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Pseudoexfoliation Glaucoma Treatment & Management

  • Author: Mauricio E Pons, MD; Chief Editor: Hampton Roy, Sr, MD  more...
Updated: Jul 27, 2015

Medical Care

See the list below:

  • Patients with pseudoexfoliation syndrome should have annual eye examinations for early detection of glaucoma. Glaucoma in pseudoexfoliation is more resistant to medical therapy and has a poorer prognosis than primary open-angle glaucoma.
  • The treatment of pseudoexfoliation glaucoma is the same as that of primary open-angle glaucoma; however, topical medications tend to be less effective. Miotics lower IOP, but they aggravate the blood-aqueous barrier dysfunction and decrease iris mobility, thereby increasing the risk of posterior synechiae and cataract formation.
  • Argon laser trabeculoplasty is frequently used with excellent initial success. Its hypotensive effect may be facilitated by enhanced heat absorption because of increased trabecular pigmentation.
  • According to a published study, selective laser trabeculoplasty (SLT) has been shown to be equivalent to argon laser trabeculoplasty in terms of lowering IOP at 1 year. The theoretical advantage of SLT is that SLT is a repeatable procedure because it does not seem to produce thermal damage to the trabecular meshwork.

Surgical Care

See the list below:

  • If medical therapy and laser therapy are unsuccessful to control the glaucoma, trabeculectomy can be performed with similar success rates to that of primary open-angle glaucoma. Because patients with pseudoexfoliation glaucoma have higher IOP, they tend to undergo glaucoma filtering surgery more frequently than patients with primary open-angle glaucoma.
  • Cataracts occur more commonly in patients with pseudoexfoliation syndrome. The Blue Mountains Eye Study suggest that the presence of pseudoexfoliation syndrome is associated with an increased risk of nuclear cataract and cataract surgery.[45] Weakness of the zonular fibers, spontaneous lens subluxation, and phacodonesis also can be present. Therefore, in these patients, cataract surgery alone or combined cataract surgery and glaucoma filtering surgery in the presence of pseudoexfoliation is associated with a higher incidence of intraoperative complications, most notably zonular dialysis, vitreous loss, and lens dislocation.
  • The increased intraoperative posterior capsule complication rate appears to correlate with the level of cataract maturity. Modern surgical techniques involving the use of capsulorrhexis, small-incision surgery, and better viscoelastics have improved the surgical outcome. Capsular tension rings have been used to decrease surgical stress on the zonules.
  • Postoperative cataract surgery complications can occur after uneventful operations due to continued destabilization of the zonules and capsular contraction.
  • Jacobi et al described a nonfiltering surgical technique consisting of trabecular aspiration with or without cataract removal with encouraging results.[46] The operation attempts to increase the outflow facility along the trabecular meshwork by removing pretrabecular and trabecular debris using an externally applied suction device.


The use of supplements with vitamin B-12 and folic acid to decrease hyperhomocysteinemia in patients at risk has been suggested. A randomized clinical trial is needed to prove its benefit.

Contributor Information and Disclosures

Mauricio E Pons, MD Associate Physician, California Retina Associates

Mauricio E Pons, MD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Society of Retina Specialists

Disclosure: Nothing to disclose.


Babak Eliassi-Rad, MD Assistant Professor, Director of Glaucoma Service, Department of Ophthalmology, Boston University School of Medicine

Babak Eliassi-Rad, MD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Martin B Wax, MD Professor, Department of Ophthalmology, University of Texas Southwestern Medical School; Vice President, Research and Development, Head, Ophthalmology Discovery Research and Preclinical Sciences, Alcon Laboratories, Inc

Martin B Wax, MD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, Society for Neuroscience

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, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

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, American Academy of Ophthalmology

Disclosure: Nothing to disclose.

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Pseudoexfoliative material can be seen in this eye with pseudoexfoliation glaucoma. Courtesy of S. Fabian Lerner, MD.
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