmented ciliary epithelium.  The exact composition of the material, however, has not been established.