Band Keratopathy

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Disease

  • Deposition of calcium salts (calcium phosphate) in the Bowman membrane, the basal membrane of the epithelium, and the anterior stroma

Causes

  • Chronic anterior uveitis
  • Phthisis bulbi
  • Silicone oil in the anterior chamber
  • Chronic corneal edema
  • Severe chronic keratitis
  • Chronic kidney failure
  • Hereditary
  • Parahyperthyroidism
  • Phosphate-containing eye drops

Findings

  • Initially, peripheral calcification in the palpebral fissure with a zone of clear cornea between the limbus and calcification
  • Slow extension centrally with band-shaped calcific plaque, sometimes transparent “holes” in between
  • Advanced lesions can become nodular and elevated

Differential Diagnoses

  • Vogt’s Limbal Girdle
    • Type 1 with a clear zone between deposition and limbus, Type 2 directly at the limbus
    • Very common age-related change, usually bilateral
    • No therapy required

Treatment

  • EDTA chelation
    • Superficial debridement with a cotton swab dipped in diluted EDTA solution (1.5 – 3%)
    • Other options: Diamond burr debridement, Excimer laser keratectomy, lamellar keratoplasty

Sources

  • EyeWiki Calcific Band Keratopathy
  • The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Nika Bagheri MD, Brynn Wajda MD, et al; Lippincott Williams&Wilkins; 7th Edition (2016)
  • Kanski’s Clinical Ophthalmology: A Systematic Approach; Jack J. Kanski MD, Brad Bowling MD; Saunders Ltd.; 8th Edition (2015)