Double arcus cornealis | Eye

Sir, INTRODUCTION Arcus cornealis (corneal arcus) is a single corneal circle of lipid deposits parallel to the limbus that usually affects both eyes symetrically.1 This greyish stromal ring

appears in the superior and inferior corneal periphery and extends around it. Its origin is presumed to be from the deep scleral vascular plexus and it appears in 20–35% of the population

usually in older age. CASE REPORT A 75-year-old Caucasian patient complained of ocular burning and tearing for a couple of months. His medical history was positive for hypercholesterolaemia,

tinitus, and benign prostatic hypertrophy. His visual acuity was 20/25 in each eye. Ocular examination revealed seborrhoeic blepharitis and bilateral double arcus cornealis (Figure 1). The

double arcus was composed of two complete greyish rings at the level of the deep stroma separated by two clear intervals (Figure 2). The inner ring was narrower than the outer one and more

distinct at the upper and lower part of the cornea. Fundus examination was normal. The patient was treated for the blepharitis and was followed for 2 years. Over this period, the two corneal

rings increased gradually in their density but not in size. Lipid serum profile showed high cholesterol levels (250 mg/dl). Triglycerides, high-and low-density lipoproteins, and

lecithin-cholesterol acyltransferase (LCAT) were normal. DISCUSSION Arcus cornealis appears as a single greyish ring parallel to the limbus and separated from it by a 1 mm lucid interval of

Vogt.1 It develops as a result of lipid deposition in the deep corneal stroma and the limbal sclera, and its prevalence increases with age. In children, it may be a manifestation of

hyperlipidemia, but in elderly people it may be an isolated finding. Arcus cornealis should be differentiated from other lipid metabolisms affecting the cornea, such as LCAT deficiency,

‘fish eye’ disease, or Tangier disease where lipid deposition extends into the centre of the cornea. Double corneal arcus were recently described in two patients from India.2 However, this

report had no follow-up on the patients, lipid profile was not reported, and no theory regarding the pathophysiology of the findings was suggested. In our case, the innermost ring was

narrower and less distinct than the peripheral one. It was more distinct in the upper and lower quadrants of the cornea, as usually seen in typical single arcus cornealis. The patient had

hypercholesterolaemia. The development of a second ring of lipids may suggest that lipids diffused from perilimbal vessels may migrate through the stroma according to properties such as

their size and polarity. Similar phenomena can be seen when diffusion zones are created in separation of lipids3 or antigens and antibodies seen as Mancini radial rings4 and Ouchterlony

immudifussion rings.5 In these laboratory techniques, the agents are separated based on their structural properties and create sediments where they are bound to other molecules through a

complementary binding site. Differences in the lipid compositions of the two rings in the arcus may support this theory, if a biopsy is obtained and analysis of lipids is performed. Another

explanation is that the formation of the arcus is inherent and that they are formed _in situ_ either as single or double ring. The classic theory concerning the appearance of arcus cornealis

is that lipids migrate from the limbal vascular arcade to the peripheral cornea and the clear interval of Vogt is formed due to absorption of the lipids that are closer to the vascular

arcade.1 The appearance of two rings makes the second part of the classic theory less plausible. REFERENCES * Barchiesi BJ, Eckel RH, Ellis PP . The cornea and disorders of lipid metabolism.

_Surv Ophthalmol_ 1991; 36: 1–22. Article  CAS  Google Scholar  * Agrawal S, Agrawal J, Agrawal TP . Double-ring corneal arcus. _J Cataract Refract Surg_ 2002; 28: 1885–1886. Article 

Google Scholar  * Christie WW . Lipid Analysis: Isolation, Separation, Identification and Structural Analysis of Lipids. _Pergamon Press: Oxford_ 1973, pp 43–72. * Mancini G, Carabonara AO,

Heremans JF . Immunochemical quantitation of antigens by single radial immunodiffusion. _Immunochemistry_ 1965; 2: 235–254. Article  CAS  Google Scholar  * Moor GW, Goodman M . A set

theoretical approach to immunotaxonomy: analysis of species comparisons in modified Ouchterlony plates. _Bull Math Byophys_ 1968; 30: 279–289. Article  Google Scholar  Download references

AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Department of Ophthalmology, Western Galilee — Nahariya Medical Center, Nahariya and ‘Leumit’ Health Care, Jerusalem, Israel S Rumelt & I

Rumelt-Blitstein Authors * S Rumelt View author publications You can also search for this author inPubMed Google Scholar * I Rumelt-Blitstein View author publications You can also search for

this author inPubMed Google Scholar RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Rumelt, S., Rumelt-Blitstein, I. Double arcus cornealis. _Eye_ 18,

1020–1021 (2004). https://doi.org/10.1038/sj.eye.6701393 Download citation * Published: 02 April 2004 * Issue Date: 01 October 2004 * DOI: https://doi.org/10.1038/sj.eye.6701393 SHARE THIS

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