eMedicine Specialties > Ophthalmology > Intraocular Pressure

Glaucoma, Pseudoexfoliation: Differential Diagnoses & Workup

Author: Mauricio E Pons, MD, Associate Physician, Charles A Garcia, MD, PA
Coauthor(s): Babak Eliassi-Rad, MD, Assistant Professor, Department of Ophthalmology, Boston University School of Medicine
Contributor Information and Disclosures

Updated: Feb 25, 2008

Differential Diagnoses

Glaucoma, Pigmentary
Glaucoma, Primary Open Angle
Uveitis, Fuchs Heterochromic

Other Problems to Be Considered

True exfoliation syndrome
Primary familial amyloidosis

Workup

Imaging Studies

  • Various imaging technologies are being used to document and monitor changes due to glaucomatous damage in the optic disc and the retinal nerve fiber layer.
  • Optical coherence tomography (OCT) is a valuable tool in the evaluation of glaucoma. OCT provides a cross-sectional view of the scanned retinal area that allows differentiation between the retinal layers. The thickness of the retinal nerve fiber layer can be measured using this technique.
  • The confocal scanning laser ophthalmoscope (Heidelberg retina tomograph [HRT]) provides topographical measures of the optic disc as well as indirect measurements of the retinal nerve fiber layer thickness.
  • OCT and HRT have been used to help in the diagnosis and follow-up of patients with glaucoma. Both OCT and HRT have shown a high correlation between the retinal nerve fiber layer thickness and the visual field mean defect during achromatic perimetry.
  • The GDx Nerve Fiber Analyzer has been reported to be a valuable tool in helping the clinician to discriminate between healthy eyes and glaucomatous eyes.

Other Tests

  • Gonioscopy and visual field testing

Histologic Findings

Gottanka et al found marked differences in the optic nerve between primary open-angle glaucoma and pseudoexfoliation glaucoma.17 Eyes with primary open-angle glaucoma were found to have axon loss associated with more connective tissue in the septa and surrounding the central retinal vessels and a decrease in the density of capillaries as compared with eyes with pseudoexfoliation glaucoma where the capillary density did not change with axon loss.

More on Glaucoma, Pseudoexfoliation

Overview: Glaucoma, Pseudoexfoliation
Differential Diagnoses & Workup: Glaucoma, Pseudoexfoliation
Treatment & Medication: Glaucoma, Pseudoexfoliation
Follow-up: Glaucoma, Pseudoexfoliation
Multimedia: Glaucoma, Pseudoexfoliation
References
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References

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Further Reading

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Keywords

exfoliation glaucoma, pseudoexfoliation glaucoma, capsular glaucoma, glaucoma capsulare, exfoliative glaucoma, pseudoexfoliative glaucoma, pseudoexfoliation syndrome, fibrillopathia epitheliocapsularis, FEC, epithelio-capsular fibrillopathy

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Contributor Information and Disclosures

Author

Mauricio E Pons, MD, Associate Physician, Charles A Garcia, MD, PA
Mauricio E Pons, MD is a member of the following medical societies: American Academy of Ophthalmology and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Coauthor(s)

Babak Eliassi-Rad, MD, Assistant Professor, Department of Ophthalmology, Boston University School of Medicine
Babak Eliassi-Rad, MD is a member of the following medical societies: American Academy of Ophthalmology and American Glaucoma Society
Disclosure: Nothing to disclose.

Medical Editor

Bradford Shingleton, MD, Assistant Clinical Professor of Ophthalmology, Harvard Medical School; Consulting Staff, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary
Bradford Shingleton, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Ophthalmology
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Martin B Wax, MD, Clinical Professor, Department of Ophthalmology, University of Texas Southwestern Medical School; Vice President, Ophthalmology Research and Development, Head, Ophthalmology Discovery Research, Alcon Labs, Inc
Martin B Wax, MD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Society for Neuroscience
Disclosure: Alcon Labs Salary Employment

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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