A 30-year-old woman with longstanding chronic anterior uveitis presents with a greyish band across the central cornea and reduced vision (6/24). The band spares the very periphery near the limbus.
Examination Findings
Slit lamp: a grey-white calcific band across the interpalpebral cornea at the level of Bowman’s layer, with clear intervals at the limbus; underlying quiet chronic uveitis with old keratic precipitates; vision 6/24.
Investigations
Slit-lamp documentation; serum calcium/phosphate and renal function (exclude systemic hypercalcaemia); uveitis activity assessment.
Questions to Think About
- Why does calcium deposit in a horizontal band — and why is the limbus spared?
- What systemic condition must be excluded?
- How is the band removed?
Diagnosis
Calcific band keratopathy secondary to chronic anterior uveitis.
Reasoning
Reasoning: In chronic uveitis the inflamed eye’s pH and tear evaporation concentrate calcium, which precipitates in Bowman’s layer across the exposed interpalpebral zone — the band shape follows the open eyelids, and the limbus is spared because limbal blood flow keeps the periphery healthier. The same band occurs in hypercalcaemia (chronic kidney disease, sarcoidosis), so serum calcium must be checked — the eye can be the presenting sign of systemic disease. Removal is by chelation: EDTA applied to the cornea dissolves the calcium, often combined with superficial scraping — but the uveitis must be quiet first, or the band recurs. Diagnosis: calcific band keratopathy secondary to chronic anterior uveitis. Management: typical management includes confirming the uveitis is controlled, checking serum calcium/renal function, and EDTA chelation with mechanical debridement for vision-affecting bands. She is told the band is calcium, not a scar, and that it can be dissolved once the inflammation is quiet.
Differential Diagnosis
- Calcific band keratopathy — the interpalpebral band with limbal sparing is classic.
- Lipid keratopathy — yellow, associated with corneal vascularisation; this is grey-white and calcific.
- Corneal dystrophy — genetic and symmetric without uveitis history; this follows chronic inflammation.
- Acute hydrops — sudden, painful, oedematous; not this chronic band.
Management
Control uveitis; check serum calcium and renal function; EDTA chelation with debridement for vision-affecting bands.
Key Learning Points
- Band keratopathy is calcium in Bowman’s layer across the interpalpebral zone, sparing the limbus.
- Chronic uveitis is the commonest ocular cause; hypercalcaemia is the systemic cause to exclude.
- EDTA chelation dissolves the band — but only after inflammation is controlled.
- The band shape follows the open eyelids; limbal sparing reflects limbal vascular health.
Red Flags
- Chelating while uveitis is active — quiet the inflammation first or it recurs.
- Missing systemic hypercalcaemia — the eye may present renal or parathyroid disease.
- Mistaking the band for irreversible scarring — calcium can be dissolved.
Educational content only — not medical advice. Clinical decisions must be made by a qualified professional for the individual patient.
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