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associated with backache, osteoporosis most commonly causes the disease. There is no effusion or synovial thickening. Crepitus is present.

Rheumatoid arthritis involves the peripheral joints too in association with the knee and ankle. Early morning stiffness with relief of pain as day advances is characteristic of rheumatoid arthritis. There is synovial thickening and effusion and minimal local tenderness. A classical doughy feeling is elicited. There is atrophy of muscles around the joints of the interossei. Deformities in rheumatoid arthritis as mentioned early are typical, when the knee and ankle are alone involved in rheumatoid in rheu- matoid arthritis.

Rest in Cases of osteoporosis, adequate mobilisation and change of occupation as in drivers with cervical spondylosis are simple but important guidelines.

THIS LECTURE LASTED FOR TWO HOURS DIVIDED INTO TWO SESSIONS OF ONE HOUR EACH. FOUR CASES OF OSTEOARTHRITIS-KNEE, TWO CASES RHEUMATOID ARTHRITIS AND ONE CASE EACH OF OSTEOPOROSIS AND CERVICAL SPONDYLOSIS WERE DEMONSTRATED.

-R. Subramaniyan

EYE DISEASES

Visual handicap is the major physical sensory deficit in the elderly. Cataract, glaucoma, diabetic and hypertensive retinopathy, macular degeneration, corneal degeneration, refractive errors, dacryocystitis and conjunctivitis are some of the common diseases in the old. Arcus senilis is a normal physiological change in this age group. Early intervention prevents blindness, hence early referral is absolutely essential.

Cataract

Any lenticular opacity is called cataract. Development of cataract is a physiological process in senility. Factors like working in welding, manufacture of gun-powder, genetic predisposition and constant exposure to ultraviolet rays (sunlight) influence the onset of cataract formation. There occurs gradual painless loss of vision. Depending upon the progress of opacity, cataract formation is divided into four stages viz. (i) early (ii) immature (iii) mature and (iv) hypermature. A white opacity in the pupillary area denotes cataract. In cases of immature cataract, the iris throws a shadow which can be well visualized. Absence of iris shadow signifies a mature cataractous lens. In the hypermature stage, calcified spots are seen in the anterior chamber as a result of which intraocular pressure shoots up. Emergency removal of the cataract is then indicated.ln cases of immature cataract, glasses would suffice. Early surgery can be done for immature cataract-surgical intervention depends upon the visual needs and acuity. If defective vision interferes with the occupation of the person, surgery can be done. Mature cataract always demands surgery. Expulsive haemorrhage is a complication that can be met with during surgery. Post-operatively infections as panophthalmitis, iridocyclitis and endophthalmitis may occur. Iridocyclitis can be cured in few days.

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