Due to accumulation of abnormal basement membrane material at the pupillary margin, there is increased apposition with the iris and subsequent erosion of iris pigment as the pupil dilates and constricts. This leads to increased iris transillumination and deposition of pigment granules on the endothelium, iris surface and trabecular meshwork similar to pigment dispersion syndrome. Because this condition involves deposition of material on the anterior lens capsule, and not flaking-off of the lens capsule, lensectomy is not a remedy. In fact, some have observed exfoliative material deposits on intraocular lens implants. The development of glaucoma typically occurs due to a buildup within the trabecular meshwork of pigment granules and pseudoexfoliative material.
Patients develop a secondary open angle glaucoma.
However, studies have identified patients with increased IOP but no decrease in aqueous outflow. In these cases, the glaucomatous mechanism is unknown. When first diagnosing pseudoexfoliation syndrome, perform automated visual fields to look for preexisting field loss since pseudoexfoliative glaucoma undergoes periods of exacerbation and remission. Treat pseudoexfoliative glaucoma in the same manner as primary open angle glaucoma. Use topical beta-blockers, topical carbonic anhydrase inhibitors, prostaglandin analogs and alpha adrenergic agonists if not systemically contraindicated.