In every patient with ocular hypertension, search for signs of pseudoexfoliation syndrome as these patients are at significant risk of converting to glaucoma

The science behind the tip

Patients with ocular hypertension and pseudoexfoliaton syndrome are twice as likely to convert to glaucoma as those without this condition (1). The IOP is often high on presentation and tends to fluctuate widely. If glaucoma develops in pseudoexfoliaton syndrome the rate of progression is greater than that found in patients with primary open-angle glaucoma (2).

In the early stages of pseudoexfoliation syndrome the ocular signs are subtle and easily missed on clinical examination. The pupils should be dilated to check for fibrillar material on the anterior lens surface. Gonioscopy should be undertaken, as signs of excessive trabecular meshwork pigmentation may precede the detection of pseudoexfoliaton syndrome (3).

Contributor: John F Salmon MD FRCS, Oxford UK

References:

1. Grodum K, Heijl A, Bengtsson B. Risk of glaucoma in ocular hypertension with and without pseudoexfoliation. Ophthalmology 2005; 112: 386-90

2. Heijl A, Bengtsson B, Hyman L et al. Natural history of open-angle glaucoma. Ophthalmology 2009; 116: 2271-6

3. Wishart PK, Spaeth GL, Poryzees EM. Anterior chamber angle in the exfoliation syndrome. Br J Ophthalmol 1985; 69: 103-7

Tip Reviewer: Roger Hitchings Tip Editors: John Salmon and Gordana Sunaric Mégevand