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Corneal Arcus (Arcus Lipoides)

ROUTINE — Cornea

Symptoms

Asymptomatic

  • Almost always an incidental finding; patients are visually asymptomatic.
  • No pain, redness, or visual disturbance is caused by the ring itself.

Presentation

  • Noticed by the patient or a family member as a whitish-gray ring around the colored part of the eye.

Clinical Findings

Core findings

  • A grayish-white to yellow-white ring or arc of lipid deposition in the peripheral corneal stroma, most often starting superiorly and inferiorly before becoming circumferential.
  • Sharp outer border (at the limbus) and a diffuse, feathery inner border, with a clear lucid interval (of Vogt) separating the arc from the limbus itself — this clear zone is a key differentiating feature.
  • Does not involve the corneal epithelium or endothelium; the cornea itself remains clear and vision is unaffected.

Terminology by age

  • Arcus juvenilis: Onset before age 40 — more specific for an underlying dyslipidemia.
  • Arcus senilis: Onset after age 50 — extremely common (over 60% by age 60) and usually a benign, age-related finding with a normal lipid panel.

Etiology

Mechanism

  • Deposition of extracellular lipid (cholesterol, phospholipids, triglycerides) within the peripheral corneal stroma, diffusing in from the limbal vasculature.

Age-related (arcus senilis)

  • A simple aging change in most older adults; usually no associated lipid abnormality once past age 50.

Younger patients (arcus juvenilis)

  • Suggests a hyperlipidemia syndrome: familial hypercholesterolemia, familial combined hyperlipidemia, or familial dysbetalipoproteinemia.
  • Consider secondary causes: hypothyroidism, nephrotic syndrome, or alcohol use.

Unilateral arcus

  • A rare finding suggesting ipsilateral carotid artery disease or ocular hypotony, which slows lipid clearance on that side (the unaffected eye develops arcus first/more completely).

Red Flags

Arcus juvenilis (under 40 years old)

  • Mandates a fasting lipid panel — screen for familial hypercholesterolemia, a major cardiovascular risk factor.

Unilateral arcus

  • Evaluate the contralateral carotid artery for stenosis/occlusive disease.

Investigations

Clinical exam

  • Slit-lamp confirmation of the lucid interval to distinguish arcus from other peripheral corneal opacities.

Laboratory (if under 50 years old)

  • Fasting lipid panel: total cholesterol, LDL, HDL, triglycerides.
  • Consider thyroid function tests.

Vascular (if unilateral)

  • Carotid duplex ultrasound.

Treatment

Ocular

  • None required — arcus itself is never treated; it does not threaten vision.

Systemic

  • Treat any underlying dyslipidemia identified on screening (lifestyle modification, statins) per primary care/cardiology guidance.

Clinical Pearl

The lucid interval of Vogt — a clear zone of normal cornea between the arc and the limbus — is what separates arcus from other peripheral corneal opacities. In a patient under 40, arcus is a lipid panel, not just a cosmetic finding.

Differential Diagnosis

  • Limbal girdle of Vogt
  • Posterior embryotoxon
  • Peripheral corneal dystrophies
  • Band keratopathy

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