Band Keratopathy (Symptoms,Causes and Treatment)

Band keratopathy, also known as corneal arcus or arcus senilis, is a condition characterized by the deposition of calcium in the cornea, which is the transparent front part of the eye. This calcium deposition appears as a whitish-grayish band or ring around the periphery of the cornea.

The condition primarily affects older individuals, especially those over the age of 50, although it can occur in younger people as well, particularly in cases of certain underlying medical conditions. Band keratopathy is more commonly observed in individuals with conditions such as chronic inflammation of the eye (uveitis), long-term use of certain medications like diuretics or high-dose vitamin D, or systemic diseases such as renal failure or hypercalcemia.

The deposition of calcium in the cornea occurs due to a variety of mechanisms. In some cases, it is a result of the breakdown of the normal protective barriers that prevent calcium from entering the cornea. This breakdown can be caused by inflammation, injury, or changes in the normal balance of calcium and other minerals in the body.

Band keratopathy is typically asymptomatic and does not affect vision in its early stages. However, as the calcium deposition progresses, it can lead to visual disturbances, such as blurred vision or glare, especially when the band of calcium encroaches on the visual axis. If the central cornea becomes involved, it can cause significant vision impairment.

The diagnosis of band keratopathy is made through a comprehensive eye examination, which may include visual acuity testing, slit-lamp examination, and corneal imaging techniques. The presence of the characteristic whitish-grayish band in the cornea is usually apparent during the examination.

Treatment options for band keratopathy depend on the underlying cause and the extent of corneal involvement. In mild cases without visual impairment, no specific treatment may be necessary other than regular monitoring. However, if the visual axis is affected or if the condition is causing significant visual symptoms, treatment options may include the use of eye drops, such as chelating agents that can help dissolve the calcium deposits, or surgical interventions like corneal debridement or phototherapeutic keratectomy (PTK) to remove the calcium deposits.

It is important for individuals with band keratopathy to have regular follow-up appointments with an ophthalmologist to monitor the progression of the condition and address any changes in visual function.

This article covers the following topics :

What is band keratopathy?

Band keratopathy, also known as corneal arcus or arcus senilis, is a condition characterized by the deposition of calcium in the cornea, the transparent front part of the eye. The calcium deposits form a whitish-grayish band or ring around the periphery of the cornea, typically near its outer edge.

The condition is often seen in older individuals, especially those above the age of 50, although it can occur in younger individuals as well, particularly in cases of certain underlying medical conditions. Band keratopathy is more commonly observed in people with conditions such as chronic inflammation of the eye (uveitis), long-term use of certain medications like diuretics or high-dose vitamin D, or systemic diseases such as renal failure or hypercalcemia.

The exact mechanisms underlying the formation of calcium deposits in the cornea are not fully understood. However, it is believed to involve the breakdown of the normal protective barriers that prevent calcium from entering the cornea. This breakdown can be caused by factors such as inflammation, injury, or imbalances in calcium and other minerals in the body.

In the early stages, band keratopathy is typically asymptomatic and does not affect vision. However, as the calcium deposits progress and encroach on the visual axis, it can lead to visual disturbances such as blurred vision or glare. If the central cornea is involved, it can cause significant vision impairment.

Diagnosis of band keratopathy is made through a comprehensive eye examination, which may include visual acuity testing, slit-lamp examination, and corneal imaging techniques. The characteristic whitish-grayish band in the cornea is usually visible during the examination.

Treatment for band keratopathy depends on the underlying cause and the extent of corneal involvement. In mild cases without visual impairment, no specific treatment may be necessary other than regular monitoring. However, if the visual axis is affected or if the condition is causing significant visual symptoms, treatment options may include the use of eye drops, such as chelating agents that help dissolve the calcium deposits, or surgical interventions to remove the calcium deposits.

Regular follow-up appointments with an ophthalmologist are important for individuals with band keratopathy to monitor the condition and address any changes in visual function.

How does band keratopathy affect my body?

Band keratopathy primarily affects the cornea, which is the transparent front part of the eye. The deposition of calcium in the cornea can lead to various effects on the eye and vision. Here’s how band keratopathy can affect the body:

1-Vision Impairment: As the calcium deposits progress and encroach on the visual axis, they can cause visual disturbances. Common symptoms include blurred vision, decreased visual acuity, and glare sensitivity. If the central cornea is involved, it can lead to significant vision impairment.

2-Reduced Contrast Sensitivity: Band keratopathy can affect contrast sensitivity, making it difficult to distinguish between objects of similar tones or shades. This can impact tasks that require visual discrimination, such as reading, driving, or recognizing facial expressions.

