Arcus senilis

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Arcus senilis
Other namesarcus adiposus, arcus juvenilis, arcus lipoides corneae, arcus cornealis
Four representative slides of corneal arcus.jpg
Arcus senilis deposits tend to start at 6 and 12 o'clock and progress until becoming completely circumferential. The thin clear section separating the arcus from the limbus is known as the clear interval of Vogt.
Specialty Ophthalmology   OOjs UI icon edit-ltr-progressive.svg
Symptoms Opaque ring in the peripheral cornea
CausesNormal aging, Hyperlipidemia
Differential diagnosis Limbus sign, limbal ring
TreatmentNone
Prognosis Benign condition in elderly, associated with cardiovascular disease for <50 yrs old

Arcus senilis (AS), also known as gerontoxon, arcus lipoides, arcus corneae, corneal arcus, arcus adiposus, or arcus cornealis, are rings in the peripheral cornea. It is usually caused by cholesterol deposits, so it may be a sign of high cholesterol. It is the most common peripheral corneal opacity, and is usually found in the elderly where it is considered a benign condition. When AS is found in patients less than 50 years old it is termed arcus juvenilis. The finding of arcus juvenilis in combination with hyperlipidemia in younger men represents an increased risk for cardiovascular disease.

Contents

Pathophysiology

AS is caused by leakage of lipoproteins from limbal capillaries into the corneal stroma. Deposits have been found to consist mostly of low-density lipoprotein (LDL). Deposition of lipids into the cornea begins at the superior and inferior aspects, and progresses to encircle the entire peripheral cornea. The interior border of AS has a diffuse appearance, while the exterior border is well demarcated. The clear space between the exterior border and the limbus is called the interval of Vogt. [1]

Bilateral AS is a benign finding in the elderly, but it can be associated with hyperlipidemia in patients less than 50 years old. Bilateral AS may also be caused by increased levels of free fatty acids in the circulation secondary to alcohol use. [2]

Unilateral AS can be associated with contralateral carotid artery stenosis or decreased intraocular pressure in the affected eye. As these are serious medical conditions, unilateral AS should be examined by a physician. [3]

Diagnosis

Corneal arcus in a patient age 60 years Corneal arcus.jpg
Corneal arcus in a patient age 60 years

AS is usually diagnosed through visual inspection by an ophthalmologist or optometrist using a slit lamp. [4]

Differential diagnoses

Several conditions can have a similar color and appearance.

Other conditions with similar appearance, but differing in color are limbal ring, and Kayser–Fleischer ring.

Treatment

In the elderly, arcus senilis is a benign condition that does not require treatment. The presence of an arcus senilis in males under the age of 50 may represent a risk factor for cardiovascular disease, [6] and these individuals should be screened for an underlying lipid disorder. The opaque ring in the cornea does not resolve with treatment of a causative disease process, and can create cosmetic concerns. [6]

Epidemiology

In men, AS is increasingly found starting at age 40, and is present in nearly 100% of men over the age of 80. For women, onset of AS begins at age 50 and is present in nearly all females by age 90. [1]

Risk factor for cardiovascular disease

AS is not an independent predictor of cardiovascular disease, as demonstrated by a prospective cohort study of 12,745 Danes aged 20-93 followed up for an average of 22 years. [7]

The presence of AS in men less than 50 years old(arcus juvenilis) in combination with an underlying condition causing hyperlipidemia has been shown to significantly increase the relative risk of mortality from cardiovascular disease and coronary artery disease, as demonstrated by a study following 6,069 Americans aged 30-69 for an average of 8.4 years. [8]

The presence of AS in men less than 50 years old (arcus juvenilis) in conjunction with xanthomas on the achilles tendon has been linked to the presence of atherosclerosis in the coronary arteries and aorta by computed tomography. [9]

See also

Related Research Articles

<span class="mw-page-title-main">Cholesterol</span> Sterol biosynthesized by all animal cells

Cholesterol is the principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils.

<span class="mw-page-title-main">Atherosclerosis</span> Form of arteriosclerosis

Atherosclerosis is a pattern of the disease arteriosclerosis, characterized by development of abnormalities called lesions in walls of arteries. These lesions may lead to narrowing of the arterial walls due to buildup of atheromatous plaques. At onset there are usually no symptoms, but if they develop, symptoms generally begin around middle age. In severe cases, it can result in coronary artery disease, stroke, peripheral artery disease, or kidney disorders, depending on which body part(s) the affected arteries are located in the body.

Macrovascular disease is a disease of any large (macro) blood vessels in the body. It is a disease of the large blood vessels, including the coronary arteries, the aorta, and the sizable arteries in the brain and in the limbs.

