Abstract.Two studies, both retrospective, were done at our institution. The first study evaluated 100 consecutive patients with exfoliation (EX) syndrome found as an incidental finding in a private, general ophthalmology practice, to determine the incidence of glaucoma. The second determined the long‐term course of EX as it relates to the onset of elevated intraocular pressure (IOP). In the first study, of 124 eyes having EX 78 % had normal IOP, 15 % had intraocular pressure greater then 22 mm Hg but no cupping or field loss (ocular hypertension or glaucoma suspect), and 7 % had glaucoma. In the second study 347 patients who initially had normal IOPs and either unilateral or bilateral EX were followed over time. Elevated IOP developed in 35 patients (44 eyes) during the study. The cumulative probability for eyes with EX to develop elevated intraocular pressure was 5.3 % in 5 years and increased to 15.4 % in 10 years. These probabilities predict that patients with EX have a higher incidence of developing elevated intraocular pressure than would be expected in patients without EX of similar ag