title: Combined exfoliation and pigment dispersion: an overlap syndrome.
abstract: OBJECTIVE
  To describe a series of patients with combined pigment dispersion syndrome (PDS) and exfoliation syndrome (XFS) and to introduce a concept, the overlap syndrome, to aid in assessing multiple risk factors for glaucomatous damage.
  
  
  METHODS
  A retrospective review of the records of all patients on our database who carried a diagnosis of both PDS/pigmentary glaucoma (PG) and XFS/exfoliative glaucoma (XFG).
  
  
  RESULTS
  We identified 26 patients as having both XFS/XFG and PDS/PG. The average age was 64.3 +/- 9.8 years and 19 of 26 were men. All patients had bilateral PDS/PG. Bilateral XFS/XFG was present in 9 of 26 patients, and of the 17 patients with unilateral involvement, the left eye was affected in 13.
  
  
  CONCLUSIONS
  Both XFS and PDS are common. Middle-aged patients with known PDS/PG should be suspected of having the onset of XFS if 1 eye escapes intraocular pressure control. Patients presenting with unilateral XFG may also have signs of PDS/PG, often remitted. We define an overlap syndrome as the appearance of a new co-morbidity for glaucomatous damage in a patient with a pre-existing risk factor, which then changes the course, and prognosis of the disease. This concept should be particularly useful in dealing with secondary and normal-tension glaucoma.
authors.affiliation: Department of Ophthalmology, New York Eye and Ear Infirmary, NY, USA.
authors.forename: R
authors.initials: R
authors.lastname: Mudumbai
authors.forename: J M
authors.initials: JM
authors.lastname: Liebmann
authors.forename: R
authors.initials: R
authors.lastname: Ritch
mesh_terms: D017889:Exfoliation Syndrome / Q000150:complications* / Q000175:diagnosis; D005260:Female; D005902:Glaucoma, Open-Angle / Q000209:etiology; D006801:Humans; D007429:Intraocular Pressure; D007498:Iris / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010857:Pigment Epithelium of Eye / Q000473:pathology*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors