Contributor: William Charles Caccamise, Sr, MD, Retired Clinical Assistant Professor of Ophthalmology, University of Rochester School of Medicine and Dentistry
*Dr. Caccamise has very generously shared his images of patients taken while operating during the "eye season" in rural India as well as those from his private practice during the 1960's and 1970's. Many of his images are significant for their historical perspective and for techniques and conditions seen in settings in undeveloped areas.
A partial arcus senilis
The typical course of an arcus senilis: an arc begins above and below in varying intensity. The two arcs may then creep towards 9 and 3 o'clock. They may eventually meet to form a complete circle. The central corneal disease - a healed corneal ulcer - has the potentiality for a descemetocele. The classification of corneal scars according to the density of the scar is: 1. nebula - difficult to detect without increased illumunation and magnification, e.g. slit-lamp 2. macula - more easily seen with oblique illumination with a pen-light 3. leucoma - readily evident as a dense white scar under room illumination. The scar in the photo is arguably in the pre-leucoma stage, i.e. somewhere between a macular and a leucomatous stage.
Prominent arcus senilis
Also called gerontoxon. The arcus normally does not reach completely to the corneal margin.
Complete arcus senilis (gerontoxon)
The arcus senilis usually starts inferiorly and then appears superiorly. In some cases the two arcs will meet at 9:00 o'clock and 3:00 o'clock as in the photo. There may be a recessive inheritance aspect. An arcus senilis is not usually related to serum lipids or cholesterol.
Ophthalmic Atlas Images by EyeRounds.org, The University of Iowa are licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.