Senile calcific scleral plaques

Case contributed by Dr Ashesh Ishwarlal Ranchod

Presentation

The patient presented with syncope, with a background history of hypertension. Incidental orbital finding.

Patient Data

Age: 90 years
Gender: Female

There is no acute intracranial abnormality to account for presentation.

Incidental findings:

  • bilateral senile calcific scleral plaques
  • bilateral intracranial internal carotid arterial calcific plaques
  • bilateral distal vertebral calcific plaques
  • bilateral punctate basal ganglia calcifications
  • bilateral choroid plexus xanthogranulomata
  • midline tiny intracranial falx lipomas and calcifications

Case Discussion

Senile calcific scleral plaques usually appear as ovoid calcific densities anterior to the medial and lateral rectus muscle insertions. They represent asymptomatic "do not touch" lesions.

Differential diagnosis always includes radio-opaque foreign bodies especially if unilateral or asymmetric in appearance. Consider scleral buckle if there is a history of previous orbital surgical intervention. Trochlear apparatus calcification is in the superomedial orbit.

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