Conjunctiva The conjunctiva is the thin mucous membrane covering the sclera. Its goblet cells produce mucin, essential for lubricating eyelid movement and providing a protective layer to slow evaporation of the tear film. With aging, the number of mucous cells decreases, either as a result of keratitis sicca (with or without Sjogren’s syndrome) or non-specifically. [...]
The sclera is seen more clearly when the overlying conjunctiva is thinning. Arcus senilis, a deposit of calcium and cholesterol salts appearing as a gray-white ring at the edge of the iris, is a common finding in those > 60 yr. Usually, this sign is not associated with systemic disease, although rarely it is linked [...]
Arcus senilis usually occurs in the cornea, 1 to 2 mm inside the lim-bus, but it will not progress to interference with vision. The major age-related change of the cornea is degeneration of the endothelial cells lining its inner surface. Progressive degeneration can eventually result in failure to keep the cornea free of extracellular fluid. [...]
The iris contains two sets of muscles that regulate pupillary size and reaction to light. With age, the pupil becomes smaller, reacts more sluggishly to light, and dilates more slowly in the dark. Thus, elderly persons may complain that objects are not as bright (a smaller pupil allows less light to enter the eye), that [...]
Ophthalmoscopy of the retina is difficult in elderly patients because of their small pupils, eye movement, and opacities, but providing a target to stare at may help. Such an examination provides the only opportunity to directly visualize a cranial nerve (optic nerve), the portion of the retina responsible for the highest level of visual acuity [...]
Evaluation of the symptoms and signs associated with disorders of the aging eye and visual axis must be based on an understanding of anatomy and physiology. FIG. 102-1 depicts the structures that undergo anatomic or physiologic changes with aging. OCULAR STRUCTURES Conjunctiva The conjunctiva is the thin mucous membrane covering the sclera. Its goblet cells [...]
Lids With age, the lid margins (especially the lower one) can fall away from the eyeball (ectropion). This usually results from decreased strength of the orbicular muscles of the eyes, which squeeze the lids shut. If the lower lid margin no longer touches the eyeball, the punctum of the medial lower lid no longer touches [...]
Headache In the elderly patient, three general types of headaches can be distinguished: tension headache, eye muscle pain, and vascular headache. Patients with acute ocular disorders such as acute glaucoma may also complain of headache. Tension headache: This headache is related to any cause of increased muscle tone, eg, stress, arthritic pain, fatigue, or anxiety. [...]
Tension headache: This headache is related to any cause of increased muscle tone, eg, stress, arthritic pain, fatigue, or anxiety. These conditions may lead to chronic spasm of the scalp, the face, or the six extraocular muscles that control eye movements. Over time, the spasmodic muscles accumulate lactic acid, which stimulates local pain receptors, resulting [...]
Eye muscle pain: This type of headache often presents as a brow ache, first occurring on awakening, especially if the patient was reading or watching television late the previous night. The pain can be a throbbing, dull ache localized behind one or both eyes or across the brow or the entire forehead. It may affect [...]
