PXF Glaucoma
Pseudoexfoliation (PXF) glaucoma is a relatively common form of open-angle glaucoma that can cause significantly high eye pressures. This condition is characterized by a dust-like material observed on the surface of the iris and lens inside the eye. This ‘fibrillar’ material also deposits within the inner workings of the eye’s drainage system, the trabecular meshwork, thereby increasing intraocular pressure (IOP). There is also growing evidence that this disease of the basement membrane affects other organs within the body. Pseudoexfoliation can occur in one or both eyes, although it tends to be quite asymmetrical and is most commonly seen in patients over the age of 70. Pseudoexfoliation Glaucoma is found in all ethnic groups, although it was once felt to be a condition exclusive to those of Scandinavian ancestry.
‘Exfoliative’ Glaucoma
PXF is sometimes referred to as Exfoliative Glaucoma. However, Exfoliation of the lens capsule is an entirely different condition in which the outer membrane covering the lens of the eye is peeling off, or exfoliating. This is caused by exposure to infrared radiation and has been seen in Glassblowers. In Pseudoexfoliation, the lens capsule appears to be peeling, but it is a deposit of material, hence the term ‘pseudo’.
How PXF Glaucoma presents
PXF Glaucoma has a broad spectrum of clinical presentations. This ranges from the incidental finding of PXF material on the lens surface in the eye with normal intraocular pressures to presenting with very high pressures, often exceeding 40 mmHg. Unlike acute angle closure glaucoma, in which the pressure suddenly jumps above 40 mmHg, there is usually no pain associated with the extremely high pressures of PXF glaucoma, as the rise in pressure tends to be more gradual, allowing the eye to get used to it.
Treatment
Treatment is often required for pseudoexfoliation glaucoma, consisting of medication, laser treatment (eg SLT), or surgery. Pseudoexfoliation can lead to increased complications during cataract surgery, as the zonules that hold the crystalline lens in place are often weakened. There is some evidence to suggest that this is due to chronic inflammation directed toward these fibres within the eye. With proper treatment and monitoring, patients with pseudoexfoliation glaucoma tend to do well, although constant vigilance is required to watch for the precipitous phase.
Revised 2025
© 2025, 2020, 2015, 2009 Dr. Robert Schertzer Inc. based on 2007 The American Academy of Ophthalmology
