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Title:
Dark Ring Around the eye
Author(s):
SphynxCatVP

There are a variety of eye conditions that can lead to rings - or other things - around parts of the eyes. It has also been theorized that a black ring - or dark ring - arund the iris is a symptom of real vampirism. (It needs to be stressed that this is ONLY THEORY, not fact!) So far, the site where this originates from simply states that it is a DARK ring, so it's not necessarily black - but it may look black under dim lighting, if it's dark enough, or if the observer has a color blindness affects how the ring is perceived.

In the interest of being sure that my readers are not ignoring possible medical ailments, this article will cover different types of rings and other discolorations of the eyes, and what - medically speaking - health conditions may possibly be represented by each of them.

BASIC ANATOMY OF THE EYE

Let's start with some basic eye anatomy. Referring to the various parts of the eye with the correct names will make it much easier to do further research. :) First up is a very basic frontal view, with the parts identified that most people will be likely to see when they're looking at the eyes of a person:

Front of eye with sclera, pupil, and iris labeled

And a side view, with a few more parts labeled (some of these are refrenced in the eye condition descriptions below):

 

GLOSSARY

Arcus:
Latin word meaning arch or bow. Used to refer to the curve around the eye.

Bowman's Membrane / Bowman's Layer:
Smooth layer in the eye located in between corneal layers. It is composed of collagen and helps the cornea maintain it's shape. (Patients with collagen disorders - Marfan's, Hypermobility, Ehlos-Danlos, etc. - will notice this affects their vision a lot, and their vision prescriptions may change to a larger degree than that of most other people.)

Ciliary Body / Iris:
Tissue inside the eye composed of both ciliary muscles and what's called "ciliary processes". Where the ciliary body crosses the lens, it is more commonly referred to as the "iris", and contains the muscles that dilate and contract the iris, depending on the amount of exposed light. The ciliary processes are the tissue folds that create the patterns you see (the blue circular part in the first eye picture, above) in the colored iris itself. (No, "ciliary processes" doesn't make much sense as a logical name to me either...)

Cornea:
The transparent, dome shaped 'window' covering the front of the eye

Conjunctiva:
Clear mucous membrane covering the whites of the eyes. Inflammation of this part of the eye is called conjunctivitis, commonly known as "pinkeye".

Cyclitis:
Inflammation of the ciliary body that causes redness of the sclera near the cornea.

Limbus:
The junction between the cornea and the sclera. This is the area surrounding the iris.

Pupil:
This is actually a gap in front of the lens, rather than tissue. The iris expands and contracts to make this gap larger or smaller, depending on the amount of available light.

Sclera:
The whites of the eyes.

Uveitis:
Swelling and irritation of the center of the eye. The uvea provides most of the blood supply to the retinas.


GENERAL PIGMENTATION ISSUES
(Not limited to rings, but may appear as such in rare situations)

Argyria / Argyrosis (rare; caused by excessive silver salts, long term minocycline use, etc.)
Bluish-black pigmentation due to excessive applications of insoluble albuminate of silver, such as colloidal silver. This is rare, but most often seen as a general blueish-black skin discoloration, but can be localized to the eyes if the patient is just using a silver salt compound near or in the eyes on a long-term basis. The discoloration is permanent, and harmless by itself, however extremely high doses of silver compounds will eventually be fatal. The discoloration often gets confused with cyanosis (lack of oxygen, which also causes a blueish tint) and can present extra challenges in medical care.

Calcific Band Keratopathy
Grayish-white Calcium deposits (often in a band, but sometimes occurring in a ring) either across the cornea or in the limbus. Caused by conditions resulting in high calcium, such as primary hyperparathyroidism, chronic renal insufficiency (evidenced by elevated calcium in relation to phosphate), sarcoidosis, milk-alkali syndrome, multiple myeloma, Hodgkin's disease, and beryliosis (beryillium disease due to inhallation of beryillium dust.)
This may get confused for Arcus (see description in next section) but high calcium conditions can be noted on a complete metabolic/chem20 blood test - get a cholesterol panel at the same time to determine whether it's a calcium issue, cholesterol issue or something else completely.

Chrysiasis / chrysoderma (caused by excessive gold insolubles)
Similar to Argyrosis, only due to gold instead of silver. This discoloration is also permanent, and is similar in color. Gold salts were once used as a treatment for joint pain conditions such as rheumatoid arthritis (RA); Methotrexate is now the preferred agent for RA treatment.

Foreign Bodies
Metallic objects, and components from things such as makeup or mascara can get in the eye, get under the top layers, and remain there lending the color of the object to the part of the eye it's in. Iron deposits from eye makeup and mascara are just one example of this.

Jaundice
Yellowing of the eyes (and also other parts of the body prone to discoloration in this situation.) This is caused by various types of liver problems (cirrhosis, chronic hepatitis, Wilson's Disease, Sarcoidosis, acetaminophen/Tylenol overdosing/poisoning, etc.), as the liver becomes unable to filter bile out of the body in a timely manner. This is the most common medical ailment associated with yellowing of the eyes and skin, however Ochronosis can also sometimes cause a yellow tint. (No, the color is not "off" in this sample picture - jaundice affects the skin as well as the eye, giving everything a yellowish tint.)
Example of jaundiced eye. Yellowing of entire picture is normal in Jaundice case, not bad photography.

Not to be confused with Lycopenemia, a harmless yellowish-orange discoloration due to excessive dietary consumption of lycopenes (found in tomato products and other fruits and berries) and/or carotenes (such as found in carrots.)

Ochronosis (rare, recessive, inherited)
Blueish-black or dark yellow deposits in the skin of the eyelids, conjunctiva, sclera and limbus; also in various connective tissues throughout the body causing them to become brittle. This is a sign of alkaptonuria, a metabolic disorder caused by deficiency of homogentisic acid oxidase.

Tumors
Tumors may also appear (such as Kaposi's Sarcoma in immunocompromised patients, or a conjunctival melanoma that turns the location black) but are generally distinguishable by a professional from simple discoloration due to size, shape and location in the eye.

Sample tumor pictures are very "ewww, gross!" - run your own search if you really want to see them, I'm not forcing them upon anyone who's unprepared.


SPECIFIC ISSUES

Arcus Senilis / Corneal Arcus
Greyish-white ring, or partial ring, around the outer edge. True Arcus is caused by deposits due to abnormally high lipid levels (hyperlipoproteinemia). A cholesterol panel can reveal whether cholesterol is the cause; paired with a complete metabolic/chem20 panel can differentiate between cholesterol, calcium and other issues. The pigmentation changes are permanent, but do not seem to cause visual impairments (they don't cross the pupil). It is referred to as "Arcus Senilis" in the elderly (it's occurrence is more frequent with age) and "corneal arcus" in younger people.
Example of arcus ring.

Heterochromia, Central
The central zone of the iris (surrounding the pupil) is a different color from the rest of the iris. Often this different color is yellow, brown, orange, and is often (sometimes incorrectly) referred to as "hazel" if it coveres most of, or all of, the iris. It may be a small skinny ring, or covering larger portions of the iris. It's often cosmetic - and hotly debated as to whether it's due to excessive toxins in the body. (I wouldn't rule out the toxin theory, it's wouldn't be the first time conventional medicine ignores something simple because they think it couldn't possibly be a cause...)
Mld example of central heterochromia .

Alternate causes can include a condition called Fuchs' Heterochromic Uveitis/Iridocyelitis, a chronic low-grade inflammatory condition that also includes cataracts, opacities, and glaucoma, and is typically seen between ages 20-60, with an average age of diagnosis being around 40.

Heterochromia, Sectoral (inherited)
The heterochromic coloration only occurs in one section (hence "sectoral") of the iris. Much less common than central heterochromia or complete heterochromia, and typically found with such ailments as Hirschsprung's disease (enlargement of the colon caused by obstruction) and Waardenburg syndrome (characterized by varying degrees of hearing impairment, pigmentary abnormalities of the skin, hair and eyes, and sometimes including intestinal and spinal defects.)
Minor example of sectoral heterochromia.