3-Visual Distortions: In some cases, band keratopathy can cause visual distortions, such as halos or irregular astigmatism. These distortions can further impact visual clarity and quality.

4-Dry Eye Symptoms: Some individuals with band keratopathy may experience dry eye symptoms, such as eye discomfort, redness, or a gritty sensation. The calcium deposits can disrupt the normal tear film and affect tear production, leading to dryness.

It’s important to note that band keratopathy typically affects the eyes and vision, and its impact is localized to the cornea. It does not have direct systemic effects on other parts of the body. However, in some cases, band keratopathy may be associated with underlying medical conditions that can affect the body as a whole, such as renal failure or hypercalcemia. These systemic conditions may have their own set of effects on the body, independent of band keratopathy itself.

If you have band keratopathy or suspect you may have it, it’s recommended to consult with an ophthalmologist for a proper diagnosis, evaluation, and appropriate management of the condition.

What are the signs and symptoms of band keratopathy?

The signs and symptoms of band keratopathy can vary depending on the extent of calcium deposition in the cornea and its impact on vision. Here are the common signs and symptoms associated with band keratopathy:

1-Whitish-Grayish Band: The hallmark sign of band keratopathy is the presence of a whitish-grayish band or ring around the periphery of the cornea. This band is typically seen near the outer edge of the cornea and may appear hazy or opaque.

2-Asymptomatic in Early Stages: Band keratopathy is often asymptomatic in its early stages. Many individuals may not experience any symptoms or visual disturbances, especially if the calcium deposition is limited and not encroaching on the visual axis.

3-Visual Disturbances: As the calcium deposits progress and affect the visual axis, individuals may start experiencing visual disturbances. These can include blurred vision, decreased visual acuity (sharpness of vision), or difficulty focusing on objects.

4-Glare Sensitivity: Band keratopathy can cause increased sensitivity to glare, particularly in bright light conditions or when exposed to direct sources of light. Glare can lead to discomfort and reduced visual clarity.

5-Visual Field Changes: In some cases, the calcium band may extend further into the central cornea, affecting the visual field. This can result in visual field changes or restrictions, making it difficult to see objects in certain areas of the visual field.

It’s important to note that band keratopathy may not cause symptoms or vision problems in all cases, especially if the calcium deposits are minimal or located away from the visual axis. However, if you notice any changes in your vision or have concerns about your eyes, it’s advisable to seek an evaluation from an ophthalmologist or eye care professional for a comprehensive examination and proper diagnosis.

What causes band keratopathy?

Band keratopathy is primarily caused by the deposition of calcium salts in the cornea. The exact mechanisms underlying the development of calcium deposits in the cornea are not fully understood, but several factors and conditions have been associated with its occurrence. Here are some common causes and risk factors:

1-Chronic Inflammation: Prolonged inflammation of the eye, known as uveitis, is a common cause of band keratopathy. Inflammatory conditions in the eye can disrupt the normal metabolism of calcium and other minerals, leading to their deposition in the cornea.

2-Underlying Systemic Conditions: Band keratopathy can be associated with certain systemic conditions that affect calcium metabolism. These include chronic kidney disease or renal failure, hypercalcemia (high levels of calcium in the blood), hypoparathyroidism (low parathyroid hormone levels), and vitamin D disorders.

3-Medications: Long-term use of certain medications can contribute to the development of band keratopathy. Diuretics, particularly thiazide diuretics, and high-dose vitamin D supplements have been associated with an increased risk of calcium deposition in the cornea.

4-Aging: Band keratopathy is more commonly observed in older individuals, particularly those over the age of 50. The aging process may contribute to changes in the cornea’s physiology and increase the likelihood of calcium deposits.

5-Other Factors: Band keratopathy can occasionally occur as a result of eye trauma, corneal surgeries, or conditions that disrupt the normal integrity of the cornea.

It’s important to note that band keratopathy can be multifactorial, with multiple causes and risk factors interacting to contribute to its development. It’s advisable to consult with an ophthalmologist or eye care professional for a thorough evaluation and appropriate management if you have or suspect you have band keratopathy. They can determine the underlying cause and provide targeted treatment or management options based on your specific situation.

How is band keratopathy diagnosed?

Band keratopathy is typically diagnosed through a comprehensive eye examination performed by an ophthalmologist or an eye care professional. The diagnosis involves a combination of clinical evaluation and specialized tests. Here are the common methods used to diagnose band keratopathy:

1-Medical History and Symptoms: The healthcare provider will begin by taking a detailed medical history, including any existing eye conditions, systemic diseases, medications, or symptoms you may be experiencing.

