A clinical and ultramicroscopic review, including discussion of both scanning and transmission microscopy of the exfoliation syndrome, suggests that the term pseudoexfoliation be replaced by exfoliation syndrome. Involvement of the lens epithelium and, particularly, the pigment epithelium of the iris and the ciliary body epithelium are emphasized as being the likely sources of the exfoliative fibrils. A case of exfoliation syndrome in an eye with an eccentric pupil revealed that the granular material seen on the lens capsule occurs only where the iris is in contact with the lens surface and the process may even involve the central anterior capsule under proper conditions. This finding, together with the evidence of continuing deposits after intracapsular cataract extraction, suggests that the granular material is deposited from the iris and that the material formed by the lens epithelium remains within the lens capsule.
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