CALCIFIC BAND KERATOPATHY ; HOW CAN YOUR EYES SAY SO MUCH ?

Calcific band keratopathy also known as Band Keratopathy is a corneal degeneration that is characterized by the appearance of an opaque white band of variable density across the central cornea, formed by the precipitation of calcium salts directly under the epithelium. The diagnosis relies primarily on history and slit lamp examination. The etiology is extensive, so it is imperative to get a thorough history and serologic work-up to identify any underlying causative pathology that may be prognostic.

Ophthalmology Department, Châteaudun Hospital, Châteaudun, France.

We report the case a 54 years old male who was referred to our Ophthalmology Department for evaluation of a corneal scar in his both eyes evolving over the last 6 months, associated with decreased visual acuity, photophobia and ocular irritation.

There was no history of trauma, red eyes, long-term use of topical drops. Visual acuity with correction at distance was 5/10 on the right and 1/10 on the left eye.
The intraocular pressure by applanation was 16 mmHg OD and 15 mmHg OS, pachymetry was 585 µm OD and hard to quantify on OS. Slit lamp microscopy in both eyes showed dense, band-shaped, horizontal, gray-white sub-epithelial corneal opacity in the inter-palpebral fissure with involvement of visual axis on OS. Inadequate view fundus on OS and normal on the right. The rest of the ocular examination was unremarkable.

In this case the approach was based on lubricating drops, gels, ointments and scleral lens to control ocular irritation, in conjunction with a detailed systemic evaluation that revealed some abnormalities. Serum calcium and corrected serum calcium level was high, alkaline phosphatase was also twice the standard rate. Blood urea, serum creatinine were normal. The chest X-ray were unremarkable. Ultrasonography of the kidneys and parathyroid hormone wasn’t checked yet.

To date, no etiology has been found as the assessment is still in progress to raise the issue of hyperparathyroidism, Paget disease, gout, tuberous sclerosis malignancy (such as multiple myeloma, and metastatic disease).

Band Keratopathy (BK) is a corneal degeneration following an imbalance of calcium and phosphate that iinitially deposits into the cornea. Medical management should be the first line treatment option in BK. Without treatment of the underlying cause, even with surgical management, the band keratopathy will most likely recur, or the cornea will have poor healing.