We reviewed the records of 74 patients with exfoliation syndrome. Patients with exfoliation syndrome represented 12% of the current Glaucoma Clinic population. There were 40 unilateral and 34 bilateral cases. Thirteen percent of the patients who originally had unilateral exfoliation later developed exfoliation in the fellow eye. Forty percent of the affected eyes with exfoliation had appreciable cataracts. Evidence for bilateral glaucoma was present in only 22% of the patients with unilateral exfoliation (and ipsilateral glaucoma). The evidence suggests that the exfoliation syndrome is, in most cases, the cause of the glaucoma, and that this is generally a true secondary open-angle glaucoma. Trabecular pigmentation may be a prognostic factor relating to the occurrence of glaucoma.