eMedicine Specialties > Ophthalmology > Cornea

Keratopathy, Band

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

Introduction

Background

Band keratopathy derives its name from the distinctive appearance of calcium deposition in a band across the central cornea. This corneal degeneration can occur from a variety of causes, both systemic and local.

Pathophysiology

Band keratopathy is the result of precipitation of calcium salts on the corneal surface (directly under the epithelium). Serum and normal body fluids (eg, tears, aqueous humor) contain calcium and phosphate in concentrations that approach their solubility product. Evaporation of tears tends to concentrate solutes and to increase the tonicity of tears; it is especially true in the intrapalpebral area where the greatest exposure of the corneal surface to ambient air occurs. Elevated serum calcium or serum phosphate can tip the balance in favor of precipitation. Topical medications that contain phosphates also may contribute to this problem. Finally, elevation of the surface pH out of the physiologic range changes the solubility product and favors precipitation. This type of tissue pH change can be seen in chronically inflamed eyes and may explain, in part, why patients with uveitis are at risk for the development of band keratopathy.

Endothelial function may play a role in the formation of calcium deposition. Compromise of endothelial function and corneal edema are sometimes seen in patients who have silicone oil inside the eye when it comes into contact with the posterior cornea. Although this association has been noted, the exact reasons remain uncertain.

Frequency

United States

The exact incidence of calcific band keratopathy is unknown.

Mortality/Morbidity

Patients with band keratopathy may experience a decrease in vision as the deposition progresses across the visual axis. A foreign body sensation and irritation associated with an irregular surface are common symptoms. The ocular discomfort may worsen to the point of becoming disabling. The plaque itself often is visible and of cosmetic concern to the patient and family members.

Sex

No known difference exists in the incidence of band keratopathy between men and women.

Age

No known association of band keratopathy exists with increasing age.

Clinical

History

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

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.

  • 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.

Causes

  • The following systemic conditions are associated with band keratopathy:
    • Hypercalcemia due to the following:
      • Hyperparathyroidism
      • Excessive vitamin D intake
      • Renal failure
      • 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
    • Anterior mosaic dystrophy
  • Drug-associated calcium deposition
    • Steroid phosphate preparations
    • 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) 
  • Chemical fume related
    • Mercury vapor
    • Calcium bichromate vapor
    • Intraocular use of recombinant tissue-plasminogen activator (rt-PA)

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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