Welcome to question of the day #184

Welcome to question of the day #184

One of my patients has a white ring around his corneal limbus on each eye. He is 35-years-old and denies any health problems and using any medication. What is going on?

This sounds like corneal arcus. There are two types; arcus senilis for people over the age of 40 and arcus juvenilis for those under 40. It is usually an age-related condition in which a deposit of cholesterol, phospholipids, and triglycerides forms in an arc on the superior and/or inferior corneal periphery at the limbus. Over time, the arc can grow to encircle the entire corneal circumference, creating a white, grey, blue, or yellowish band.

Corneal arcus is generally considered to be part of the normal aging process and expected in older people. However, there are controversial reports regarding the association of corneal arcus with lipid metabolism. Corneal arcus may indicate a variety of different health concerns, including high blood pressure, high cholesterol, and atherosclerosis.

This condition usually develops with age and can be found in around 60% of individuals between 50 and 60 years of age, and that climbs to almost 100% in people 80 years old and older.

Corneal arcus is generally caused by lipid deposits developing on the cornea’s edge, typically related to the slowdown in lipid metabolism that occurs with age. If corneal arcus develops as a result of aging, it is usually not a cause for concern. However, in individuals younger than 40, corneal arcus may indicate higher than normal cholesterol or triglyceride levels. Higher cholesterol and triglyceride levels could indicate an increased risk of cardiovascular disease and stroke.

As your patient is only 35 years old his corneal arcus is suspicious and he deserves a referral to his general practitioner for a blood workup.