The document outlines the various age-related changes in the eye, affecting structures such as the eyelids, lacrimal glands, sclera, conjunctiva, cornea, iris, crystalline lens, vitreous humor, and retina. These changes lead to conditions like cataracts, dry eyes, reduced tear production, and age-related macular degeneration, resulting in diminished visual acuity and comfort. The document details specific physical changes in the eye and their implications for vision in the elderly.

1. AGE RELATED CHANGES IN EYE
PRESENTED BY MIFTAHUL ISLAM
OPTOMETRIST

2. • AGEING – The gradual , irreversible biological
changes that occur over the course of time ,
that do not result from diseases or other
accidents and eventually lead to the increased
risk of death in near future .
• Ageing changes occur in all the structures of the
eye causing varied effects.

3. EYE LIDS -
• With age ,the orbicularis oculi
muscles ( which squeeze the lids
shut) decrease in strength.
• Poliosis in eye lashes.
• Ptosis,brow ptosis,crow
feet,wrinkles
• Senile ectropion
• Spasm of orbicularis oculi muscle
may cause the lid margin to turn
inward.(entropion)
• Trichiasis resulting in chronic
irritation .
• The lids contains many gland that
secrete sebum or sweat.
• These gland blocked.
• Dermatochalasis is a term used to
describe the presence of loose and
redundant eyelid skin.
Trichiasis
Meibomian gland dysfunction
Dermatochalasis

4. LACRIMAL GLAND AND TEAR DRAINAGE -
• Tear production by the lacrimal
gland may decrease with age .
• Abnormalities of the lacrimal
system may result in decrease or
increase tear production .
• Watery eye .
• Nasolacrimal duct obstruction.

5. SCLERA -
1. age related changes include
yellowing or, browning due to
exposure to UV light , wind and
dust more random splotches of
pigments.
2. Sclera thinning called
staphyloma.
Browning pigments in sclera

6. CONJUNCTIVA -
• Pinguecula.
• Pterygium.
• Muddy conjunctiva.
• Decrease in mucus cells.

7. AQUEOUS HUMOR-
• Reduction in the production of
aqueous humor
• Increase in accumulation of
extracellular material in both the
trabecular meshwork and ciliary
muscles and a loss of trabecular
meshwork cells ,which contribute to
reduction in outflow and result in an
increase in intraocular pressure.

8. CORNEA-
• There is against rule astigmatism.
• Arcus senilis,crocodile shagreen .
• Corneal luster,corneal fragility.
• Corneal sensitivity decreases with age .
• Corneal guttate,pleomorphism, corneal
xerosis
• Age related changes like corneal
degeneration, corneal dystrophies .
Arcus senilis Corneal sensitivity decrease
Corneal degeneration( crocodile
shagreen )
Corneal degeneration( corneal guttata)
Map dot fingerprint dystrophy Epithelial basement membrane dystrophy

9. IRIS -
• The iris contains two set of
muscle that work together to
regulate pupillary size and
reaction to light .
• with age, these muscle
weaken, and the pupil
becomes smaller , reacts more
sluggishly to light , and dilate
more slowly in dark.
• They also experience difficulty
when going from a brightly
light environment to a darker
one (delay dark adaptation).
• Iris atrophy
• Hyper pigmentation also seen
in older age .
Iris atrophy
Hyperpigmented iris

10. CRYSTALLINE LENS -
• Lens thickness and surface curvature
are changed by the action of the ciliary
muscle and suspensory ligaments
(zonules).
• The lens continuously grows during life
and increase in density and weight .
• These changes decrease the elasticity
of the lens .
• Between the age of 40 and 50, the lens
usually becomes so in elastic that close
object can no longer be brought into
focus (presbyopia)without the
assistance of corrective lenses.
• Opacification of lens .i.e CATARACT.
• Cataract is an opacity(cloud formation )
of the eye lens , develop due to ageing.
• Subluxation of lens.
Cataract is an opacity(cloud formation ) of the eye lens ,
develop due to ageing.
Vision of normal eye vs cataract eye

11. VITREOUS HUMOR-
• The vitreous undergoes
liquefaction with age as a
result , normal eye
movement produce
intermittent tension at
the attachment point on
the retina.
• The tugging stimulus the
peripheral retina .
• floaters, enhancements
of fibrins structure.
• PVD,peripheral retinal
detachments, curtain like
shaddow.
Vitreous opacities and changes
Flashes and floaters
Vitreous degeneration

12. RETINA-
• The retina is difficult to examine in
elderly patients because of their small
pupils, increased random eye movement
and lens opacities .
• The retina ,which glistens in younger
persons ,becomes duller with age .
• The macula, which in younger persons
usually has a bright central foveal light
reflex . may show no foveal reflex in
elderly persons.
• Yellowish white spots (drusen) often
appear in the macular area .
• The retina layer may become disrupted
resulting in pigmentation and obscuring
the view of underlying blood vessels.
• Age Related Macular degeneration
Retinal pigment epitheliopathy
Normal retina
Drusen

13. AGE RELATED CHANGES IN OCULAR FUNCTION-
May be divided into two group
• Related to vision – like refractive changes , visual acuity, contrast sensitivity , glare, haziness, flashing light,
moving spot,colour vision and visual field .
• Related to eye comfort- foreign body sensation , headache ,dryness,watering and irritation.