CLS on the web
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
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).
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.
Contact Lens Spectrum, Volume: 27 , Issue: May 2012, page(s): 11