band keratopathy

Band Keratopathy: A Corneal Degeneration

Band keratopathy is a degenerative condition that affects the cornea, the clear dome-shaped structure at the front of the eye. It is characterized by the appearance of an opaque white band or line across the central cornea, caused by the precipitation of calcium salts, primarily hydroxyapatite, on the underside of the corneal epithelium [2].

This corneal degeneration can result from a variety of causes, either systemic or local, with visual acuity decreasing in proportion to the density of the band. The condition is often described as having a "Swiss cheese" appearance due to clear areas and small circular holes where nerve endings perforate the Bowman's layer [3].

Key Features:

• A linear band of calcium deposits across the cornea
• White and holey appearance, often referred to as "Swiss cheese"
• Can result from systemic or local causes, including diseases that affect only the eye or the whole body
• Visual acuity decreases in proportion to the density of the band

References:

[1] Refers to search result 4, which states that band keratopathy is an example of metastatic calcification, occurring in the presence of hypercalcemia.

[2] Refers to search result 2, which describes the corneal degeneration caused by calcium precipitation on the underside of the corneal epithelium.

[3] Refers to search result 3, which notes that clear areas and small circular holes give the band a "Swiss cheese" appearance.

Signs and Symptoms of Band Keratopathy

Band keratopathy is a corneal disease characterized by the deposition of calcium salts in the superficial layers of the cornea, leading to various signs and symptoms. The following are some common signs and symptoms associated with band keratopathy:

• Blurred vision: Decreased visual acuity due to the deposition of calcium salts in the cornea [1][2]
• Eye pain: Pain or discomfort in the eye, especially if some of the deposits break off and scrape the eye [1][5]
• Foreign body sensation: A feeling like there is sand or grit in the eye [1][4][6]
• Ocular irritation: Redness, itching, or burning sensations in the eye [2][3][7]
• Photophobia: Sensitivity to light [1][4]
• Red eye: Redness of the eye due to inflammation or irritation [1][4]
• Decreased vision: Gradual decrease in visual acuity as the deposits become white and dense [3][5]
• Painful: Pain or discomfort in the eye, especially if some of the deposits break off and scrape the eye [5]

These symptoms can vary in severity and may be accompanied by other signs such as corneal opacification, white or grayish-yellowish band formation in the cornea, decreased visual acuity, corneal epithelial irregularity, and pain or discomfort in the eye.

Diagnostic Tests for Band Keratopathy

Band keratopathy, also known as calcific band keratopathy, is a condition characterized by the deposition of calcium in layers of the cornea. To diagnose this condition, several tests and examinations are performed.

• Slit Lamp Examination: A thorough slit-lamp examination is essential for diagnosing band keratopathy. This examination allows ophthalmologists to view the eye under magnification and observe the characteristic gray-white corneal plaque.
• Blood Tests: Blood tests, including serum calcium, phosphorus, and uric acid levels, are also recommended as part of the diagnostic work-up. These tests help identify any underlying metabolic disorders that may be contributing to the condition (1).
• Renal Function Tests: Renal function tests, such as blood urea nitrogen (BUN) and creatinine, should be performed to assess kidney function (2).
• Imaging Studies: In some cases, imaging studies like chest radiography or chest spiral CT may be ordered if sarcoidosis is suspected based on ocular or systemic findings (4).

Key Takeaways

• A slit-lamp examination is crucial for diagnosing band keratopathy.
• Blood tests and renal function tests are also essential components of the diagnostic work-up.
• Imaging studies may be ordered in specific cases to rule out underlying conditions like sarcoidosis.

References:

(1) [3] (2) [5] (4) [4]

Treatment Options for Band Keratopathy

Band keratopathy, a condition characterized by the deposition of calcium salts in the cornea, can be treated with various methods, including drug treatment.

• Chelation Therapy: Chelation therapy is considered the most common and effective treatment for band keratopathy. This involves applying ethylene-diamine-tetra-acetic acid (EDTA) to remove calcium deposits from the eye.
  • EDTA can be made in compounding pharmacies, but its availability may be limited [3].
  • A study by Lee et al. found that Dipotassium-EDTA (K2-EDTA), commonly used in blood draw tubes and rinsing solutions, is an effective treatment for band keratopathy [4].
• Topical Steroids: Topical steroids, such as prednisolone acetate 1.0%, can be used to reduce inflammation and promote healing.
  • A study by J Narvaez in 2021 proposed a simplified method for treating band keratopathy with EDTA [6].
• Other Treatment Options: Other treatment options include scraping with a blade, chelation with EDTA, and phototherapeutic keratectomy. However, each of these methods has its own set of risks and benefits.

References

[1] Context result 4 [2] Context result 14 [3] Context result 3 [4] Context result 4 [5] Context result 7

Differential Diagnosis of Band Keratopathy

Band keratopathy, also known as corneal calcification, is a degenerative condition affecting the cornea. When diagnosing this condition, it's essential to consider various differentials to rule out other possible causes. Here are some conditions that can be considered in the differential diagnosis of band keratopathy:

• Gout: Gout can cause deposition of calcium salts in the cornea, leading to a similar appearance to band keratopathy [10].
• Interstitial keratitis: This condition can also lead to calcification and opacification of the cornea, making it a differential diagnosis for band keratopathy [9, 12].
• Primary and secondary calcarous degeneration of the cornea: These conditions involve deposition of calcium salts in the cornea, which can be similar to band keratopathy [10, 14].
• Caliphylaxis: This is a rare condition that involves calcification of the skin and subcutaneous tissue, but it can also affect the cornea, making it a differential diagnosis for band keratopathy [9, 13].
• Spheroidal degeneration and Salzmann nodular degeneration: These conditions are important differentials of band keratopathy, particularly in cases where the band-shaped appearance is not typical [2].

It's worth noting that the differential diagnosis of band keratopathy can be extensive, and a thorough history and serologic work-up are essential to identify any underlying causative pathology [1].