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Excessive lacrimation or epiphora is due to eversion of the lower punctum from laxity of the lids in old age. If on clinical examination, the punctum is visible when the lower lid opposes the globe, it may be considered to be everted. In mild cases, the eversion may be sufficiently counteracted by burning a deep gutter in the fornix just behind and below the position of the punctum with diathermy. As the cicatrical tissue contracts, the punctum is pulled inwards towards the eye.

If this fails and in severe cases the conjunctiva should be slit. This is mostly avoided. Chronic dacryocystitis with acute exacerbations is another ophthalmic condition seen in the elderly. Repeated syringing of the nasolacrimal duct with a view to reducing the swelling of the inflammed mucosa and restoring patency helps in recent cases. In chronic state, dacryocystectomy is the treatment of choice.

Arcus senilis

Arcus senilis is a lipoid infiltration of the cornea met with in old people. It commences as a crescentric grey line, concentric with the upper and lower margins of the cornea, the extremities of which finally meet so that an opaque line thicker above and below is formed completely round the cornea. It is characterized by being separated from the margin by a narrow line of comparatively clear cornea, being sharply defined on the peripheral side, fading off on the central. It is never more than 1 mm broad and is of no importance either from the point of view of vision or of the vitality of cornea.

The most disastrous result of ocular disease, short of relatively rare loss of life is blindness. The term blindness implies inability to perceive light. But, it is obvious that many people who yet retain some degree of visual capacity are helpless from the economical standpoint. In the elderly, cataract, glaucoma, senile macular degeneration and diabetic retinopathy account for blindness. Early intervention and preventive measures can help prevent blindness.

THE ABOVE LECTURE LASTED FOR ONE HOUR. SIX CASES OF IMMATURE CATARACT IN ONE OR BOTH EYES, TWO CASES OF HYPERMATURE CATARACT AND CASES OF CORNEAL OPACITY AND LACRIMAL SAC DISEASE WERE DEMONSTRATED.

-G. Venkatasamy

NEUROLOGICAL DISORDERS

The common neurological diseases and complaints in the elderly are (i) cerebral arteriosclerosis (ii) dizziness or vertigo (iii) headache (iv) dementia and (v) peripheral neuropathy. Cerebrovascular disease is the most disabling illness which leads on to stroke. Most of these patients die of myocardial infarction.

The management of cerebrovascular disorders like cerebral haemorrhage, embolism and thrombosis is the prerogative of well equipped hospitals. At the PHC, one should pay attention to the symptoms and as far as possible give symptomatic relief. Previous history of strokes, paralysis, epilepsy and ischemic heart disease is important. Family history is elicited by asking about specific illness. Family members must be visited

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