A patient with pseudoexfoliation syndrome is noted to have scattered white flaky deposits on the anterior lens capsule, pupillary margin, and trabecular meshwork. What is the mechanism by which pseudoexfoliation leads to elevated IOP?

• A Deposition of abnormal fibrillar extracellular matrix material on and clogging the trabecular meshwork reducing outflow ✓
• B Pseudoexfoliation material obstructs the pupil causing pupillary block
• C Increased aqueous production due to abnormal ciliary body epithelium
• D Elevated episcleral venous pressure from abnormal aqueous veins

Explanation

Pseudoexfoliation (exfoliation) syndrome is caused by abnormal production and deposition of fibrillar extracellular matrix material (pseudoexfoliation material) by the lens epithelium, ciliary body, iris, and trabecular endothelial cells. Accumulation of this material within the trabecular meshwork impairs aqueous outflow and raises IOP. Pseudoexfoliation glaucoma is the most common identifiable cause of secondary open-angle glaucoma worldwide and tends to respond less well to topical medications than POAG, with higher rates of surgical intervention needed.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.