Short description on age related diseases in ocular Adnexa. Fruitful for, optometry students

1. Age Related Disease
in Ocular Adnexa
Aasma Marasini
B.optom-1st batch
NAMS, Bir Hospital

2. Introduction
• Ageing is simply defined as being older that results from the accumulation of
wide variety of molecular and cellular damage over time.
• Just like the rest parts of our body, our eyes also changes with age which can
reduce our eye’s optimum functioning.
• Here, we are going to discuss about the age related disease in ocular adnexa.

3. Age Related Disease in Eyelid
• The involutional changes that result in eyelid pathology includes ectropian
and entropian, dermatochalasis, ptosis and madarosis.

4. Ectropian
• Out rolling or outward turning of lid margin is ectropian.
• It occurs due to following age related changes:
-Horizontal laxity of eyelid.
-Medial canthal tendon laxity.
-Lateral canthal tendon laxity.
-Disinsertion of lower lid retractors.

5. • Epiphora is the main symptom.
• Treatment includes following operations:
-Medial conjunctivoplasty
-Horizontal lid shortening.
-Byron Smith’s modified Kuhnt-Szymanowski operation.

6. Entropian
• Entropian refers to inward rolling and rotation of lid margin towards globe.
• It occurs due to following age related changes:
-Horizontal laxity of lid.
-Vertical lid instability.
-Over riding of pretarsal orbicularis.
-Laxity of orbital septum.

7. • Symptoms include foreign body sensation, irritation, lacrimation and
photophobia due to rubbing of cilia against cornea and conjunctiva.
• Treatment include:
-Transverse everting suture.
-Wies operation.
-Plication of lower lid retractors.

8. Dermatochalasis
• It is redundancy and laxity of eyelid skin and muscles which is also termed as
“baggy eyes”.
• Gravity, loss of elastic tissue in the skin and weakening of eyelid connective
tissues contribute to dermatochalasis.
• Frequently involves upper lids but is also common in lower lids.

9. • Clinical features include:
-Obstruction of superior visual fields due to excess lid skin.
-Blepharitis.
-Wrinkles in lower eyelid and at lower canthus.
• Dermatochalais can be corrected by upper and lower eyelid blepharoplasty to
remove excess eyelid skin and orbital fat, with reconstruction of the upper
eyelid crease.

11. Ptosis
• Abnormal drooping of upper eyelid is called ptosis.
• It occurs due to:
-Gradual loss of tone of both the levator muscle and muller muscle.
-Disinsertion or dehiscence of levator aponeurosis.
-Surgery and chronic inflammatory disease that disinsert levator aponeurosis
from tarsal plate.

12. • Moderate ptosis has symptom similar to dermatochalasis.
• Severe ptosis decreases the visual field so that patients need to raise eyebrows
or eyelids with their hand.

13. Clinical Evaluation
1. History
It includes age of onset, family history, history of trauma, eye surgery and
variability in degree of ptosis.

14. 2. Examination
• Exclude pseudoptosis
It may occur due to ipsilateral condition like microphthalmos,phthisis bulbi,
enophthalmos, prosthesis,dermatochalasis and hypertropia and contralateral
conditions like eyelid retraction, high myopia and proptosis.

15. • Following points are observed:
-Unilateral or bilateral ptosis is checked as bilateral ptosis is caused by
congenital ptosis, myasthenia gravis, myotonic dystrophy, kearns-Sayre
syndrome and chronic progressive ophthalmoplegia.
- Function of orbicularis oculi muscle.
- Presence or absence of crease.
- presence or absence of jaw winking phenomenon.

16. - Associated weakness of any extraocular muscle.
- Presence or absence of Bell’s phenomenon.
• Measurement of amount (degree) of ptosis
- In unilateral case, difference between vertical height of palpebral fissure
of two sides indicates degree of ptosis.

17. - In bilateral cases it can be determined by measuring the amount of cornea
covered by upper lid and subtracting 2 mm.
Grades of ptosis
. Mild Ptosis : 2mm
. Moderate Ptosis : 3mm
. Severe Ptosis : 4 mm

18. • Marginal reflex distance:
Normal value is 4-5 mm.
• Assessment of levator function:
Levator function is graded as follows-
.Normal : 15 mm
.Good : 8 mm or more.
.Fair : 5-7 mm
.Poor: 4 mm or less

19. • Special investigations:
- Tensilon test for myasthenia gravis suspected patients.
- Phenylephrine test for Horner’s syndrome suspected patients.
- Neurological investigations to find the cause in neurogenic ptosis.
• Photographic record

20. • Treatment includes:
-Treatment of underlying cause.
-Surgical treatment depends on levator function where good levetor
function still exist.

21. Madarosis
• It is a condition that causes people to lose their hair from their eyelashes or
eyebrows.
• Causes of madarosis are:
-Blepharitis infects both eyelids and eyelashes.
-Infections like bacterial, viral and fungal.
-Nutritional deficiencies like zinc, iron or biotin.

22. • Main symptoms of madarosis is losing hair on eyebrow and eyelashes.
• Additional symptoms include redness or itching depending on underlying
cause.
• Treatment includes:
- Treatment of underlying cause.
- Use of cosmetic products.

23. Age Related Disease in Lacrimal Apparatus
• Lacrimal gland undergoes structural and functional alteration with increasing
age.
• A decrease in the lacrimal gland secretory formation can lead to dry eye
disease.
• Lacrimal Apparatus disorders related to ageing are dry eye and dacryocystitis.

24. Dry Eye
• Dry eye is a condition occurring as a sequelae to deficiency or abnormalities
of tear film.
• Its causes are:
-Changes in the composition of tear film where lacrimal fluid contains too
little oil as tears evaporate more quickly through the lack of stabilizing lipid
layer.
-Reduction in tear production where sufficient fluid is no longer present to
keep the eye moist.

25. • Symptoms include irritation, foreign body sensation, feeling of dryness, and itching.
• Can be examined through tear film break up time, Schirmer test and rose Bengal
staining.
• Treatment include:
- Tear substitutes supplementation.
-Treatment of underlying causes like lagophthalmos.
-Preservation of existing tears by reducing evaporation and drainage.

26. Dacryocystitis
• Inflammation of lacrimal sac in the lower corner of eye is dacryocystitis.
• It is of two types: chronic and acute.
• Most commonly seen in age of 40-60 years of age.
• Causes are:
-Anatomical factors which retards drainage of tears include comparatively
narrow bony canal, partial canalization of membranous Nasolacrimal duct and
excessive membranous folds in Nasolacrimal duct.

27. • Presenting symptoms are watering. Milky or gelatinous fluid regurgitation is
present in long term condition.
• Treatment includes:
-Balloon catheter dilation.
-Dacryocystorhinostomy
-Dacryocystectomy.

28. Age Related Disease in Orbit
• In some older people, the fat around the orbit shrinks, causing the eyeball to
shrink backward in the orbit.
• This condition is called enophthalmos.
• Due to presence of lax tissues in eyelids, the orbital fat can also bulge
forward into eyelids, making them appear puffy.
• Significant enophthalmos may cause a slight blockage of a person’s
peripheral vision.

30. Other Age Related Disease in Eye
• Presbyopia
• Cataract
• Floaters
• Glaucoma
• Age Related Macular Degeneration
• Retinal Detachment
• Conjunctivitis
• Corneal Disease