Pseudoexfoliation Glaucoma – Causes, Symptoms, Diagnosis, and Treatment
Pseudoexfoliation glaucoma (PEG) is a type of secondary glaucoma that develops due to pseudoexfoliation syndrome. Pseudoexfoliation syndrome is a condition in which abnormal protein-like material builds up in the front part of the eye.
This material clogs the eye’s aqueous drainage system, leading to raised intraocular pressure (IOP) that damages the optic nerve. Since the condition often progresses silently, early detection and treatment are essential to prevent permanent vision loss.
What Is Pseudoexfoliation Glaucoma?
Definition
Pseudoexfoliation glaucoma (PEG) is a chronic, progressive form of glaucoma linked to pseudoexfoliation syndrome (PXF). In this condition, whitish, dandruff-like deposits accumulate on the lens, iris, and other eye structures.
These deposits obstruct the trabecular meshwork, increasing IOP and leading to optic nerve damage. Unlike primary open-angle glaucoma, PEG tends to be more aggressive, requiring closer monitoring and timely intervention.
Is Pseudoexfoliation Glaucoma Serious?
Potential for Vision Loss
If untreated, PEG can cause irreversible optic nerve damage and permanent vision loss. Since symptoms appear late, many patients are unaware until significant vision is already lost.
Severity Comparison
Compared with primary open-angle glaucoma (POAG), PEG is typically more severe, with greater fluctuations in IOP and faster disease progression.
Difficulty in Treatment
PEG is often harder to control with medications alone, and many patients require laser or surgical intervention earlier than those with POAG.
Causes of Pseudoexfoliation Glaucoma
Transforming Growth Factor-Beta 1 (TGF-β1)
Research suggests TGF-β1 plays a role in the overproduction of pseudoexfoliative material that deposits within the eye.
Oxidative Stress
An imbalance of free radicals and antioxidants causes cellular damage, contributing to the abnormal deposits seen in PEG.
Iris Hypoperfusion
Reduced blood flow to the iris impairs normal tissue health, encouraging pseudoexfoliative material formation.
Anterior Chamber Hypoxia
Lack of oxygen in the anterior chamber alters cellular activity, contributing to the buildup of material.
Genetic Factors and Risk Factors
PEG is more common in people over 60 years, with higher prevalence in Nordic and eastern Mediterranean populations. Family history also increases the risk.
Symptoms of Pseudoexfoliation Glaucoma
Early-Stage Symptoms
In the initial stages, PEG may show no noticeable symptoms, making routine eye exams critical for early detection.
Progressive Symptoms
As PEG advances, patients may experience blurred vision, halos around lights, glare, and difficulty seeing in dim light.
Ocular Changes Detected by Eye Doctor
Eye specialists can detect the presence of white, flaky pseudoexfoliative deposits on the lens or iris during a slit-lamp exam.
Risk of Bilateral Impact
While it often starts in one eye, the second eye has a 50% chance of being affected within 15 years.
Diagnosis of Pseudoexfoliation Glaucoma
Comprehensive Eye Exam
A detailed exam includes measuring IOP, assessing the optic nerve, and checking the visual field for damage.
Dilated Slit-Lamp Examination
This allows ophthalmologists to see pseudoexfoliative deposits on the lens, iris, and zonules.
Imaging Tests
Advanced imaging tools such as OCT and gonioscopy help assess the angle and optic nerve.
Optical Coherence Tomography (OCT)
OCT provides cross-sectional images of the optic nerve and retinal layers, detecting early glaucomatous damage.
Gonioscopy
This test evaluates the anterior chamber angle to identify blockages caused by pseudoexfoliative deposits.
Treatment for Pseudoexfoliation Glaucoma
Medication
Eye drops such as prostaglandin analogues, beta-blockers, and carbonic anhydrase inhibitors are used to reduce IOP. However, PEG often requires stronger or combination therapy.
Laser Trabeculoplasty
Selective laser trabeculoplasty (SLT) improves drainage and lowers IOP by about 30%, making it an effective option when drops are insufficient.
Surgical Options
When medications and laser treatments fail, surgery such as trabeculectomy or tube shunt procedures may be necessary, though PEG patients face higher risks of complications.
Regular Monitoring
Patients require frequent follow-ups to monitor IOP fluctuations, changes in the optic nerve, and disease progression.
Conclusion
Pseudoexfoliation glaucoma is a serious, progressive eye disease that can cause permanent vision loss if not treated promptly. Since it is often difficult to manage, early diagnosis, regular monitoring, and timely treatment are essential to protect vision. Patients at higher risk, especially those over 60, should schedule comprehensive eye examinations regularly.
FAQs
What is the difference between pseudoexfoliation syndrome and pseudoexfoliation glaucoma?
Pseudoexfoliation syndrome is the presence of abnormal white, dandruff-like deposits in the eye without raised eye pressure. Pseudoexfoliation glaucoma develops when these deposits block fluid drainage, causing high intraocular pressure and optic nerve damage, leading to vision loss.
How serious is pseudoexfoliation?
Pseudoexfoliation is serious because it significantly increases the risk of developing glaucoma, particularly a more aggressive form that progresses faster than primary open-angle glaucoma. Without treatment, it can cause irreversible optic nerve damage and permanent vision loss over time.
Does cataract surgery help with pseudoexfoliation glaucoma?
If a patient has pseudoexfoliation glaucoma along with cataract, then cataract surgery can improve vision in a patient with PEG, though the underlying PEG still require medical management or a combined trabeculectomy along with cataract surgery
Who is at risk for pseudoexfoliation?
Pseudoexfoliation is more common in people over 60, especially in populations from Nordic or Mediterranean regions. Risk factors include family history, genetic predisposition, and systemic conditions like cardiovascular disease, making regular eye examinations essential for early detection and prevention.
What are the complications of untreated cataracts?
Untreated cataracts can cause progressive clouding of the lens, resulting in blurred vision and difficulty performing daily tasks. Early detection and timely treatment help preserve visual clarity and prevent avoidable vision impairment.
This information is for general awareness only and cannot be construed as medical advice. Recovery Timelines, specialist availability, and treatment prices may vary. Please consult our specialists or visit your nearest branch for more details.Insurance coverage and associated costs may vary depending on the treatment and the specific inclusions under your policy. Please visit the insurance desk at your nearest branch for detailed information.
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