Arcus Corneae

Although arcus may be a manifestation of a disorder of lipid metabolism, it is likely that this is by no means always the case. MacAraeg et al. (1968) showed that arcus corneae occurs in higher frequency and develops at an earlier age in blacks than in whites. They could not relate it to diastolic hypertension, myocardial infarction, or cerebrovascular accidents. Arcus corneae develops precociously in Tangier disease (HDLDT1; 205400), Norum disease, and in homozygotes for type II hyperlipoproteinemia. In osteogenesis imperfecta a ring resembling arcus is seen. The Kayser-Fleischer ring of Wilson disease (277900) bears some similarity.

In England, Winder et al. (1998) attempted to quantitate relationships between hyperlipidemia and increased cardiovascular risk through determination of the graded prevalence of corneal arcus with age for 81 males and 73 females suffering from heterozygous familial hypercholesterolemia (FHC; 143890) at presentation, and for 280 male and 353 female unselected patients (age range, 16 to 76 years) attending a country general practice. Some degree of arcus affected 50% of FHC patients by age 31 to 35 years, and 50% of practice patients by age 41 to 45 years. Complete full-ring arcus affected 50% of the FHC group by age 50 years, with only 5% similarly affected in the non-FHC group. Arcus grade with age was advanced by some 5 years in males versus females. Premature arcus potentially alerting to FHC could be broadly defined for males and females combined, as heavy full ring by age 50 years, or any degree of arcus by age 30 to 35 years. Arcus grade was not related to the presence of coronary disease.

Vurgese et al. (2011) investigated the prevalence of corneal arcus and its associations in Central India. Mean body mass index (BMI) was 19.8 kg/m2 with 41.3% of subjects being underweight (BMI less than 18.5 kg/m2). Corneal arcus to any degree was detected in 10.7% of subjects. Corneal arcus was significantly associated with increasing age. It was not significantly (all P greater than 0.10) associated with serum concentrations of high-density lipoproteins, cholesterol, creatinine, glucose, and glycosylated hemoglobin; with prevalence of arterial hypertension and diabetes mellitus; with body height, weight, and BMI; or with level of education, daily activities, nutrition, alcohol consumption, smoking, or blood pressure. In an intereye comparison, corneal arcus was significantly more marked in the eye with the lower intraocular pressure, thinner central cornea, and more hyperopic refractive error. Vurgese et al. (2011) concluded that in this Central Indian population with low BMI, the only systemic parameter associated with corneal arcus was increasing age.