Kayser-Fleischer Ring
Coppery (or dark green) coloration in the limbus area. This is common in Wilson's disease due to a failure to metabolize copper. It also occasionally occurs in populations with liver issues (chronic hepatitis, cirrhosis, high cholesterol in the liver, etc.) In Wilson's Disease, there is a corresponding gene defect mapped to chromosone 13. The upper portion of the eye is affected more frequently than the lower.
Example Kayser-Fleischer Ring.

Limbus / Limbal Ring
General term referencing pigmentation of the limbus. Limbal rings are always dark - they may even appear black, depending on a person's vision (remember up to 1 in 12 people have some form of color blindness, whether mild or severe) - and the visibility does depend on ambient lighting and eye moisture. One proposed theory on one site is that it's a shadow caused by the shape of the cornea, but I haven't found anything in medical literature to verify or deny that yet.

Possible medical causes:

  • Addison's Disease (a form of hyptothyroidism)
  • Arcus rings (see above) - benign
  • Calcium Deposits, occasionally
  • Chronic hepatitis or other liver disease
  • Kayser-Fleischer rings (see above) - Wilson's Disease / failure to metabolize copper
  • etc.

Example of limbal ring.

In other aspects, limbal rings are very popular from an aesthetic viewpoint, as they are VERY commonly added to contact lenses, especially in Asian countries, to highlight the iris.

"DARK CIRCLES"

To make things even more confusing, there is also what most people refer to as "dark circles around the eyes" - or "dark circles under the eyes". This is not to be confused with anything like a limbal ring because, as you'll see from the picture below, it's not even ON the eye - it's a darker patch of skin surrounding the eyelids! Sometimes it appears brown if the discoloration is in the upper layers, and sometimes the discoloration appears more blue in the deeper layers.

Possible causes include:

  • Aging (due to loss of collagen and the skin getting thinner)
  • Anemia - Possibly iron deficiency anemia
  • Bad blood circulation
  • Dehydration
  • Exhaustion (makes rest of skin paler, leaving this area to appear darker)
  • Heredity
  • Medications that cause blood vessels to dilate


 


This site contains articles on various medical topics; however, no warranty whatsoever is made that any of the articles are accurate - and even if a statement made about medical matters is accurate, it may not apply to you or your symptoms. These medical articles are provided on a general informational basis only - nothing on this site should be construed as an attempt to offer or render a medical opinion or otherwise engage in the practice of medicine.

Even though the authors may be capable of doing extensive research, it must be understood that neither SphynxCatVP, nor the rest of the contributors, are doctors, despite the presence of any books of the medical profession in the personal libraries of any of the authors. Any such articles are thusly written, in part or in whole, by nonprofessionals. Consequently, there is absolutely no guarantee that any statement contained or cited in an article touching on medical matters is true, precise, or up-to-date.

At best, you can use the article to strike up a conversation with your doctor or other medical professional ABOUT your symptoms, and share any concerns you may have for them to investigate. The medical information provided by this site is of a general nature and CANNOT legally be considered a substitute for the advice of a medical professional.


Credits/References:

eMedicine: Argyria
eMedicine: Cirrhosis
eMedicine: Drug Induced Pitmentation
eMedicine: Fuchs Heterochromic Uveitis
eMedicine: Hirschsprung Disease
eMedicine: Hyperlipoproteinemia
eMedicine: Hyperlilpoproteinemia - Differential Diagnosis & Workup
eMedicine: Melanoma, Conjunctival
eMedicine: Ochronosis
eMedicine: Uveitis, Evaluation and Treatment
eMedicine: Waardenburg Syndrome
eMedicine: Wilson's Disease
eMedicine: Wilson's Disease - Differential Diagnosis & Workup
EyeNet Magazine: The Whites of My Eyes Have Turned Blue!
Merck Manual: Hyperpigmentation Disorders
Merck Manual: Jaundice
Opthamology: A Pocket Textbook Atlas
   by Gerhard K. Lang, Oskar Gareis
Patient Who Turned to the Dark Side
EPJournal: ...Limbal Ring Influences Facial Attractiveness PDF
PubMed: Appearance of the Human Eye - Contributions to the "Limbal Ring"
Medscape Today: Wilson's Disease - Pathogenesis and Pathology
Wikipedia: Heterochromia

Image Sources: Getty, Medscape and Google searches

Contact Author(s):
SphynxCatVP

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