The prevalence of exfoliation syndrome among Saudis was determined during the National Survey of Blindness and Eye Disease in 1984 in Kingdom of Saudi Arabia. The subsample of this study consists of 376 persons aged 40 years or more from 50 different locations examined under mydriasis by the authors using Kowa hand-held microscope. There were 192 men and 184 women with the mean age of 56.0 f 1.2 years (median 53.5 years, range 40-95 years).The overall prevalence of exfoliation syndrome was 9.3 Yo: in the age group 40 to 49 years 1.6 Yo, 50 to 59 years 7.8 Yo, 60 to 69 years 8.9 Yo, and 26.5 Yo in persons 70 years of age and over. No significant association was found between exfoliation syndrome and sex or parental kinship.In 16 persons the exfoliation syndrome was unilateral, and in 19 persons bilateral. In 24 eyes the phenomenon could not be evaluated due to the anterior segment pathology.Exfoliation syndrome was associated with higher intraocular pressure (20 f 3 mmHg (n = 49) vs. 17 f 0.4 mmHg (n = 601), P < 0.05), and more cataract changes (P < 0.001) than eyes without. These eyes were also associated with poorer visual acuity than the eyes without exfoliation syndrome: in 26 of 35 persons with exfoliation syndrome, the affected eye was the better eye but in 35 Yo the vision was < 0.05 (< 3/60) i.e. the person was blind, compared to 6 Yo of persons whose better eye did not have exfoliation syndrome (P < 0.001).