From the Guidelines
Ocular pain in the elderly is most commonly caused by dry eye syndrome, glaucoma, cataracts, age-related macular degeneration (AMD), and conjunctivitis, with cataracts being a leading cause of bilateral low vision in adults over 40 years old. According to a recent study published in JAMA in 2022 1, the prevalence of cataracts increases sharply with age, with an estimated 50% of US adults 75 years or older having cataracts. Some key points to consider when evaluating ocular pain in the elderly include:
- Dry eye syndrome, which can be treated with artificial tears or prescription medications like cyclosporine (Restasis)
- Glaucoma, which causes pressure-related pain and requires prescription eye drops such as timolol 0.5% or latanoprost 0.005%
- Cataracts, which typically cause gradual vision changes with occasional discomfort and may eventually require surgical removal
- AMD, which is the leading cause of blindness in adults older than 65 years, with a prevalence of 13.4% in those 60 years or older
- Conjunctivitis, which causes inflammation and discharge, treated with antibiotic drops like moxifloxacin four times daily for bacterial cases. It is essential to note that any sudden or severe eye pain in elderly individuals warrants prompt medical attention, as early intervention can prevent vision loss and provide effective pain relief.
From the Research
Causes of Ocular Pain in the Elderly
- Common eye conditions that can cause eye pain in the elderly include conjunctivitis, corneal abrasion, and hordeolum, as well as more serious conditions such as acute angle-closure glaucoma, orbital cellulitis, and herpetic keratitis 2
- Ocular pain can also occur in the absence of visible pathology, and can be a sign of threatening conditions such as intermittent angle closure glaucoma, carotid artery dissection, idiopathic intracranial hypertension, and giant cell arteritis 3
- Neurological disorders are a common etiology of ocular pain, and ophthalmologic, otorhinolaryngological, and oral and maxillofacial origins should also be considered 4
- Eye diseases such as cataracts, glaucoma, age-related macular degeneration (AMD), and diabetic retinopathy can contribute to ocular pain and visual impairment in the elderly 5, 6
- Age-related macular degeneration (AMD) is a leading cause of registered blindness in people over the age of 50 years in the western world, and can cause ocular pain and vision loss 6
Associated Symptoms and Conditions
- Ocular pain can be associated with vision changes, foreign body sensation, photophobia, and headache 2
- Eye diseases and visual impairment can contribute to falls, fractures, depression, and social isolation in the elderly 5
- Visual impairment is strongly linked to cognitive decline, which is a key component of frailty 5
- Reduced sensory input from vision loss can lead to decreased cognitive stimulation, reduced engagement in activities, and accelerated neurodegenerative processes 5