Arcus senilis

Arcus senilis is a depositing of phospholipid and cholesterol in the peripheral cornea in patients over the age of 60 which appears as a hazy white, grey, or blue opaque ring (peripheral corneal opacity). Arcus is common and benign when it is in elderly patients. However, if arcus appears in patients less than 50 years old, it is termed "arcus juvenilis" and is associated with abnormally high cholesterol in the body with increased risks for cardiovascular disease.

Arcus senilis
Other namesarcus adiposus, arcus juvenilis (when occurring in younger individuals), arcus lipoides corneae, arcus cornealis
Four representative slides of corneal arcus - arcus deposits tend to start at 6 and 12 o'clock and fill in until becoming completely circumferential. There is a thin, clear section separating the arcus from the limbus, known as the lucid interval of Vogt. Image from Zech and Hoeg, 2008.[1]
SpecialtyOphthalmology 

Arcus may also present as a white ring, which is visible in front of the periphery of the iris.

Causes

Arcus results from cholesterol deposits in or hyalinosis of the corneal stroma, and may be associated with ocular defects or with familial hyperlipidemia. It is common in the apparently healthy middle aged and elderly; a prospective cohort study of 12,745 Danes followed up for a mean of 22 years found that it had no clinical value as a predictor of cardiovascular disease.[2]

Arcus can be a sign of disturbance in lipid metabolism, an indicator of conditions such as hypercholesterolemia, hyperlipoproteinemia or hyperlipidemia.

Unilateral arcus is a sign of decreased blood flow to the unaffected eye, due to carotid artery disease or ocular hypotony.

Diagnosis

Arcus is usually diagnosed through visual inspection by an ophthalmologist or optometrist using a biomicroscope.

Arcus senilis can be confused with the limbus sign, which reflects calcium rather than lipid deposits. Anterior embryotoxon is a benign, congenital, elongation of the sclera-cornea transition zone which is present at birth and has a similar appearance to arcus juvenilis.[3]

Alternative names

It is also called arcus adiposus, arcus corneae, arcus juvenilis (when it occurs in individuals younger than 50 years)[4], arcus lipoides corneae or arcus cornealis; sometimes a gerontoxon.

See also

References
  1. Zech Jr, LA; Hoeg, JM (2008). "Correlating corneal arcus with atherosclerosis in familial hypercholesterolemia". Lipids in Health and Disease. 7: 7. doi:10.1186/1476-511X-7-7. PMC 2279133. PMID 18331643.
  2. Christoffersen, M; Frikke-Schmidt, R; Schnohr, P; Jensen, GB; Nordestgaard, BG; Tybjærg-Hansen, A (15 September 2011). "Xanthelasmata, arcus corneae, and ischaemic vascular disease and death in general population: prospective cohort study". BMJ (Clinical Research Ed.). 343: d5497. doi:10.1136/bmj.d5497. PMC 3174271. PMID 21920887. Retrieved 27 November 2012.
  3. Yanoff, Myron; Duker, Jay S. (2014). Ophthalmology (Fourth ed.). Elsevier Saunders. p. 174. ISBN 978-1455-7398-44.
  4. Yanoff, Myron; Duker, Jay S. (2014). Ophthalmology (Fourth ed.). Elsevier Saunders. p. 269. ISBN 978-1455-7398-44.
Classification
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