2-Visual Acuity Testing: Visual acuity testing assesses the clarity of your vision using an eye chart. This test helps determine if band keratopathy is affecting your visual acuity.

3-Slit-lamp Examination: A slit lamp is a specialized microscope that allows the eye care professional to examine the structures of the eye in detail. During the slit-lamp examination, the cornea is observed under magnification to identify the presence of a whitish-grayish band or ring.

4-Corneal Imaging: Various imaging techniques may be employed to evaluate the cornea. Anterior segment optical coherence tomography (OCT) or corneal topography can provide detailed images of the cornea, allowing the healthcare provider to assess the extent of calcium deposition and its impact on the corneal structure.

5-Fluorescein Staining: Fluorescein staining involves placing a dye (fluorescein) onto the surface of the eye to evaluate the integrity of the corneal epithelium. This test helps assess the presence of any corneal abrasions or epithelial defects that may contribute to band keratopathy.

In most cases, the characteristic appearance of a whitish-grayish band in the cornea is sufficient for the diagnosis of band keratopathy. However, additional tests may be performed to determine the underlying cause of the condition if deemed necessary.

If you suspect you have band keratopathy or are experiencing changes in your vision, it is recommended to consult with an ophthalmologist or an eye care professional. They can perform a comprehensive evaluation, make an accurate diagnosis, and discuss appropriate treatment options or management strategies.

How is band keratopathy treated?

The treatment of band keratopathy depends on the severity of symptoms, the extent of calcium deposition, and the underlying cause. Here are some common treatment approaches for band keratopathy:

1-Observation and Monitoring: In mild cases of band keratopathy without significant vision impairment or symptoms, no specific treatment may be required. Regular monitoring by an ophthalmologist is recommended to assess any progression or changes in the condition.

2-Symptomatic Management: If band keratopathy is causing visual disturbances or discomfort, symptomatic management may be pursued. This can include the use of lubricating eye drops or ointments to relieve dryness and improve comfort.

3-Chelating Agents: Chelating agents, such as ethylenediaminetetraacetic acid (EDTA) eye drops, can be used to dissolve the calcium deposits in the cornea. These drops help to chelate or bind to the calcium, facilitating its removal. Chelating agents are typically used in more advanced cases with significant calcium deposition and visual impairment.

4-Surgical Intervention: In cases where band keratopathy is causing severe vision impairment or if conservative measures have been unsuccessful, surgical interventions may be considered. Some surgical options include:

*Corneal Debridement: In this procedure, the outer layer of the cornea (epithelium) is gently removed to eliminate the calcium deposits. This can provide temporary relief and improve vision, but the deposits may reoccur over time.

*Phototherapeutic Keratectomy (PTK): PTK is a laser procedure that selectively removes the superficial layers of the cornea, including the calcium deposits. It aims to smoothen the cornea and improve vision. PTK can be an effective treatment option, but the underlying cause of band keratopathy should be addressed to prevent recurrence.

5-Treatment of Underlying Causes: If band keratopathy is associated with an underlying systemic condition, such as kidney disease or hypercalcemia, the treatment should focus on managing and addressing the underlying cause. Treating the systemic condition may help prevent or slow down the progression of band keratopathy.

It’s essential to consult with an ophthalmologist or eye care professional for a thorough evaluation and personalized treatment plan based on your specific condition. They can determine the most appropriate treatment approach and provide guidance on managing band keratopathy effectively.

How can I reduce my risk of developing band keratopathy?

Reducing the risk of developing band keratopathy involves addressing modifiable factors and maintaining overall eye health. While some risk factors are not within your control, here are a few measures that may help reduce the risk or progression of band keratopathy:

1-Regular Eye Examinations: Schedule routine eye examinations with an ophthalmologist or eye care professional. Regular eye exams can help detect early signs of any eye conditions, including band keratopathy, and allow for timely intervention.

2-Manage Underlying Systemic Conditions: If you have systemic conditions associated with band keratopathy, such as kidney disease or hypercalcemia, work closely with your healthcare provider to manage and treat these conditions effectively. Proper management can help reduce the risk of developing band keratopathy or slow down its progression.

3-Medication Review: If you are taking medications that have been associated with an increased risk of band keratopathy, such as diuretics or high-dose vitamin D supplements, discuss with your healthcare provider. They can evaluate the necessity and potential alternatives or adjustments to your medication regimen.

4-Eye Protection: Take measures to protect your eyes from injury or trauma. When engaging in activities that pose a risk to your eyes, such as sports or hazardous work, wear appropriate eye protection, such as safety goggles or glasses.