<span class="mw-page-title-main">Fibrate</span> Class of chemical compounds

In pharmacology, the fibrates are a class of amphipathic carboxylic acids and esters. They are derivatives of fibric acid. They are used for a range of metabolic disorders, mainly hypercholesterolemia, and are therefore hypolipidemic agents.

<span class="mw-page-title-main">Peripheral artery disease</span> Medical condition

Peripheral artery disease (PAD) is a vascular disorder that causes abnormal narrowing of arteries other than those that supply the heart or brain. PAD can happen in any blood vessel, but it is more common in the legs than the arms.

<span class="mw-page-title-main">Cardiovascular disease</span> Class of diseases that involve the heart or blood vessels

Cardiovascular disease (CVD) is any disease involving the heart or blood vessels. CVDs constitute a class of diseases that includes: coronary artery diseases, heart failure, hypertensive heart disease, rheumatic heart disease, cardiomyopathy, arrhythmia, congenital heart disease, valvular heart disease, carditis, aortic aneurysms, peripheral artery disease, thromboembolic disease, and venous thrombosis.

<span class="mw-page-title-main">Hypercholesterolemia</span> High levels of cholesterol in the blood

Hypercholesterolemia, also called high cholesterol, is the presence of high levels of cholesterol in the blood. It is a form of hyperlipidemia, hyperlipoproteinemia, and dyslipidemia.

Dyslipidemia is a metabolic disorder characterized by abnormally high or low amounts of any or all lipids or lipoproteins in the blood. Dyslipidemia is a risk factor for the development of atherosclerotic cardiovascular diseases (ASCVD), which include coronary artery disease, cerebrovascular disease, and peripheral artery disease. Although dyslipidemia is a risk factor for ASCVD, abnormal levels don't mean that lipid lowering agents need to be started. Other factors, such as comorbid conditions and lifestyle in addition to dyslipidemia, is considered in a cardiovascular risk assessment. In developed countries, most dyslipidemias are hyperlipidemias; that is, an elevation of lipids in the blood. This is often due to diet and lifestyle. Prolonged elevation of insulin resistance can also lead to dyslipidemia. Likewise, increased levels of O-GlcNAc transferase (OGT) may cause dyslipidemia.

Hyperlipidemia is abnormally high levels of any or all lipids or lipoproteins in the blood. The term hyperlipidemia refers to the laboratory finding itself and is also used as an umbrella term covering any of various acquired or genetic disorders that result in that finding. Hyperlipidemia represents a subset of dyslipidemia and a superset of hypercholesterolemia. Hyperlipidemia is usually chronic and requires ongoing medication to control blood lipid levels.

<span class="mw-page-title-main">Carotid artery stenosis</span> Medical condition

Carotid artery stenosis is a narrowing or constriction of any part of the carotid arteries, usually caused by atherosclerosis.

The lipid hypothesis is a medical theory postulating a link between blood cholesterol levels and the occurrence of cardiovascular disease. A summary from 1976 described it as: "measures used to lower the plasma lipids in patients with hyperlipidemia will lead to reductions in new events of coronary heart disease". It states, more concisely, that "decreasing blood cholesterol [...] significantly reduces coronary heart disease".

<span class="mw-page-title-main">Familial hypercholesterolemia</span> Genetic disorder characterized by high cholesterol levels

Familial hypercholesterolemia (FH) is a genetic disorder characterized by high cholesterol levels, specifically very high levels of low-density lipoprotein cholesterol, in the blood and early cardiovascular diseases. The most common mutations diminish the number of functional LDL receptors in the liver or produce abnormal LDL receptors that never go to the cell surface to function properly. Since the underlying body biochemistry is slightly different in individuals with FH, their high cholesterol levels are less responsive to the kinds of cholesterol control methods which are usually more effective in people without FH. Nevertheless, treatment is usually effective.

<span class="mw-page-title-main">Lipoprotein(a)</span> Low-density lipoprotein containing apolipoprotein(a)

Lipoprotein(a) is a low-density lipoprotein variant containing a protein called apolipoprotein(a). Genetic and epidemiological studies have identified lipoprotein(a) as a risk factor for atherosclerosis and related diseases, such as coronary heart disease and stroke.

<span class="mw-page-title-main">Limbal ring</span> Dark ring around the iris of the eye

A limbal ring is a dark ring around the iris of the eye, where the sclera meets the cornea. It is a dark-colored manifestation of the corneal limbus resulting from optical properties of the region. The appearance and visibility of the limbal ring can be negatively affected by a variety of medical conditions concerning the peripheral cornea. It has been suggested that limbal ring thickness may correlate with health or youthfulness and may contribute to facial attractiveness. The thickness of the limbal ring varies by pupil dilation - when the pupil is larger, the limbal ring narrows. Some contact lenses are colored to simulate limbal rings.

