Senile calcific scleral plaques, also known as senile scleral plaques (SSP), are benign scleral degenerations common in elderly individuals. They are a common incidental finding on CT imaging.
The prevalence of SSP increases with age, from ~2.5% at age 60, to 25% at age 80 years and over 1,2. They may be more prominent in women than men.
There are no known systemic associations 3.
On physical examination, SSP appear as flat, well-circumscribed, ovoid scleral patches located lateral or medial to the limbus. The patches appear translucent-blue (due to scleral dehydration and exposure of the underlying uvea), or an opaque grey-white (due to calcification), and tend to be taller than wide (longer in vertical dimension).
SSP occur just anterior to the insertion of the medial and lateral recti muscles. Plaques involving the vertical muscle insertions are very rare 4,5.
These lesions are asymptomatic.
Although the precise etiology is unknown, SSP are considered a form of dystrophic calcification, similar to that which occurs in other parts of the body in areas of hyaline degeneration 6. Various proposed causes include mechanical stress from the rectus muscle insertions, dehydration, and actinic (solar) damage 5.
Histopathologic evaluation demonstrates calcific deposits within the scleral stroma. These range from fine granular deposits to the confluent plaques which are apparent on imaging. Various staining methods can confirm the presence of calcium, including von Kossa and Alizarin Red stains. Senile calcific plaques were previously thought to represent focal hyalinization of the sclera; however, this has been shown to be false 3,4.
As SSP calcify centrally, they become radiographically evident.
Scleral plaques appear as small ovoid calcifications along the anterior globe, at the site of insertion of medial and lateral rectus muscles. 1-3, 7.
Benign senile scleral plaques are a common finding in elderly patients are generally considered "do not touch" lesions given their commonality and stereotypical appearance.
Less commonly, scleral calcification may occur in the setting of inflammation, lymphoma, or hypercalcemic states. Other specific considerations include:
- foreign body
- atypical shape or location of calcification
- should recommend clinical correlation with physical/ophthalmologic evaluation
scleral buckle (prosthesis)
- distinct appearance, often encircling, are located more posteriorly, and are placed between the muscle and the globe
- trochlear apparatus calcification
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- 2. Alorainy I. Senile scleral plaques: CT. (2000) Neuroradiology. 42 (2): 145-8. Pubmed
- 3. Manschot WA. Senile scleral plaques and senile scleromalacia. (1978) The British journal of ophthalmology. 62 (6): 376-80. Pubmed
- 4. Moseley I. Spots before the eyes: a prevalence and clinicoradiological study of senile scleral plaques. (2000) Clinical radiology. 55 (3): 198-206. doi:10.1053/crad.1999.0348 - Pubmed
- 5. Marco Beck, Bettina Schlatter, Sebastian Wolf, Martin S. Zinkernagel. Senile scleral plaques imaged with enhanced depth optical coherence tomography. (2015) Acta Ophthalmologica. 93 (3): e188. doi:10.1111/aos.12547 - Pubmed
- 6. Gossner J, Larsen J. Calcified senile scleral plaques. (2009) Journal of neuroradiology. Journal de neuroradiologie. 36 (2): 119-20. doi:10.1016/j.neurad.2008.06.001 - Pubmed
- 7. LeBedis CA, Sakai O. Nontraumatic orbital conditions: diagnosis with CT and MR imaging in the emergent setting. (2008) Radiographics : a review publication of the Radiological Society of North America, Inc. 28 (6): 1741-53. doi:10.1148/rg.286085515 - Pubmed