Exfoliation syndrome (XFS) is characterized by the production and progressive accumulation of a fibrillar extracellular material in many ocular tissues. It has only recently been recognized to be the overall most common identifiable cause of glaucoma worldwide.1 Exfoliative glaucoma (XFG) comprises over 50% of open-angle glaucomas in some countries and is now considered one of the leading causes of visual loss in elderly patients.2 It causes not only severe, chronic open-angle glaucoma, but also lens subluxation, angle-closure glaucoma, blood–aqueous barrier impairment, and serious complications at the time of cataract extraction, such as zonular dialysis, capsular rupture, and vitreous loss.
Based on the recent identification of accumulations in orbital tissues, skin specimens, and visceral organs, XFS is now recognized as a generalized disorder of the extracellular matrix. Preliminary information suggests a relationship with transient ischemic attacks, stroke, and heart disease. The potential ramifications of this disorder appear to be far more important than ever before realized.
Exfoliation syndrome (XFS) is the most common identifiable cause of glaucoma worldwide. Exfoliative glaucoma (XFG) comprises over 50% of open-angle glaucomas in some countries and is now considered one of the leading causes of visual loss in elderly patients.