Band keratopathy

Specialty: Ophthalmology.

• calcium deposits in the cornea
• cornea in Swiss cheese
• superficial corneal calcification

Why it occurs

• Long-term persistent chronic anterior uveitis (most common ophthalmological cause, especially common in children with juvenile idiopathic arthritis)
• Uncontrolled systemic hypercalcemia (secondary to primary hyperparathyroidism, chronic renal failure, vitamin D intoxication, sarcoidosis or osteolytic bone metastases)
• Eyes with phthisis bulbi, disorganized or with chronic terminal intraocular inflammation
• Chronic occupational exposure to mercury vapors or irritating chemical gases
• Chronic and prolonged use of ophthalmic eye drops preserved with phosphates in corneas that present chronic epithelial damage

Initial workup

Biomicroscopic examination with a slit lamp (grayish calcareous subepithelial deposits are observed with small clear holes that give a "Swiss cheese" pattern at the level of the palpebral slit); Analytical determination in peripheral blood of levels of total and ionized calcium, phosphorus, parathyroid hormone (PTH), creatinine and urea nitrogen to rule out parathyroid or renal dysfunction; Ocular ultrasound if opacity prevents assessment of the posterior pole.

Standard management

• There is no conventional topical pharmacological treatment for chronic administration to spontaneously dissolve corneal calcium. The decisive management is surgical-therapeutic through epithelial scraping and instillation of 1.5% or 2% disodium Ethylenediaminetetraacetic Acid (EDTA) on the stripped cornea to chelate and dissolve calcium locally in the operating room.
• Sodium hyaluronate 0.4% without preservatives — eye drops, apply every 3-4 hours to minimize the sensation of eyelid rubbing
• Erythromycin in ophthalmic ointment (apply every 12 hours as post-EDTA chelation procedure prophylaxis).