The exfoliation syndrome has now been recognised all over the world and even in such ethnic groups as the Skolt Lapps, Navajo Indians, Australian aborigines and all major tribes of the South African Bantu. The prevalence appears rather all major tribes of the South African Bantu. The prevalence appears rather similar in those countries where population-based surveys have been conducted. The exfoliation syndrome is age-dependent. In Caucasians the prevalence is low before the age of 60 years, increasing steadily to about 8 per cent in the group aged 80 to 90 years. However, the Bantus show a 6.4 per cent prevalence in the age group 30 to 39 years. In population-corrected surveys the females show a higher prevalence of the syndrome than do the males. Familial occurrence of exfoliation and population genetics have suggested an autosomal dominant mode of heredity. Suggestions of differences in prevalence of the exfoliation syndrome in different countries and even in different areas of the same country call for further population-based even in different areas of the same country call for further population-based surveys. Recognition of exfoliation is clinically of paramount importance as 20 percent of exfoliation patients show abnormalities of intraocular pressure. Poor pupillary dilatation, fragile zonular fibres and 2 per cent lens displacement may induce difficulties in extracapsular cataract surgery with posterior chamber lens implantation. Ciliary sulcus fixation of intraocular lenses with large diameter of the haptics is recommended.