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Degenerations
Band keratopathy developed in a silicone oil-filled eye.

  • Clinical features:
    • Symptoms:
      • Decrease visual acuity as the deposits become white and dense
      • Painful
    • Signs:
      • Interpalpebral deposition of calcium phosphate salts in the
        subepithelial and anterior stroma with clear areas separating it from
        the limbus
      • Clear areas and small circular areas where nerve endings perforate
        the Bowman's layer are seen within the band and give it a "Swiss
        cheese" appearance
  • Identifiable causes: dry eye syndrome, chronic exposure keratopathy, chronic ocular
    inflammation such as uveitis, phthisis bulbi, old interstitial keratitis, long standing
    glaucoma and repeated trauma such as multiple ocular surgeries.
  • Systemic conditions that cause increased serum calcium or phosphorus levels such
    as multiple myeloma, hyperparathyroidism, sarcoidosis, metastatic disease and
    chronic renal failure may all lead to the formation of band keratopathy.
  • Association with chronic exposure to chemical irritants such as prolonged use of
    pilocarpine that contain mercurial preservatives or intraocular substances, including
    silicone oil for retinal detachment repair are also noted.
  • Management:
    • Treatment is indicated for loss of visual acuity, intolerable eye irritation or
      cosmesis.
    • Repeated application of calcium binding agent EDTA
      (ethylenediaminetetraacetic acid) and scraping of the corneal surface after
      removing the epithelium is usually effective to treat relatively mild cases.
    • Excimer laser phototherapeutic keratectomy has been effectively performed
      to treat more extensive cases.

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