Occurrence of pseudoexfoliative material in parabulbar structures in pseudoexfoliation syndrome

The blind and painful left eye of a 88-year-old woman was enucleated and examined by light and transmission electron microscopy. Three years earlier, after unilateral pseudoexfoliation syndrome with advanced open angle glaucoma of the left eye had been diagnosed, argon laser trabeculoplasty and pars plicata diathermy were performed. Light microscopy showed deposits of typical pseudoexfoliative material in the anterior segment and endothelialization of the chamber angle. By transmission electron microscopy we demonstrated pseudoexfoliative fibers not only at the typical intraocular locations and in the bulbar conjunctiva but also ultrastructurally identical material in hitherto not described extraocular locations such as extraocular rectus and oblique muscles, vortex veins and the optic nerve sheaths. Ultrastructurally, the fibers showed all the characteristic features of pseudoexfoliative material. Our findings are another strong indication that pseudoexfoliation syndrome is not a purely intraocular disorder but represents a more widespread disease.