Ocular System

Pseudoexfoliation syndrome (PEX/PES/PXS)

Age-related systemic disease having ocular manifestations characterized by deposition of a white fluffy amyloid-like proteinaceous material in the eye.



Complex and age-related systemic disorder characterized by progressive accumulation and granular deposition of abnormal extracellular whitish pseudoexfoliative material (PXM) in various intraocular and extraocular tissues.

  • Common sites of deposition:
    • Anterior chamber and its angle
    • Trabecular meshwork
    • Anterior surface of iris
    • Anterior capsule of lens
    • Cornea


In 1917, Lindberg first described exfoliation syndrome after observing the presence of whitish-gray material deposited on the pupillary border in approximately half his patients with chronic glaucoma. Subsequently, in 1926, Vogt named this disease “capsular glaucoma”, because he believed that this whitish material could originate from peeling of the anterior lens capsule. Later, in 1954, the term “pseudoexfoliation syndrome” was used by Dvorak-Theobald, who observed the deposition of PXM on the lens capsule, ciliary body, and zonules.

Also known as “Viking disease”, PES principally affects northern Europeans and especially Scandinavians, although it has been reported in all population types and races.


Diagnosis of PES is based on the observation of pseudoexfoliative material on nearly all the structures of the anterior segment of the eye.

Slit lamp examination, including gonioscopy and pupillary dilation

Gold-standard procedures


  • Argon Laser Trabeculoplasty (ALT)
  • Selective Laser Trabeculoplasty (SLT)
  • Trabeculectomy
  • Angle-Based Procedures
  • Ab-interno trabeculectomy “Trabectome”
  • Trabecular aspiration
  • Viscocanalostomy
  • ExPress implant procedure
  • Aqueous Shunt Implantation
  • Combined Cataract and Glaucoma Surgery

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