Background: Pseudoexfoliation syndrome (XFS) has been found to occur more commonly among indigenous Australians. This paper was designed to determine the prevalence of XFS within the indigenous Australian population living in central Australia. Design: Clinic-based cross-sectional study. Participants: One thousand eight hundred eightyfour individuals living in one of 30 remote communities within the statistical local area of ‘Central Australia’ were recruited. This equated to 36% of those aged 20 years or older and 67% of those aged 40 years or older within this district. Methods: Participants aged 20 years or over were recruited as they presented to the eye clinic at each remote community. Slit-lamp examination was performed, and the presence of XFS in each eye was recorded and presented. Main Outcome Measure: Prevalence and associations of XFS. Results: XFS was present in one or both eyes of 4.7% of the individuals recruited into the study. Prevalence increased with age (5.9% of those ≥40 years and 12.7% ≥60 years). There was a significant association between the presence of XFS and climatic keratopathy (χ2 = 240.13; P <0.00001). Notably, none of those with XFS had ocular hypertension or glaucoma. Conclusion: XFS was present in a significantly higher proportion of indigenous Australians compared with previously reported prevalence estimates among non-indigenous Australians. The association found between XFS and climatic keratopathy may represent a common causal link between the two conditions. The lack of association of XFS with ocular hypertension and glaucoma appears to be a unique feature of the indigenous Australian population, and this merits further investigation.