eMedicine Specialties > Ophthalmology > Cornea

Keratopathy, Band: Differential Diagnoses & Workup

Author: Michael Taravella, MD, Director of Cornea and Refractive Surgery, Rocky Mountain Lions Eye Institute; Associate Professor, Department of Ophthalmology, University of Colorado School of Medicine
Contributor Information and Disclosures

Updated: Dec 19, 2008

Differential Diagnoses

Gout
Keratitis, Interstitial

Other Problems to Be Considered

Primary and secondary calcareous degeneration of the cornea
Calciphylaxis (an ocular and systemic hypersensitivity response characterized by calcium deposition in response to specific antigens or agents)
Spheroidal degeneration (bandlike deposition of hyaline)

Workup

Laboratory Studies

  • Patients who present with band keratopathy should have a serum calcium and phosphate level drawn unless the deposition has been documented previously and a known underlying cause exists. Renal function tests, such as BUN and creatinine, should be performed as well.  Renal failure and the need for dialysis can be associated with an elevation in serum phosphate and calcific band keratopathy.
  • If sarcoid is suspected, an angiotensin-converting enzyme (ACE) should be obtained.
  • Parathyroid hormone levels should be checked in otherwise idiopathic cases.

Histologic Findings

Band keratopathy is characterized by calcium deposition involving the Bowman layer and the superficial stroma of the cornea. The earliest changes include basophilic staining of the Bowman layer. Amorphous eosinophilic connective tissue and a fibrous pannus often are present between the calcium deposition and the overlying epithelium in more advanced cases. Calcium is deposited intracellularly when hypercalcemia is the cause; extracellular deposits are characteristic of local ocular disease.

More on Keratopathy, Band

Overview: Keratopathy, Band
Differential Diagnoses & Workup: Keratopathy, Band
Treatment & Medication: Keratopathy, Band
Follow-up: Keratopathy, Band
Multimedia: Keratopathy, Band
References
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References

  1. 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].

  2. 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].

  3. 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].

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

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

  6. 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].

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

  8. 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].

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

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

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

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

  14. 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].

  15. 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].

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Further Reading

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Keywords

band keratopathy, calcium plaques, calcific band keratopathy, corneal degeneration, calcium deposition, corneal disease, cornea

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Contributor Information and Disclosures

Author

Michael Taravella, MD, Director of Cornea and Refractive Surgery, Rocky Mountain Lions Eye Institute; Associate 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, Association for Research in Vision and Ophthalmology, Contact Lens Association of Ophthalmologists, and Eye Bank Association of America
Disclosure: Alcon Honoraria Speaking and teaching; Allergan Honoraria Speaking and teaching; Surgical Specialties Honoraria Speaking and teaching; BD Surgical Supplies Honoraria Speaking and teaching

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Christopher J Rapuano, MD, Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Co-Chairman of the Cornea Service, Co-Chairman 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, Eye Bank Association of America, Pennsylvania Medical Society, and Philadelphia County Medical Society
Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other

CME Editor

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.

 
 
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