Impaired vision and hearing in the elderly

Chapter 36 Impaired vision and hearing in the elderly



Case 36.1


During a routine visit, 78-year-old Martha mentions that she can’t see as well as she used to. You need to determine exactly what she means by that, as you are aware that there are many different types of visual disturbances.




Questions



1. Select no more than five questions which will help you determine the type (not the cause) of visual disturbance Martha is complaining about.

2. You discover that the problem is a decrease in visual acuity. What does this mean?

3. What are some of the more common causes of diminished visual acuity in elderly people?

4. What do you wish to examine?

5. Physical examination of Martha’s eye was normal. She was referred to an optometrist for further assessment, as the diagnosis of many eye disorders require the use of specialised equipment. His report stated that Martha had some opacification of her lens. What is the name of this disorder?

6. What are the most common causes of this disorder?

7. Why does it cause a decrease in visual acuity?

8. Do you need to refer this patient?


Case 36.2


While having treatment for a chronic back problem, a 75-year-old patient mentions that he is having difficulty with reading. On further questioning, you elicit that he complains of ‘gaps’ on the page, where he can’t ‘see’ the word clearly.




Questions



1. What do you think the patient may be referring to? What will you ask him in order to clarify what his problem may be?

2. What are you going to examine in this man? Why?

3. Your results indicate a small area in the centre of both visual fields, where he is unable to see an object. What is the most likely diagnosis?

4. What is the most common cause of this disorder?

5. Are there any known predisposing factors for the development of this condition?


Case 36.3


Stan, 82-years-old, has red and painful eyes. He states that this has occurred in the past, but it has never been as bad as on this occasion. He asks you who he needs to consult about this problem. Previously, he was using some ointment that his daughter gave him, which seemed to help, but he has now used it all up.




Questions



1. What questions do you need to ask to determine the cause of his symptoms?

2. What is the most likely diagnosis, based only on the history?

3. What would you expect to find when you examine him?

4. Your expectations are confirmed on examination. There is increased erythema of both palpabral and bulbar conjunctiva, and his lower eyelid is slightly everted. What two diagnoses can you make, based on this description?

5. Could these two disorders be connected in some way? Explain.

6. Describe the aetiology of both these disorders.


Case 36.4


Your grandfather calls you in distress, and asks you for help. He has suddenly developed severe pain in his right eye, which is so severe it is making him feel nauseated. He has even vomited due to the pain. You go to his aid, and inspect his eye. This is shown in Figure 36.1.


image

Figure 36.1


(Source: Mir, MA. Atlas of Clinical Diagnosis [2nd edn]. Edinburgh: Saunders; 2003: 101, Fig 3.64)

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Dec 26, 2016 | Posted by in MANUAL THERAPIST | Comments Off on Impaired vision and hearing in the elderly

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