week 2 co2 - aging eye

What happens to the lids during aging?

• dry skin from loss of oily secretions

• wrinked and thin due to loss of elasticity

• pseudoptosis - overhanging skin

• corneal shape changes - less pressure on lids 

• malposition of lower lid - ectropion and entropion 

• malposition of punctum - watery eyes

• weaker, less efficient blinks - dry eyes, discomfort, Cl intolerance 

what happens to the conjunctiva during ageing? 

• Pigmented areas can appear (racial/complexion-associated melanosis).

• Pigment spots may be seen.

• Limbal epithelial folds (palisades of Vogt) become less distinct.

• Pinguecula (yellowish elastotic degeneration near the limbus) more common.

• Conjunctivochalasis (redundant, loose conjunctiva) develops.

• Conjunctival cysts may occur (benign epithelial inclusion cysts).

Implications:

• Mostly benign and cosmetic.

• Pinguecula/pterygium can induce irritation or astigmatism.

• Conjunctivochalasis may cause watery eyes and discomfort.

Q: What happens to the tear film with age

Tear production decreases (↓ aqueous & lipid secretion), tear film stability reduces, and evaporation increases.
Implications: Dry eye symptoms, burning/stinging, CL intolerance.

What happens to the cornea with age?

Cornea

• Astigmatism shifts WTR → ATR → Change in spectacle Rx

• Arcus senilis (lipid at corneal periphery) → Cosmetic, no VA effect

• Vogt’s limbal girdle → Cosmetic only

• ↓ Endothelial cell density → ↓ transparency, ↓ VA & contrast

• ↓ Sensitivity → Higher injury risk

• ↓ Metabolism → ↑ fluorescein permeability

What is this and explain what it is?

arcus senilis

• grey-white blurish ring at periphery of cornea

• lipid deposits

what happens to normal endothelial cell (ECD) with age?

• declines

what is low ECD a risk factor of?

cataract and corneal surgeries

what is polymegethism?

change from uniform cell size to variable cell sizea - indication if distress to endothelium

what happens to the sclera with age?

• Yellowing (lipid deposition) → Cosmetic only

• Bluish hue (thinning) → Apparent fragility

• Loss of elasticity → Reduced structural support

what happens to the anterior chamber with age?

• Becomes shallower (lens growth) → ↑ risk of angle closure glaucoma

• Pigmentation/thickening of trabecular meshwork → ↑ IOP, risk of glaucoma

• Shallow AC → Caution with dilation

What happens to the iris with age? 

• Depigmentation/atrophy (moth-eaten appearance) → Cosmetic, reduced pupil response

• Iris naevi may appear → Usually benign

what happens to the pupil with age?

• Senile miosis (smaller pupil) → ↓ retinal illuminance, impaired colour vision, ↑ glare

• Persistent pupillary membrane may remain → Usually no clinical impact

What happens to the lens with age?

• Thickens & hardens, capsule less elastic → Presbyopia (↓ accommodation)

• Lens sclerosis & yellowing → ↓ VA, impaired colour vision (esp. blue-yellow)

• Nuclear cataract → ↑ glare, ↓ vision

• ↓ Light transmission → ↓ retinal illuminance

what happens to the vitreous with age?

• Liquefaction of vitreous gel → Posterior vitreous detachment (PVD)

• PVD → Floaters & flashes, risk of retinal tears/detachment, possible haemorrhage

what’s going on here? 

increased liquefaction

pockets of fluid 

can lead to PVD

what happens to the retina with age?

• Narrower/sclerotic vessels (arteriosclerosis) → ↓ retinal perfusion

• Lipofuscin accumulation in RPE → Depigmentation, impaired function

• Loss of foveal reflex, retinal thinning → ↓ central & peripheral vision

• Drusen in macula → ARMD risk

what happens to the choroid with age?

• Choroidal crescent → Common benign ageing change

• Choroidal atrophy → Reduced retinal support, age-related degeneration

what happens to visual acuity with age?

Stable until ~60, then declines → ↓ VA due to cataract, ARMD, diabetic retinopathy, open angle glaucoma

what happens to refractive error with age? 

Refractive Error

• Hyperopia increases (40–65 yrs) → More near blur complaints

• Myopia may increase after 70 → Often due to cataract/diabetes

• Astigmatism shifts WTR → ATR → Change in spectacle Rx

what happens to contrast sensitivity with age? 

↓ at mid–high spatial frequencies → Reduced ability to detect fine details, poor vision in low contrast environments

what happens to depth perception with age?

↓ (due to reduced contrast sensitivity) → Difficulty judging kerb heights, ↑ risk of falls

What happens to accomodation with age?

• AoA (amp of accom) decreases (presbyopia) → Reduced near vision, need for reading correction

• Small pupils increase depth of focus → May mask some presbyopia temporarily

what happens to colour vision with age? 

• Lens yellowing & ↑ light scatter → Whites appear yellow, blue colours appear darker

• Senile miosis + lens changes → ↓ colour discrimination, esp. blue-yellow defects

what happens to glare with age?

↑ due to lens scatter (cataract) → Disability glare (reduced contrast), discomfort glare

what happns with visual fields with age?

• Senile ptosis → Field restriction superiorly

• Senile miosis & yellowing lens → Reduced peripheral sensitivity

• Retrobulbar fat loss → Relative enophthalmos → Field constriction

what happens to dark adaptation with age? 

Slower rhodopsin regeneration & ↑ lens scatter → Slower adaptation to dark, higher light threshold needed

what happens to Eye Movements – Versions & Pursuits with age?

Reduced smooth pursuit, restricted horizontal versions → Lag for moving targets, reliance on saccades

what are saccades, espc in age?

• ballisitic eye movements 

• Latency increases → Slower initiation of eye movements

• Velocity unchanged → Once initiated, still fast

what happens with Vergence with age?

Near exophoria increases, ↓ accommodative convergence → Difficulty maintaining near fixation, may need prism/adds

what advice would you give your elderly px?

• increase contrast around the house

• consider glare, hat with brim

• discuss driving - night drivibg and bright sun may be diffuclt