The aging eye

Image courtesy of Sohrab Gollogly website at

Image courtesy of Sohrab
Gollogly website at

Age is never a diagnosis. Although certain eye conditions may become more common with increasing age, you should not assume that they cannot be corrected. It can be confusing for a patient to know what part of the normal aging process is correctable and what is not. In this article we hope to clear up some of the most common symptoms of the aging eye.

Eyelid Changes

Collagen and elastin in the eyelids breaks down as we age. These substances keep our skin smooth and elastic. As these tissues begin to break down and gravity takes hold, a series of normal changes take place.

The lower eyelids may become lose and a loss of fat may cause the eyes to appear to “sink in”. The loosening of the lower eyelid may result in the eyelid turning outward (ectropion) or inward (entropion), resulting in chromic irritation. The effects of these changes can be easily fixed by an operation to tighten the eyelid tissues.

For the upper lids, age-related descent of eyelid tissues (dermatochalasis) are common causes of a chronically “tired” look. As with lower eyelid changes, surgery can correct the symptoms caused by this age-related condition.

Watery eyes in the elderly can be a sign of a clog in the tear drain. Your lower eyelid has a small hole on the inside corner. This hole, called the punctum, is the drain for your tears. If this drain gets clogged your eye will water, similar to a sink running over with water when the drain is clogged. It is often an easy procedure for your optometrist to flush the drain to remove the clog.

Crystalline Lens Changes

When we are born, the lens in the eye is perfectly clear. As we get older, this lens becomes cloudy and discolored. This is called cataract formation. Cataracts are part of the normal aging process and occur to us all as a result of a lifetime exposure to oxidative stresses. However, certain medical conditions such as diabetes or medications such as steroids may cause a person to get premature cataracts.

A person with cataracts often complain of glare, especially at night. They will also need more lighting especially when reading. Decreased contrast sensitivity, such as being able to tell the difference between two similarly colored socks, is common due to the discolored lens.

Fortunately, cataracts are very easily removed with a procedure called “cataract extraction”. During this procedure, a cataract surgeon will remove your cloudy lens and replaces it with a clear implant. The procedure takes approximately 10 minutes in an outpatient center, many times within the surgeon’s everyday office.

One of the first and most familiar normal signs of aging also occurs to the lens. Called Presbyopia, this is the condition requiring us to need reading glasses or bifocals in our early 40s. Presbyopia is caused by age related changes to the elasticity of the lens and focusing mechanism of the eye.

Vitreous Changes

The vitreous is the gel-like substance that fills the eye. Composed primarily of water and collagen, changes with age cause the collagen to break down and forms dense fibrils. If one of these fibrils passes though the center of the eye, and light catches it just right, you will notice it as a shadow, called a “floater”. Floaters, although annoying, are completely harmless.

As the eye continues to age, the vitreous liquefies and shrinks. As the vitreous shrinks, it pulls on the retina (the sensory tissue of the eye). Similar to tugging your skin causes you to feel it, when the retina gets tugged on you will see it as a flash of light.

Although a perfectly normal part of aging, any new floaters or flashing lights should be evaluated by an eye doctor immediately as they occasionally may indicate more serious conditions.

Retina Changes

Working like the film of a camera, the retina lines the inside surface of the eye. The macula is the part of the retina responsible for fine detail vision. As we age, retinal tissue become less able to remove cell waste from accumulating. This process is associated with macular degeneration, an age related disease leading to progressive central visual loss.

In 75 year olds, about 50% have at least an early form of macular degeneration. However, certain risk factors may make you more at risk. The strongest modifiable risk factor is smoking (3x the risk). Other risks include exposure to UV light and hypertension. Recent studies have confirmed certain vitamins may slow the progression. Your eye doctor will give you more information on these studies.

​​​​​​​​​​​Although many conditions arise with age, it is important to remember that many are correctable or benign. Only a comprehensive eye exam by your eye doctor can determine the best course of action for you. Don’t let your inner voice telling you “it is just my age” keep you from getting the help that you need.
~ David McCleary, O.D.
California Optometric Association

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