A 48-year-old woman with long-standing chronic uveitis presents with gradual vision loss, glare and a gritty sensation in both eyes. Vision is 6/36 right, 6/24 left. Slit-lamp shows a grey-white band across the interpalpebral cornea.
Examination Findings
Both eyes: a horizontal grey-white calcific band in the interpalpebral zone at the level of Bowman layer, with clear zones at the limbus and a lucid interval; the surface is irregular with punctate staining. Chronic uveitis is quiet on current treatment. Intraocular pressure normal.
Investigations
Anterior-segment OCT confirms calcium deposition at Bowman layer with an intact deeper stroma. Serum calcium and renal function are checked to exclude systemic hypercalcaemia; chronic uveitis and long-term silicone oil are noted as local drivers. The band is photographed and measured.
Questions to Think About
- What causes band keratopathy, and when is EDTA chelation indicated?
- Describe the chelation procedure and its expected outcome.
Diagnosis
Band keratopathy (chronic uveitis-related) — EDTA chelation indicated.
Reasoning
Band keratopathy is calcium deposited in Bowman layer across the exposed interpalpebral cornea, driven by chronic ocular inflammation (uveitis), silicone oil, or systemic hypercalcaemia — the clear limbal zones and lucid interval are characteristic. EDTA chelation is indicated when the band causes visual loss, glare or surface breakdown: after removing the epithelium over the band, EDTA solution is applied to chelate (bind and dissolve) the calcium, which is then wiped away, leaving a smooth surface to re-epithelialise. Typical management: control the underlying uveitis first (or the band recurs), check and correct systemic calcium, then chelate per corneal specialist — often combined with PTK for smoothing. Counsel that vision usually improves markedly, that recurrence is common if inflammation persists, and that dense deep plaques may need lamellar surgery instead. Diagnosis: band keratopathy secondary to chronic uveitis — for EDTA chelation.
Differential Diagnosis
- Band keratopathy from chronic uveitis — confirmed: interpalpebral calcific band at Bowman layer in chronic ocular inflammation.
- Calcific keratopathy from phosphate-containing drops — considered and excluded by medication history; the pattern and uveitis history fit band disease.
- Salzmann nodular degeneration — ruled out: discrete blue-grey nodules, not a continuous interpalpebral band.
Management
Optimise control of the underlying uveitis before surgery to reduce recurrence. Check serum calcium and renal function. Refer for EDTA chelation (epithelial removal, EDTA application, calcium wipe-off) per corneal specialist, with PTK smoothing if needed. Postoperative: bandage lens, lubrication, infection prophylaxis per protocol until re-epithelialised. Maintain long-term uveitis control and monitor for recurrence; counsel on the visual improvement expected and the possibility of repeat treatment.
Key Learning Points
- Band keratopathy is Bowman-layer calcium in a characteristic interpalpebral band with clear limbal zones — chronic uveitis is the commonest driver, so quiet the inflammation before treating the band.
- EDTA chelation dissolves the calcium and restores the surface: remove epithelium, apply EDTA, wipe away — then maintain uveitis control, because active inflammation brings the band back.
Red Flags
- Chelating while uveitis is active — the band will recur; quiet the inflammation first.
- Phosphate-containing drops in a compromised cornea — a preventable cause of calcific keratopathy; review the drop list.
- Deep stromal calcium plaques — EDTA only clears Bowman-layer deposits; deeper disease needs surgical planning.
Educational content only — not medical advice. Clinical decisions must be made by a qualified professional for the individual patient.