The New England Journal of MedicineDouble Corneal Arcus

The Implications of Double Corneal Arcus: An Insight into Rare Lipid Deposition Patterns

In a detailed observation of an unusual ophthalmic condition, a 63-year-old woman presenting for cataract evaluation revealed a rare presentation of double corneal arcus in both eyes. Typically associated with lipid deposition and seen as a single peripheral ring in aging patients, this case study reveals the importance of recognizing variations in corneal arcus and their differential diagnoses, despite normal lipid levels.

Key Points:

• Patient Background: A 63-year-old woman presented at an ophthalmology clinic for cataract evaluation and exhibited two concentric white-yellow rings in each cornea, indicative of double corneal arcus.
• Clinical Findings: No history of keratitis or ocular trauma was reported by the patient, who had only noticed a mild worsening of vision over a few years.
• Lipid Levels: Interestingly, the lipid panel results from a health check-up conducted six weeks prior were within normal limits, suggesting that the double ring appearance was not linked to hypercholesterolemia.
• Ophthalmologic Examination: Visual acuity was measured at 20/30 in each eye. Peripheral opacities consistent with age-related cataracts were noted, but the funduscopic examination was normal.
• Diagnosis: The distinctive finding of double corneal arcus was made based on the slit-lamp examination, a rare manifestation of an otherwise common condition known as arcus senilis.
• Management and Counseling: The patient was informed that the double corneal arcus was a benign condition and that her visual acuity issues were primarily due to the cataracts, not the arcus itself.
• Clinical Relevance: Double corneal arcus, although rare, can occur without accompanying high cholesterol levels, particularly in older patients, indicating the need for clinicians to assess such presentations on a case-by-case basis.

In a 2015 study, corneal arcus was present only in 45% of the total 500 patients screened over 40 years of age. However it was present in >70% of cases over 60.

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