My mother in law is 78 and started seeing bugs in her house a month or so ago. There are none. She has become completely obsessed with cleaning her house and herself but will not listen to reason and is becoming verbally aggressive with us as she is adamant they are there. We took photographs of everything she thought was bugs - some chips in her laminate, paint chips, grass, dust etc but she insists that it is our eyes that are the problem and not hers. (Not the case) She refuses to go for an eyetest as her optician apparently told her a year ago that her eyesight was perfect. She is falling in the street, she has bumped her car 3 times this year alone and we are seriously worried about her. She point blank refuses to see her doctor or an optician. She has had cataract surgery in both eyes over the last 5 years. Her hearing is not good either although she will tell you that is perfect too. She is on Warfarin and attends a clinic regularly. However she is and always has been economical with the truth and will not allow us to attend any appointments with her.
What on earth can we do to make her see reason?

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Elaine01, Delusional Not entierely sure, but Parasitosis, or Morgellons disease, are two syndromes that come to mind, are quite rare, but cause the patient extreme distress, as there is nothing you can do to convince them otherwise.  These people will often spend countless hours cleaning, and investing in skin care treatment and chemicals to deter infestation,  but to no avail.

 I once worked for a Dermatologist,  who had 2 patients who had these types syndromes,  and they are very difficult to treat, as there are no "bugs". The patient is often sent for a Psychological examination and then hopefully prescribed  medications to help with this.  I am so sorry this is happening to your MIL! 
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Sorry for asking about cataracts. After reading Veronica's post, I see that I missed that in your original post.
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Elaine clearly MIL is hallucinating and the question is: "what is causing it" It could be a UTI. This can be checked without her having to go to the Dr. Call the office tell them your concerns and ask for an order for a urinary test. You can pick up the necessary supplies and she can just pee in the cup at home. If it is a UTI that can be an excuse to get her to the Dr. It is legitimate to frighten her by saying that if left untreated the infection can spread to the kidneys and cause them to fail so she would have to have dialysis
You said she has had cataract surgery so her vision is probably fine unless she has developed something like macular degeneration or glaucoma. Only way to find out is a visit to the eye Dr which she refuses.
The history of small traffic accidents can also be a sign of dementia.
My suggestion would be to read up on all the stages of dementia and see how many boxes she ticks and go from there.
The bottom line is that if she is seeing bugs she is seeing bugs and you won't convince her of anything else.
At least be thankful she is keeping herself and the house clean.
Present her with a screw top jar and ask her to collect the bugs so you can get them identified so an exterminator can be called. Also ask her to show you any bug bites she has experienced. Good luck!
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Elaine, your profile states that your mother's primary problems are with vision. Does she have macular degeneration? Cataracts? Can she read? See okay to navigate around the house/

When I first read your post I didn't think of actual vision problems, but rather an OCD type disorder arising from something other than vision. That's not to be critical - I know that some people disparage OCD and mock, but it's a legitimate concern.

I'm wondering if you might have a "cleaning" time when you just spritz the air with water, or perhaps an herbal scented spray such as with lavender or rose water or another of the aromatic herbs. You can tell her it's a special blend designed to kill bugs, whether you can see them or not. If she can smell the fragrance after a few hours, that's an "indication" the bugs have been killed.

I think UTI or something else is at fault, not necessarily her vision, but it's hard to tell if she refuses to get her vision checked and at least start there. What other vision issues have you identified?

Sometimes you just have to take a firm stand and tell her she needs to have her vision checked and if she won't agree, there's nothing you can do.

However, I'd be cautious about saying something like unless you're sure she doesn't have dementia at any stage.

I've had to take this approach sometimes; if I can't be allowed to help, then there's no point in complaining to me. Tough love for seniors is often necessary. And that's not to diminish your concern; it's just a reality.
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It sounds like it's going to be a bear wrenching the car keys from her but it sounds like it's time.

This may be a situation where you need to wait for an emergency. Not technically but some excuse to get her to the ER. The next time she falls or if she comes down sick, something, anything, to get her to the ER so you can get her diagnosed with dementia and address any other health issues she may be keeping under her hat.

She may not be able to see reason. She doesn't sound reasonable about the bugs she thinks are in her house and she doesn't sound reasonable when you tell her that what she's seeing are paint chips, dust, and whatever else and she continues to insist there are bugs. That doesn't sound so much like an eye issue as it does a UTI or dementia issue. But that's just my opinion.

With your mom a high fall risk and perhaps either a UTI or  dementia lurking around you probably won't have to wait long before you can get her to the ER. If she falls, don't pick her up. Claim that you can't. Then call 911. This is what I did when I needed my mom to seek medical attention and she refused. They don't want to be a burden but by hanging on by their fingernails and insisting that they remain independent they are a bigger burden than if they would just accept help. It's a difficult situation.
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Elaine, ah the bugs... my Dad had that, and it turned out to be a Urinary Tract Infection. Once the infection started to clear up with antibiotics, the bugs started to go away.  UTI's can cause many strange things in seniors. 

As for the falling, usually that isn't an eye issue, it is an age issue. Two years ago I had a fall where I broke my arm. I fell in my office parking lot.
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I wish I had a better response, and I hope others who have been through the same kind of situation respond. For many of us, the ability to reason with our loved ones is long gone. Even if they understand the reasoning at the time of discussion, for many of us, they won't remember it minutes later.

If she's had issues with driving and potential psychiatric and vision issues, might turning her into the DMV for an evaluation be a potential course of action to at least end the driving? Although this involves yet another set of issues, arguments, and the like...

Do you happen to have a health care power of attorney so that you might be able to talk with her primary care physician about her situation?

I'm so very sorry for your difficult situation.
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