Band Keratopathy Clinical Presentation

  • Author: Michael Taravella, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Nov 16, 2011
 

History

  • Patients with band keratopathy complain of the following:
    • Decreased vision
    • Foreign body sensation
    • Ocular irritation
    • Redness (occasionally)
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Physical

Visual acuity will be decreased in proportion with the density of deposition of calcium salts in the central cornea. Slit lamp examination often reveals a whitish-grayish plaquelike deposition that occurs in a band across the cornea. The very periphery of the cornea may be spared because of the buffering effect of limbal blood vessels. Holes in the plaque may be apparent; these holes represent spaces where the corneal nerves are traversing the Bowman membrane to the epithelial surface. See the image below.

Band keratopathy. Note the bandlike whitish-grey lBand keratopathy. Note the bandlike whitish-grey lesion across the corneal surface, sparing the superior and inferior cornea.
  • The calcium deposition typically begins in the periphery and progresses centrally but, occasionally, may begin centrally.
  • The calcium may be very fine or thick and plaquelike. When it is thick, it may flake off, causing epithelial defects and painful symptoms.
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Causes

  • The following systemic conditions are associated with band keratopathy:
    • Hypercalcemia due to the following:
      • Hyperparathyroidism
      • Excessive vitamin D intake
      • Renal failure[6]
      • Hypophosphatasia
      • Milk-alkali syndrome
      • Paget disease
      • Sarcoidosis
    • Other systemic conditions
      • Discoid lupus erythematosus
      • Tuberous sclerosis
  • Local ocular conditions
    • Chronic uveitis
    • Juvenile idiopathic arthritis with uveitis
    • Phthisis bulbi
    • End-stage glaucoma[7]
    • Anterior mosaic dystrophy
  • Drug-associated calcium deposition
    • Steroid phosphate preparations[8] (See the image below.) The image shown is of a patient who developed a caThe image shown is of a patient who developed a calcium plaque following a corneal transplant and the use of a topical steroid phosphate preparation.
    • Pilocarpine containing mercurial based preservatives
    • Viscoelastic agents (rare, early formulations; may be related to phosphate buffers)
    • Silicone oil
    • Topical medications containing phosphate buffers (especially in the setting of chemical eye burns)[9]
  • Chemical fume related
    • Mercury vapor
    • Calcium bichromate vapor
    • Intraocular use of recombinant tissue-plasminogen activator (rt-PA)
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Contributor Information and Disclosures
Author

Michael Taravella, MD  Director of Cornea and Refractive Surgery, Rocky Mountain Lions Eye Institute; Professor, Department of Ophthalmology, University of Colorado School of Medicine

Michael Taravella, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, and Eye Bank Association of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Stephen D Plager, MD, FACS  Chief, Department of Ophthalmology, Dominican Hospital; Assistant Clinical Professor, Department of Ophthalmology, Stanford University Hospital

Stephen D Plager, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, and California Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Christopher J Rapuano, MD  Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Director of the Cornea Service, Co-Director of Refractive Surgery Department, Wills Eye Institute

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery, and Pan-American Association of Ophthalmology

Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other; Vistakon Honoraria Speaking and teaching; EyeGate Pharma Consulting; Inspire Consulting fee Consulting; Bausch & Lomb Honoraria Speaking and teaching; Bausch & Lomb Consulting fee Consulting

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

  1. Jhanji V, Rapuano CJ, Vajpayee RB. Corneal calcific band keratopathy. Curr Opin Ophthalmol. Jul 2011;22(4):283-9. [Medline].

  2. Bernauer W, Thiel MA, Kurrer M, et al. Corneal calcification following intensified treatment with sodium hyaluronate artificial tears. Br J Ophthalmol. Mar 2006;90(3):285-8. [Medline].

  3. Doostdar N, Manrique CJ, Hamill MB, Barron AR. Synthesis of calcium-silica composites: a route toward an in vitro model system for calcific band keratopathy precipitates. J Biomed Mater Res A. Nov 2011;99(2):173-83. [Medline].

  4. Federman JL, Schubert HD. Complications associated with the use of silicone oil in 150 eyes after retina-vitreous surgery. Ophthalmology. Jul 1988;95(7):870-6. [Medline].

  5. Sternberg P Jr, Hatchell DL, Foulks GN, et al. The effect of silicone oil on the cornea. Arch Ophthalmol. Jan 1985;103(1):90-4. [Medline].

  6. Porter R, Crombie AL. Corneal and conjunctival calcification in chronic renal failure. Br J Ophthalmol. May 1973;57(5):339-43. [Medline].

  7. Kennedy RE, Roca PD, Landers PH. Atypical band keratopathy in glaucomatous patients. Am J Ophthalmol. Nov 1971;72(5):917-22. [Medline].

  8. Taravella MJ, Stulting RD, Mader TH, et al. Calcific band keratopathy associated with the use of topical steroid- phosphate preparations. Arch Ophthalmol. May 1994;112(5):608-13. [Medline].

  9. Kompa S, Redbrake C, Dunkel B, et al. Corneal calcification after chemical eye burns caused by eye drops containing phosphate buffer. Burns. Sep 2006;32(6):744-7. [Medline].

  10. Smolin G. Corneal dystrophies and degenerations. The Cornea. 1994;500-503.

  11. Anderson SB, de Souza RF, Hofmann-Rummelt C, et al. Corneal calcification after amniotic membrane transplantation. Br J Ophthalmol. May 2003;87(5):587-91. [Medline].

  12. Klaassen-Broekema N, van Bijsterveld OP. Limbal and corneal calcification in patients with chronic renal failure. Br J Ophthalmol. Sep 1993;77(9):569-71. [Medline].

  13. Sharma N, Mannan R, Sinha R, Kaushal S, Titiyal JS, Kumar A, et al. Excimer laser phototherapeutic keratectomy for the treatment of silicone oil-induced band-shaped keratopathy. Eye Contact Lens. Sep 2011;37(5):282-5. [Medline].

  14. Althaus C, Schelle C, Sundmacher R. [Acute band-shaped keratopathy after intraocular fibrinolysis with recombinant tissue plasminogen activator (rt-PA)]. Klin Monatsbl Augenheilkd. Nov 1996;209(5):318-21. [Medline].

  15. Binder PS, Deg JK, Kohl FS. Calcific band keratopathy after intraocular chondroitin sulfate. Arch Ophthalmol. Sep 1987;105(9):1243-7. [Medline].

  16. Doughman DJ, Olson GA, Nolan S, et al. Experimental band keratopathy. Arch Ophthalmol. Feb 1969;81(2):264-71. [Medline].

  17. Lemp MA, Ralph RA. Rapid development of band keratopathy in dry eyes. Am J Ophthalmol. May 1977;83(5):657-9. [Medline].

  18. Nevyas AS, Raber IM, Eagle RC Jr, et al. Acute band keratopathy following intracameral Viscoat. Arch Ophthalmol. Jul 1987;105(7):958-64. [Medline].

 
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Band keratopathy. Note the bandlike whitish-grey lesion across the corneal surface, sparing the superior and inferior cornea.
Calcium deposition associated with the use of dexamethasone phosphate. The calcium plaques appear as elevated white lesions at the edge of a persistent epithelial defect.
Total calcification of the cornea. Deep and superficial layers of the cornea are involved with this process.
The image shown is of a patient who developed a calcium plaque following a corneal transplant and the use of a topical steroid phosphate preparation.
 
 
 
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