IMAGES IN MEDICINE
A second corneal arcus?
S Vaikkakara, S J Talks, R A James, S H S Pearce
1 Endocrine Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK
2 Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
Correspondence to:
Correspondence to:
Dr Simon Pearce
W22, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK; s.h.s.pearce@ncl.ac.uk
| The first 150 words of the full text of this article appear below. |
A 57-year-old woman presented with a three week history of grittiness and redness in both eyes. She had noticed polyuria, nocturia and extreme lethargy over the preceding four to six months. She was taking bendroflumethazide 5 mg daily and atenolol 50 mg daily for essential hypertension. Ocular examination revealed bilateral arcus senilis, which was cream coloured and most prominent at the superior limbus. In addition, there were pure white deposits in a linear pattern on the cornea, concentrated at the medial and lateral aspects of the limbus, associated with pearly white nodules on the conjunctiva and marked conjunctival injection (fig 1
). The corneal appearances were those of a second arcus. She also had bilateral pedal oedema. Investigations revealed a serum calcium of 3.8 mmol/l, serum urea of 16.3 mmol/l, serum creatinine of 616 µmol/l in the presence of a metabolic alkalosis (arterial pH 7.58, bicarbonate 37 mEq/l). The circulating intact
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