<span class="mw-page-title-main">Evacetrapib</span> Chemical compound

Evacetrapib was a drug under development by Eli Lilly and Company that inhibits cholesterylester transfer protein. CETP collects triglycerides from very low-density lipoproteins (VLDL) or low-density lipoproteins (LDL) and exchanges them for cholesteryl esters from high-density lipoproteins (HDL), and vice versa, but primarily increasing high-density lipoprotein and lowering low-density lipoprotein. It is thought that modifying lipoprotein levels modifies the risk of cardiovascular disease. The first CETP inhibitor, torcetrapib, was unsuccessful because it increased levels of the hormone aldosterone and increased blood pressure, which led to excess cardiac events when it was studied. Evacetrapib does not have the same effect. When studied in a small clinical trial in people with elevated LDL and low HDL, significant improvements were noted in their lipid profile.

The limbus sign is a ring of dystrophic calcification evident as a "milky precipitate" at the corneal limbus. The corneal limbus is the part of the eye where the cornea (front/center) meets the sclera. Thought to be caused by increased calcium concentration in the blood, this sign however persists after calcium phosphate concentration returns to normal. Compare the limbus sign (calcification) with arcus senilis (lipid).

<span class="mw-page-title-main">Lipidology</span>

Lipidology is the scientific study of lipids. Lipids are a group of biological macromolecules that have a multitude of functions in the body. Clinical studies on lipid metabolism in the body have led to developments in therapeutic lipidology for disorders such as cardiovascular disease.

Testosterone and the cardiovascular system are the effects that the male hormone testosterone has on the cardiovascular system.

<span class="mw-page-title-main">Limbal stem cell</span>

Limbal stem cells, also known as corneal epithelial stem cells, are unipotent stem cells located in the basal epithelial layer of the corneal limbus. They form the border between the cornea and the sclera. Characteristics of limbal stem cells include a slow turnover rate, high proliferative potential, clonogenicity, expression of stem cell markers, as well as the ability to regenerate the entire corneal epithelium. Limbal stem cell proliferation has the role of maintaining the cornea; for example, by replacing cells that are lost via tears. Additionally, these cells also prevent the conjunctival epithelial cells from migrating onto the surface of the cornea.

Remnant cholesterol, also known as remnant lipoprotein, is a very atherogenic lipoprotein composed primarily of very low-density lipoprotein (VLDL) and intermediate-density lipoprotein (IDL). Stated another way, remnant cholesterol is all plasma cholesterol that is not LDL cholesterol or HDL cholesterol, which are triglyceride-poor lipoproteins. However, remnant cholesterol is primarily chylomicron and VLDL, and each remnant particle contains about 40 times more cholesterol than LDL.

References

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  3. Naumann GO, Küchle M (November 1993). "Unilateral corneal arcus lipoides". Lancet. 342 (8880): 1185. doi:10.1016/0140-6736(93)92170-x. PMID   7901520. S2CID   5395741.
  4. Turbert, David (2019-04-26). "What Is Arcus Senilis?". American Academy of Ophthalmology. Retrieved 2024-06-18.
  5. Williams ME (2010-06-21). Geriatric Physical Diagnosis: A Guide to Observation and Assessment. McFarland. p. 96. ISBN   978-0-7864-5160-9.
  6. 1 2 Munjal A, Kaufman EJ (2021). "Arcus Senilis". StatPearls. Treasure Island (FL): StatPearls Publishing. PMID   32119257 . Retrieved 2021-03-23.
  7. Christoffersen M, Frikke-Schmidt R, Schnohr P, Jensen GB, Nordestgaard BG, Tybjærg-Hansen A (September 2011). "Xanthelasmata, arcus corneae, and ischaemic vascular disease and death in general population: prospective cohort study". BMJ. 343: d5497. doi:10.1136/bmj.d5497. PMC   3174271 . PMID   21920887.
  8. Chambless LE, Fuchs FD, Linn S, Kritchevsky SB, Larosa JC, Segal P, Rifkind BM (October 1990). "The association of corneal arcus with coronary heart disease and cardiovascular disease mortality in the Lipid Research Clinics Mortality Follow-up Study". American Journal of Public Health. 80 (10): 1200–4. doi:10.2105/ajph.80.10.1200. PMC   1404822 . PMID   2400030.
  9. Zech LA, Hoeg JM (March 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.