Pseudoexfoliative material in the eyelid skin of pseudoexfoliation-suspect patients: a clinico-histopathological correlation.

The pseudoexfoliation (PSX) syndrome has recently been suggested to represent the intraocular manifestation of a systemic disorder. In the present study, we examined the correlation between the extraocular occurrence of PSX material in eyelid skin and clinical indications of early stages of PSX syndrome using transmission and immunoelectron microscopy. Typical PSX aggregates were demonstrated in 7 of the eyelid-skin biopsy specimens taken from 12 patients who had been categorized as "PSX suspects" on the basis of certain clinical signs related to loss and dispersion of melanin from the iris pigment epithelium and to iris stromal atrophy but showed no clinical evidence of PSX syndrome in either eye. Another 3 lid specimens obtained from PSX suspects exhibited signs of atypical PSX fibrillopathy. The PSX deposits revealed immunolabeling for heparan and chondroitin sulfate proteoglycan, entactin/nidogen, elastin, amyloid P, and vitronectin. These findings suggest that certain clinical signs indicating early PSX syndrome obviously correlate with the extraocular occurrence of PSX material before its clinically visible appearance on the surfaces of the anterior and posterior chambers.