Pseudoexfoliation syndrome is an age-related disorder of the extracellular matrix, characterized by the deposition of pathological fibrillar material in the structures of the anterior segment of the eye and in extraocular tissues. The accumulation of pseudoexfoliative material leads to damage and impaired function of tissues such as the lens zonules, the iris, or the drainage angle. Pseudoexfoliation syndrome is a disease entity with a multifactorial pathogenesis, involving both genetic and environmental factors, among which LOXL1 gene polymorphisms, exposure to UV radiation, and oxidative stress play a particularly significant role. Pseudoexfoliation syndrome is the most common cause of secondary open-angle glaucoma, which is characterized by a more severe course and a poorer prognosis compared to primary open-angle glaucoma. Secondary open-angle glaucoma is associated with higher intraocular pressure values and its greater diurnal fluctuations. The treatment of secondary open-angle glaucoma involves the same methods as those used for primary open-angle glaucoma; however, the specific features of glaucoma in this patient group must be taken into account. Pseudoexfoliation syndrome also predisposes to cataract formation and intra- and postoperative complications, such as poor pupillary dilation, corneal decompensation, or lens dislocation, as well as systemic diseases. Due to its prevalence and clinical significance, Pseudoexfoliation syndrome represents a major diagnostic and therapeutic challenge in contemporary ophthalmology.