Title: Band Keratopathy Case Report
Author: Martin de la Presa, BA
Keywords / Main Subjects: Band keratopathy; calcium hydroxyapatite deposition
Diagnosis / Differential Diagnosis: Interstitial keratitis; calcareous degeneration; calciphylaxis
Brief Description of Image: Band keratopathy is the pathological deposition of calcium within the superficial layers of the cornea, specifically Bowman’s layer. The condition ranges from asymptomatic to causing ocular irritation, foreign body sensation and decreased vision. Though it is often idiopathic there is a broad differential of local and systemic associated diseases. The local causes include chronic ocular irritation or inflammatory conditions such as chronic anterior uveitis (especially in Juvenile Idiopathic Arthritis), interstitial keratitis, superficial keratitis, phthisis bulbi, end-stage glaucoma and silicone oil left in the aphakic eye. Systemic diseases associations include those diseases that elevate serum calcium levels such as in hyperparathyroidism, sarcoidosis, multiple myeloma, hypophosphatemia, Paget disease and chronic renal failure.
On exam, there is a white band-like formation of calcium across the corneal surface with irregular boarders and a peripheral clearing of cornea between the calcium deposits and the limbus. The calcium deposition is typically found beneath the epithelial layer within Bowman’s layer but may extend into anterior stroma. In the absence of an explainable local etiology laboratory testing is recommended to assess serum calcium and phosphate levels and renal function. When symptomatic, the calcium deposits can be removed with superficial debridement and manual scraping of the corneal surface with or without the aid of a chelating agent such as ethylenediaminetetraacetic acid (EDTA). Recurrence is common unless the predisposing cause is identified and treated.
Faculty Approval: Griffin Jardine, MD