What is Corneal Arcus?
Corneal Arcus, also known as arcus senilis when it occurs in older adults, is a gray or white arc visible above and below the outer part of the cornea — the clear, dome-shaped surface that covers the front of the eye. Though more common in older individuals,
corneal arcus can also appear in pediatric patients, where it is often referred to as arcus juvenilis.
How is it Identified?
Corneal arcus typically presents as a bilateral, circumferential deposit of lipid in the corneal stroma. The arc usually starts at the top and bottom of the cornea and can eventually encircle the entire cornea. In
children, it is essential to differentiate it from other causes of corneal opacities.
Causes and Risk Factors
While corneal arcus in adults is usually associated with aging, its presence in
pediatric patients can be indicative of underlying conditions. The most common risk factors include:
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Familial Hypercholesterolemia: This genetic disorder results in elevated levels of low-density lipoprotein (LDL), leading to lipid deposits in various tissues, including the cornea.
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Hyperlipoproteinemia: Various types of hyperlipoproteinemia can cause lipid deposits in the cornea.
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Other Metabolic Disorders: Conditions such as hyperlipidemia and liver disease may also contribute to the development of corneal arcus in children.
Symptoms and Concerns
Corneal arcus itself is usually asymptomatic and does not affect
vision. However, its presence in children can be a marker for systemic disorders that require medical attention. Therefore, it is crucial to conduct a thorough evaluation to identify any underlying conditions.
Diagnostic Evaluation
A comprehensive approach is necessary to diagnose the underlying cause of corneal arcus in pediatric patients:1.
Ophthalmic Examination: A detailed eye exam using a slit lamp can help confirm the presence of corneal arcus.
2.
Lipid Profile: Blood tests to measure cholesterol and triglyceride levels can identify hyperlipidemia or familial hypercholesterolemia.
3.
Genetic Testing: In cases where a hereditary condition is suspected, genetic testing can offer a definitive diagnosis.
4.
Systemic Evaluation: A thorough
physical examination and history-taking are essential to identify any systemic signs and symptoms associated with metabolic disorders.
Treatment and Management
Since corneal arcus itself does not affect vision, the primary focus is on managing the underlying condition:-
Lifestyle Modifications: Dietary changes, increased physical activity, and weight management can help control lipid levels.
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Medications: Statins or other lipid-lowering agents may be prescribed to manage hyperlipidemia.
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Regular Monitoring: Ongoing follow-up with an ophthalmologist and a pediatrician is essential to monitor the condition and make any necessary adjustments to the treatment plan.
Prognosis
The prognosis for corneal arcus in pediatric patients largely depends on the management of the underlying condition. With proper treatment and lifestyle modifications, it is possible to control lipid levels and reduce the risk of cardiovascular complications associated with hyperlipidemia.When to Seek Medical Attention?
Parents should seek medical attention if they notice any unusual changes in their child's eyes, particularly if a gray or white ring is visible around the cornea. Early diagnosis and management of underlying conditions can significantly improve health outcomes.
Conclusion
Corneal arcus in pediatrics is a significant finding that warrants a thorough evaluation to identify potential systemic diseases, particularly lipid disorders. Prompt diagnosis and appropriate management can help mitigate the associated risks and improve the overall health and well-being of the child.
