SYMPTOMS AND SIGNS ASSOCIATED WITH AGING
Posted by recep on April 19th, 2009The symptoms and signs associated with aging may be divided into two groups: those related to eye comfort (foreign-body sensation and headache) and those related to vision (glare, haziness, flashing lights, moving spots, and refractive changes).
EFFECTS ON EYE COMFORT
Foreign-Body Sensation
A false foreign-body sensation may be related to a dry eye condition, entropion, chronic fatigue of the eye muscles from lack of sleep, poor health, a latent eye muscle imbalance, or excessive close vision (eg, reading when extremely tired). However, a true foreign body must be ruled out.
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. 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 in headache. Such a tension headache is usually described as a tight band about the head or as pressure, and in most cases can be related to a specific activity. The headache worsens if the activity continues and is often relieved by muscle relaxants or analgesics. Occasionally, however, the pain is truly debilitating.
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 either side of the head. Other symptoms include redness, burning, and tearing, especially after prolonged close-range work or reading at night when fatigued.
A major cause of this type of headache is a tendency for the eyes to turn outward with aging (exophoria). This results from a gradual decrease in the tone of the medial rectus muscles, which turn the eyes inward when reading or focusing on objects within 1 to 10 ft.
Exophoria is diagnosed by asking the patient to look through reading glasses at a flashlight about 1 ft away while alternately covering each eye, never allowing both to see the light simultaneously. Each eye is observed as soon as it is uncovered. If the eye moves inward to look at the light, it must have drifted outward while it was covered, suggesting exophoria.
Headache associated with exophoria can often be prevented by resting more, doing close-range work early in the day, or increasing the contractile tone of the medial rectus muscles through muscle exercise therapy.
Vascular headache: In the elderly, a vascular headache may result from temporal arteritis or a migraine. When a headache has a recent onset and is associated with hip-girdle pain, jaw claudication, fatigue, or visual changes, the physician should suspect temporal arteritis and obtain an erythrocyte sedimentation rate. If the erythrocyte sedimentation rate is elevated or if suspicion is high before the test results are known, prednisone 60 mg/day should be initiated, and a temporal artery biopsy should be obtained as soon as possible (see also Ch. 74).
Migraine headaches may occur at any age but do not commonly begin in later life. The headache is often preceded by an aura of flashing bright lights in a vertical zigzag or picket-fence configuration, either to the far left or far right of both visual fields, and is always bilateral. This aura may be followed by severe, pounding, relentless pain on the opposite side of the head. The pain is exacerbated by bright lights or movement and eased by lying down in the dark. The aura is caused by marked cerebral vasoconstriction involving vessels of the visual cortex, and the pain results from marked secondary vasodilation (with associated stretching of perivascular nerve endings).
Prophylaxis with a ?-blocker or calcium channel blocker may prevent the attack by blocking vasoconstriction. Effective treatment consists of taking ergotamine at the onset of the aura to abort the attack by maintaining vasoconstriction. Once headache supervenes, analgesics and rest are indicated. An injection of sumatriptan may ameliorate the symptoms.
