A 75-year-old woman of Scandinavian descent presents to your office for a regular checkup and mentions that she has not had her eyes checked in many years. She has no vision or eye-related complaints. Her visual acuity is 20/25 in each eye. Examination of her left eye reveals a collection of white, flaky material in a circular pattern on the anterior lens capsule, and her left eye does not dilate completely when mydriatics are topically instilled. Fine, flaky material is also observed on the pupillary margin of the iris in both eyes.
The most likely diagnosis is
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Primary open-angle glaucoma
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Pigment dispersion syndrome
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Pseudoexfoliation syndrome
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Anterior subcapsular cataract
Answer on page 687
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