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The Eye

A look at four common eye maladies: Arcus Senilis, Ectropion, Pterygium, and Pinguecula

Ophthalmology

Arcus Senilis
Arcus Senilis

InShort


by Evan Mostafa, MD and George J.Florakis, MD


Arcus Senilis

Arcus senilis, also referred to as corneal arcus, is defined by lipid and triglyceride deposits in the periphery of the cornea that lead to peripheral corneal opacity. The etiology is not well known, but it has been correlated with hyperlipidemia in the elderly and dyslipidemia in the young.


Signs and Symptoms

Arcus senilis causes a whiteish ring in the periphery of the cornea. Patients are typically asymptomatic.


Causes and Risk Factors

Risk of arcus senilis increases with age and is more prevalent among African-American males. The condition is also associated with cardiovascular disease (e.g., systolic hypertension).

Diagnostic Evaluation and Differential Diagnosis

Diagnosis of arcus senilis can be made during slit-lamp examination. A white circumferential band composed of triglyceride, cholesterol, and low-density lipid deposits appears in the periphery of the cornea. Laboratory tests may reveal elevated lipid levels. Differential diagnosis includes Terrien marginal degeneration and recurrent inflammatory limbal disease.

Treatment and Recommended Follow-Up

Because arcus senilis is asymptomatic, treatment is not usually indicated. Surgical intervention is also unnecessary. Visual prognosis is good. However, issues with lipid metabolism should be addressed.

Pearl to Know

Arcus senilis is common in patients with a familial history of familial hypercholesterolemia. Arcus deposition in one eye may suggest carotid artery disease on the contralateral side.


Ectropion

Ectropion
Ectropion

Ectropion is the eversion of the eyelid, which may lead to its separation from the globe.


Causes and Risk Factors

Causes of ectropion may be Involutional (horizontal tarsal laxity, medial canthal tendon laxity), paralytic (related to denervation of the lid protractors or paralysis of the orbicularis muscle (cranial-nerve VII palsy), cicatricial (shortening of the eyelid skin or both the eyelid skin and the muscle), congenital (congenital eyelid syndrome), or mechanical (tissue loss due to trauma, surgery, or thermal and chemical burns).


Eversion of Eye Lids


Diagnostic Evaluation and Differential Diagnosis

To evaluate the ectropion, routine ocular history and examination should take place, noting any previous eyelid trauma, surgery, nerve palsy, or contact dermatitis. In the snap-back test, the lid should return to its normal position with one blink after it is pulled from the globe. Abnormal laxity is present when it takes two or more blinks to reestablish the lid's normal position.


Treatment and Recommended Follow-Up

Treatment of ectropion includes corneal lubrication and lateral eyelid taping. In cicatricial cases, release of the cicatrix or a full-thickness skin graft may be indicated. Although mild congenital cases may not need treatment, other cases may demand treatment similar to that used for cicatricial ectropion.


Pearl to Know

When in doubt about the eyelid margin, look at the position of the meibomian-gland orifices, which are normally upright.


Pterygium

Pterygium
Pterygium

Pterygium is a common condition in which there is conjunctival degeneration that invades the superficial cornea. Pterygium is a noncancerous lesion consisting of conjunctiva and fibrovascular tissue that grows and invades the cornea which can interfere with vision. Pterygia can be bilateral or appear only on one eye. They may be nasal or temporal in each eye.


Signs and Symptoms

  1. Burning and itching

  2. Blurred vision

  3. Foreign body sensation

  4. If the pterygium grows significantly towards the visual axis, it can distort the shape of the cornea and cause astigmatism.

Causes and Risk Factors

  1. Long term ultraviolet radiation from the sun

  2. Dryness

  3. Inflammation

  4. Environmental risk factors such as warm climate, dust, and other irritants

  5. A Pingueculum usually precedes the development of pterygium

Diagnostic Evaluation and Differential Diagnosis

An eye exam is often enough to diagnose the disorder.

Treatment and Recommended Follow-Up

  1. Ultraviolet protection

  2. Lubrication

  3. Steroid eye drops for localized inflammation and swelling (usually not a chronic therapy)

  4. Artificial tears may help reduce the symptoms that relate to dry eyes

  5. Excision when the visual axis is threatened, there is significant astigmatism or if the pterygium causes considerable irritation.

  6. Conjunctival autografts or the use of amniotic membrane and/or mitomycin C ,may decrease the recurrence rate.

Pearl to Know

100% UV block sunglasses can prevent or slow the growth of a pterygium, especially on sunny days, or near reflective bodies of water (ocean, lakes etc) or even from sun reflections days after a snowstorm.


Pingueculum
Pingueculum

Pingueculum

Pingueculum is a common condition in which there is a non-cancerous growth (or degeneration) of the conjunctiva, usually in the part that is exposed when the eye is open (intrapalpebral). It is typically characterized by a yellowish and slightly raised thickening of the conjunctiva on the sclera, near the limbus of the cornea.


Causes and Risk Factors

  1. Long term ultraviolet radiation from the sun

  2. Dryness

  3. Inflammation

  4. Environmental risk factors such as warm climate, dust, and other irritants

Treatment

  1. Ultraviolet protection

  2. Lubrication

  3. Steroid eye drops for localized inflammation and swelling (usually not a chronic therapy)

  4. Artificial tears may help reduce the symptoms that relate to dry eyes

  5. Surgical excision is rarely needed and is reserved if malignancy is ever a concern, or if patient has chronic symptomatic irritation (eg makes contact lens wear unbearable).

Pearl to Know

100% UV block sunglasses can prevent or slow the growth of pterygium, especially on sunny days, or near reflective bodies of water (ocean, lakes etc) or even from sun reflections days after a snowstorm.


 

Other Ophthalmology articles in this blog:


More medical terms in FibonacciMD.app Compendium (our medical encyclopedia) has over 6,000 medical terms and medications.


 

Sources:

Hashemi H, Khabazkhoob M, Emamian MH, Shariati M, Fotouhi A. A population-based study of corneal arcus and its risk factors in Iran. Ophthalmic Epidemiol. 2014;21:339–344.

Ang M, Wong W, Park J, et al. Corneal arcus is a sign of cardiovascular disease, even in low-risk persons. Am J Ophthalmol. 2011;152:864–871.e1.

Raj KM, Reddy PAS, Kumar VC. Significance of corneal arcus. J Pharm Bioallied Sci. 2015;7:S14–S15.

Macchiaiolo M. Buonomo PS, Valente P, et al. Corneal arcus as first sign of familial hypercholesterolemia. J Pediatr. 2014;164:670.

Vrabec MP, Florakis JG, eds. Ophthalmic Essentials. Cambridge, MA: Blackwell Scientific Publications, Inc; 1992:307-308.

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