The External

The eyelids tend to lose their elasticity and become less firmly opposed to the globe. The upper and lower lid margins become progressively lower so that whereas in the infant the upper lid can ride level with or slightly above the corneal margin, in an elderly subject the upper lid might cross a significant part of the upper cornea. An area of white can be seen between the lower margin of the cornea and the lower lid. Some limitation of the ocular movements is accepted as normal in the elderly, especially limitation of upward gaze. The conjunctiva tends to become more lax and a thin fold of conjunctiva might be trapped between the lids when blinking if this becomes excessive. In some elderly patients, there is loss of connective tissue around the lacrimal puncta so that the opening is seen elevated slightly from the rest of the lid. Degenerative plaques are seen on the bulbar conjunctiva in the exposed region and the conjunctiva is especially prone to chronic inflammation.

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