THE AGEING EYE
● Ageing leads to normal non-pathological ocular changes alongside a higher risk of
eye disease.
● Population impact:
○ UK population aged ≥85 years: 1.7 million (2020; 2.5%) → projected to reach 3.1
million (2045; 4.3%).
● Importance: elderly require special eye care for both pathological and normal ageing
changes.
Learning Objectives:
● Identify common age-related ocular changes.
● Understand effects on lids, conjunctiva, tear film, cornea, lens, vitreous, retina, macula.
● Understand effects on visual functions (VA, refraction, contrast, depth perception, AoA,
colour, glare, VF, dark adaptation, eye movements).
2. External Eye Changes
Lids
● Structural changes:
○ Skin: thin, dry (loss of oily secretions), less elastic, wrinkled.
○ Overhanging skin on lid margin → pseudoptosis.
○ Less lid pressure on cornea.
● Functional changes:
○ Horizontal lid laxity → ectropion ( eyelid turned outward) /entropion (eyelid turned
inwards), punctal malposition (no longer in contact with surface of the eye.
○ Weaker/incomplete blinks → dry eye, CL intolerance.
○ Increase in ATR (against-the-rule) astigmatism.
Astigmatism is when your eye’s cornea or lens is irregularly shaped. Normally, the cornea
and lens are curved equally in all directions.
If we view the eye as a sphere, “against-the-rule” is astigmatism where the steepest curve
lies near the 180-degree meridian (imaginary line connecting east and west points of the
cornea), and “with-the-rule” astigmatism (line connecting north and south points) is near the
90-degree meridian. With-the-rule is by far the most common type of astigmatism.
Implications: Dry eyes, watery eyes, cosmetic & functional lid droop, reduced blink efficiency.
, Conjunctiva & Tear Film
● Conjunctiva: Atrophy (shrinkage), increased transparency, pinguecula (non cancerous
yellowish growth on conjunctiva)common.
● Tear film:
○ Tear production ↓ with age (lacrimal gland changes).
○ Dry eye symptoms are more frequent. - less goblet cells
● Leads to ocular discomfort, CL intolerance, and reduced visual quality.
3. Cornea & Anterior Chamber
Cornea
● Arcus senilis: lipid/cholesterol deposits in peripheral cornea. - white ring
- These are products of metabolism that aren't excreted
● Less steep vertically
● Increased surgical risk (cataract, corneal procedures).
● Reduced infection resistance
● Reduced sensitivity
● Decline in metabolism
● Increased permeability to fluorescein
● Endothelium:
○ Decline in endothelial cell density - leads to reduced transparency
○ Polymegethism (irregular cell sizes).
○ Important in ion pump and water control
● Ageing leads to normal non-pathological ocular changes alongside a higher risk of
eye disease.
● Population impact:
○ UK population aged ≥85 years: 1.7 million (2020; 2.5%) → projected to reach 3.1
million (2045; 4.3%).
● Importance: elderly require special eye care for both pathological and normal ageing
changes.
Learning Objectives:
● Identify common age-related ocular changes.
● Understand effects on lids, conjunctiva, tear film, cornea, lens, vitreous, retina, macula.
● Understand effects on visual functions (VA, refraction, contrast, depth perception, AoA,
colour, glare, VF, dark adaptation, eye movements).
2. External Eye Changes
Lids
● Structural changes:
○ Skin: thin, dry (loss of oily secretions), less elastic, wrinkled.
○ Overhanging skin on lid margin → pseudoptosis.
○ Less lid pressure on cornea.
● Functional changes:
○ Horizontal lid laxity → ectropion ( eyelid turned outward) /entropion (eyelid turned
inwards), punctal malposition (no longer in contact with surface of the eye.
○ Weaker/incomplete blinks → dry eye, CL intolerance.
○ Increase in ATR (against-the-rule) astigmatism.
Astigmatism is when your eye’s cornea or lens is irregularly shaped. Normally, the cornea
and lens are curved equally in all directions.
If we view the eye as a sphere, “against-the-rule” is astigmatism where the steepest curve
lies near the 180-degree meridian (imaginary line connecting east and west points of the
cornea), and “with-the-rule” astigmatism (line connecting north and south points) is near the
90-degree meridian. With-the-rule is by far the most common type of astigmatism.
Implications: Dry eyes, watery eyes, cosmetic & functional lid droop, reduced blink efficiency.
, Conjunctiva & Tear Film
● Conjunctiva: Atrophy (shrinkage), increased transparency, pinguecula (non cancerous
yellowish growth on conjunctiva)common.
● Tear film:
○ Tear production ↓ with age (lacrimal gland changes).
○ Dry eye symptoms are more frequent. - less goblet cells
● Leads to ocular discomfort, CL intolerance, and reduced visual quality.
3. Cornea & Anterior Chamber
Cornea
● Arcus senilis: lipid/cholesterol deposits in peripheral cornea. - white ring
- These are products of metabolism that aren't excreted
● Less steep vertically
● Increased surgical risk (cataract, corneal procedures).
● Reduced infection resistance
● Reduced sensitivity
● Decline in metabolism
● Increased permeability to fluorescein
● Endothelium:
○ Decline in endothelial cell density - leads to reduced transparency
○ Polymegethism (irregular cell sizes).
○ Important in ion pump and water control
