Common eye problems in older people

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Common eye problems in older people

Wednesday, March 27, 2019

There are several eye problems that become more common among people as they age, although they can potentially affect anyone at any age. They include:

Presbyopia/long-sightedness

Presbyopia is often corrected with reading glasses and contacts.You can try ready-made reading glasses, which can be bought from a pharmacist or supermarket. Start with a low dioptre power and increase it gradually if needed, or visit an optometrist for an eye test and bespoke glasses

N.B. everyone over the age of 40 should have a two yearly eye examination, even if you don't need glasses

Most people find they cannot read without reading glasses once they have read with them. The glasses do not change the natural ageing process, but it is more comfortable to use them than not and creates less strain

Floaters

Most people notice floaters in well-lit rooms, or outdoors on a bright day. Floaters are often normal, but they can sometimes indicate a more serious eye problem, such as retinal detachment, especially if they are accompanied by light flashes

If you notice a sudden change in the type, or number of spots or flashes, see your GP as soon as possible, who will refer tyou to an Opthamologist

Dry eyes

Tear quantity and quality reduces with age and many people, particularly women, get dry eyes

Symptoms are gritty, itchy, red and burning eyes and the eyes may even water as the body tries to flush away the irritation with ‘reflex’ floods of tears, as there is not enough continuous ‘background tear’ production

You can try lubricant drops from the pharmacist, or get them prescribed by the GP

Hypromellose drops are good to start with and if this does not help, try carbomer gels.

If this does not help, your GP or optician may suggest that you use a humidifier at home, or humidifying aerosols

The GP might also suggest preservative free drops, or drops with Hyaluronic acid

Tear duct plugs or surgery may be needed in more serious cases of dry eyes

Watering eyes and blepharitis

Having too many tears can come from being sensitive to light, wind, or temperature changes. Protecting your eyes by shielding them, or wearing sunglasses can sometimes solve the problem. Tearing may also mean indicate a more serious problem, such as an eye infection or a blocked tear duct. You should see your GP or optician in the first instance, who can refer you for treatment for both of these condition

The cause may be excess tear production, poor quality tears (see under Dry Eye), or blepharitis, which is inflammation of the eyelid margins

If eyelid margins are crusty, sticky or red, blepharitis is usually the culprit. It can be improved by keeping the lashes clean by scrubbing them with dilute baby shampoo or blepharitis solution and cotton wool balls daily

It’s also worth trying Carboner gel four times a day for a month to see if reflex tearing is the problem

If this doesn’t work, then see your optometrist or GP

If the eyelid is lax, or the tear duct blocked, referral to an ophthalmic surgeon for further expert advice and treatment may be appropriate

Conjunctivitis

It is sometimes called “pinkeye.”

It can cause redness, itching, burning, tearing, or a feeling of something in the eye

Conjunctivitis occurs in people of all ages and can be caused by infection, exposure to chemicals and irritants, or allergies

This can be treated by buying chloramphenicol drops over the counter at the chemist

Cataracts

From middle age onwards, the lens gradually becomes cloudy and this is cataract formation, but the speed of this formation and how much it affects vision varies

Cataracts often form slowly, without pain, redness, or tearing in the eye. Some stay small and do not alter eyesight.

In a healthy eye, the lens is clear like a camera lens and light has no problem passing through it to the back of the eye to the retina where images are processed. When a cataract is present, the light cannot get through the lens as easily and, as a result, vision can be impaired

Symptoms include glare in bright sunlight and headlights, blurred vision, particularly in the distance when reading road signs and recognising people from a distance

If they become large or thick, cataracts can usually be removed by surgery. If you develop symptoms, see your GP

If you are affected by the cataracts, then it is probably reasonable to go for surgery

Cataract surgery and replacement of the lens with an implant is high tech, but very safe these days

It is usually done under local anaesthetic, so age is not a barrier. Patients of 100 years old are commonly treated and more than 95% of patients will have an improvement in their vision and no complications

The operation is the same whether the cataract is mild or more severe, so you can wait until you feel they need it

Glaucoma

Glaucoma affects 1 in 50 people over 40 and this increases with age, so it is relatively common

It is a disease of the optic nerve that causes insidious painless damage to sight

The eye pressure is usually, but not always elevated

Holes in the vision at the side occur but these are only noticed when the disease is very advanced

There is no treatment that will cure loss of vision it needs to be prevented. So as most people are unaware that they suffer from glaucoma everyone over 40 years should see an optometrist every 2 years for an eye examination, even if they do not need glasses

The optometrist will check the eye pressure with a puff of air, do a visual field test and look at your optic nerve

If any of these tests are abnormal, you may be recalled for a repeat test, or referred to an eye clinic

Treatment is usually prescription eye drops but occasionally  laser or surgery

Glaucoma is like high blood pressure treatment is usually needed for life.

Age-related macular degeneration (AMD)

It is the commonest cause of visual loss in this country and your risk is increased if they smoke

It comes in two forms:

  1. dry AMD, where the central retina becomes worn out with age and reading and then distance vision are gradually lost. There is no specific treatment for dry AMD, but a good bright light and magnifying aids may help. A minority of people progress to the more severe form
  2. wet AMD, in which abnormal blood vessels grow and leak under the retina. This causes distortion of vision so that straight lines appear to have a bend in the middle and central vision is blurred. If you notice this you should see your optometrist with a few days and you will be referred to your local eye department for further tests and treatment.

Sudden loss of vision.

Never ignore sudden loss of vision. Phone your optometrist immediately and ask to be seen that day

If you can’t see an optometrist, get an emergency appointment with your GP, or go to the local emergency department if you can’t be seen by anyone else

You need to be examined and then it can be decided how urgently you need to be seen by the local eye department who will be able to advise you of the treatments available

If loss of vision is gradual, make an appointment to see an optometrist, not the GP. as they have the best training and equipment to assess you

Corneal disease.

Disease, infection, injury, and exposure to toxic agents can damage the cornea causing pain, redness, watery eyes, reduced vision, or a halo effect

Treatments include making adjustments to the glasses prescriptions, using medicated eye drops, or having surgery

Eyelid problems.

Pain, itching, and tearing are common symptoms of eyelid problems. Other problems may include drooping eyelids, blinking spasms, or inflamed outer edges of the eyelids near the eyelashes. Eyelid problems often can be treated with medication or surgery

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