5-Maintain Eye Health: Adopt healthy habits to maintain overall eye health, such as:

*Eat a balanced diet rich in fruits and vegetables, as they provide essential nutrients for eye health.

*Quit smoking or avoid exposure to secondhand smoke, as smoking has been associated with various eye conditions.

*Manage chronic conditions like diabetes and hypertension, as uncontrolled levels can affect eye health.

*Protect your eyes from excessive sun exposure by wearing sunglasses that block harmful UV rays.

6-Follow Eye Care Guidelines: Follow proper eye care guidelines, including regular and gentle eye hygiene, avoiding excessive eye rubbing, and practicing proper contact lens hygiene if you wear them.

Remember, while these measures may help reduce the risk of developing band keratopathy, it’s important to consult with a healthcare professional for personalized advice based on your individual circumstances. They can provide guidance tailored to your specific needs and help you maintain optimal eye health.

What can I expect if I have band keratopathy?

If you have band keratopathy, here are some expectations regarding the condition:

1-Visual Symptoms: The presence of band keratopathy can lead to various visual symptoms, including blurred vision, decreased visual acuity (sharpness of vision), and glare sensitivity. The severity of these symptoms can vary depending on the extent of calcium deposition and its impact on the visual axis.

2-Gradual Progression: Band keratopathy typically progresses slowly over time. The calcium deposits in the cornea may gradually increase, and the whitish-grayish band may become more pronounced. However, the rate of progression can vary among individuals.

3-Asymptomatic in Early Stages: In the early stages, band keratopathy is often asymptomatic and may not cause noticeable visual disturbances or discomfort. Many individuals may remain unaware of the condition until it progresses or is incidentally detected during an eye examination.

4-Impact on Vision: As the calcium deposits encroach on the visual axis, they can significantly affect vision. Depending on the location and extent of the deposits, they can cause blurred or distorted vision, particularly when looking at objects directly in front. Glare sensitivity, especially in bright light conditions, is also common.

5-Treatment Options: The appropriate treatment for band keratopathy depends on factors such as the underlying cause, extent of calcium deposition, and impact on vision. Treatment options can range from observation and monitoring to symptomatic management (e.g., lubricating eye drops) or more advanced interventions like chelating agents or surgical procedures.

6-Regular Follow-Up: If you have band keratopathy, regular follow-up appointments with an ophthalmologist or eye care professional are important. These appointments help monitor the condition’s progression, assess any changes in vision, and determine if any adjustments to the treatment plan are necessary.

It’s important to note that the specific experience and outcomes of band keratopathy can vary among individuals. It’s recommended to consult with an ophthalmologist or eye care professional for a thorough evaluation, personalized guidance, and appropriate management based on your specific condition.

When should I see my healthcare provider?

You should consider seeing your healthcare provider, specifically an ophthalmologist or an eye care professional, if you experience any of the following concerning signs or symptoms related to band keratopathy:

1-Changes in Vision: If you notice a decline in your vision, such as blurred vision, decreased visual acuity, or visual disturbances, it is important to seek medical attention. These changes may be indicative of band keratopathy or other underlying eye conditions.

2-Glare Sensitivity: Increased sensitivity to glare, especially in bright light conditions or when exposed to direct sources of light, can be a symptom of band keratopathy. If you find that glare is causing discomfort or significantly affecting your vision, it’s advisable to consult with a healthcare provider.

3-Appearance of Whitish-Grayish Band: If you observe the presence of a whitish-grayish band or ring around the periphery of your cornea, it may indicate band keratopathy. This visual sign should prompt you to schedule an appointment with an eye care professional for further evaluation.

4-Eye Discomfort or Dryness: If you experience eye discomfort, redness, a gritty sensation, or persistent dryness, it is important to have your eyes examined. While these symptoms may be associated with various eye conditions, they could also be related to band keratopathy, particularly if there is disruption to the tear film due to the calcium deposits.

5-Routine Eye Examinations: Regular eye examinations are essential for maintaining optimal eye health. If you have not had an eye exam in a while, it is recommended to schedule one with an ophthalmologist or an eye care professional. They can detect any early signs of band keratopathy or other eye conditions, even if you are not experiencing symptoms.

Remember, it’s always better to err on the side of caution when it comes to your eye health. If you have any concerns or are experiencing changes in your vision or eye comfort, seeking prompt medical attention from a healthcare provider is advisable. They can evaluate your specific situation, provide an accurate diagnosis, and recommend appropriate treatment or management options.