Figure 8-7 A posterior staphyloma (between arrowheads) is present in this eye as a sequela of scleritis. (Courtesy of Hans E.

Grossniklaus, MD.)

Degenerations

Senile Calcific Plaque

Senile calcific plaques occur commonly in elderly individuals as flat, firm, sharply circumscribed, gray rectangular to ovoid patches, measuring 1 cm in greatest dimension. The plaques appear bilaterally and are typically located anterior to the medial and lateral rectus muscle insertions (Fig 8- 8A). The etiology is unknown; dehydration, actinic damage, and stress on scleral collagen exerted by rectus muscle insertions have been proposed but not proven.

On histologic sections, the calcium is present within the midportion of the scleral stroma. It initially occurs as a finely granular deposition but may progress to a confluent plaque involving both superficial and deep sclera (Fig 8-8B). Senile plaques may be highlighted by special stains for calcium, such as von Kossa and alizarin red.