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Before 5 Years. The sphenoid sinuses begins to form at age 2, and are air-filled and visible on X-rays by age 5. The sphenoid sinuses sit behind the eyes and are located deeper than the other sinuses, behind the ethmoid sinuses. The right and left sphenoid are next to each other, only separated by the septum, a thin plate of bone.
Corneal arcus, or arcus senilis, is most often an involutional change modified by genetic factors. However, arcus is sometimes indicative of a hyperlipoproteinemia (involving low-density lipoproteins) with elevated serum cholesterol, especially in patients under 40 years of age (see Chapter 11). It can be a prognostic factor for coronary artery disease in this age group. Arcus occurs occasionally as a congenital anomaly (arcus juvenilis), usually involving only a sector of the peripheral cornea and not associated with abnormalities of serum lipid. Arcus is a deposition of lipid in the peripheral corneal stroma. It starts at the inferior and superior poles of the cornea and in the late stages encircles the entire circumference. The incidence is 60% in individuals between the ages of 50 and 60; it approaches 100% in individuals over 80.