Ischemic Changes in a Case of Unilateral Pseudoexfoliation Syndrome

A 66 year old man with normotensive unilateral pseudoexfoliation syndrome associated with ipsilateral marked ischemia with nerve fiber layer thinning and nasal step on successive visual field tests mimicking glaucomatous visual field loss is presented. Although the optic disc appearance of the clinically visible pseudoexfoliative left eye was not suggestive of glaucomatous cupping the disc appeared much pale and retinal vessels narrowed compared to the right eye. Color Doppler imaging of the left ophthalmic artery showed extremely high resistivity index of 0.88. The case is discussed in light of recent literature underscoring the fact that pseudoexfoliation is a cause of ocular ischemia