Introduction Pseudo-exfoliation is a complex age related disorder of production and accumulation of fibrillar material in the anterior segment of eye. It is more common as the age advances. It is also associated with serious ocular problems such as cataract and glaucoma. Aims To find out the prevalence and pattern of clinical presentation in pseudo-exfoliative syndrome in patients visiting ophthalmology out-patient department in a rural area. Materials and Methods This was a prospective study carried out over a period of one year in the department of Ophthalmology, Mamata Medical College and associated General Hospital, Khammam. In this study 2000 individuals, (1111 male and 889 female) above the age of 40 years, were selected randomly and complete ocular examination was done in these subjects. Results Ninety (4.5%) out of 2000 individuals screened showed varying degree of pseudo-exfoliation syndrome in one or both eyes. The prevalence rate increased with advancing age. It was 4.5%, at 40 years and above, 5.35%, 6.35% and 6.89% at 50, 60, and 70 years and above respectively. In males the prevalence rate was 5.67% and in females 3.03%. Mean age at which this syndrome was detected is 67.32 SD±8.81 years. In males, it was 68.84 (SD±8.26) years and in females 63.96(SD±9.20) years. Bilateral involvement of the eyes was more common. Frequency of signs of pseudo-exfoliation syndrome increased with advancing age and the common signs were pseudoexfoliation material over pupillary border, over anterior capsule of lens, peripheral band, pupillary ruff defects, pigment deposition over trabecular-meshwork and over endothelial surface of cornea, and on anterior surface of lens capsule. Conclusion Pseudo-exfoliation syndrome is common in hospital visiting population especially in the elderly population in rural South India. Thorough ophthalmologic examination helps to pick up this syndrome. Early detection helps to prevent associated complications such as cataract, glaucoma capsulare and phacodonesis.