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Bandkeratopathie

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Band keratopathy is a corneal disease characterised by a whitish haze on the front of the cornea. The opacities are caused by calcium crystals precipitating in the outer layers of the cornea (basal membrane of the epithelium, Bowman’s layer and the anterior part of the stroma) and often start at the edges of the cornea. As the condition progresses, the opacities will slowly spread towards the centre of the cornea, in the area between the upper and lower eyelids (visible as a horizontal haze over the cornea).

Causes

Band keratopathy usually occurs in combination with certain ophthalmic abnormalities, such as:

  • Chronic uveitis (inner inflammation of the eye)
  • Severe keratitis (inflammation of the cornea)
  • Phthisis bulbi (eye-shrinkage)
  • Presence of silicone oil in the eye (after vitreous surgery)
  • Chronic corneal oedema

In addition, people with physical conditions that increase blood calcium levels, such as chronic kidney disease, sarcoidosis and vitamin D intoxication, have an increased risk of developing band keratopathy. Sometimes band keratopathy is diagnosed in healthy older adults, and in rare cases, there is a familial link.

Symptoms

Band keratopathy may be associated with redness of the eye, eye irritation and the feeling of having a grain of sand in the eye. If the opacities are located in the centre of the cornea, vision is also impaired.

Examination

The eye and the cornea are first examined in detail to make a proper diagnosis and draw up a treatment plan. In addition to the standard examinations, the following ones are specifically important in the case of band keratopathy:

  • Eye measurement and visual acuity measurement
  • Split-lamp examination
  • Specular microscopy
  • Corneal tomography

Treatment

When the cloudiness has reached the central part of the cornea and reduces vision, treatment may be necessary. In addition, treatment can be useful if the eye feels uncomfortable. The treatment consists of removing the corneal epithelium, scraping off the calcium precipitate and dissolving the calcium with an EDTA solution. The epithelium will then usually close again within a week. Band keratopathy can sometimes recur after years, after which re-treatment may be necessary.

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