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What Is This Month's Mystery Condition?

Written by Mark D. Mifflin, MD, and Krista I. Kinard, MD, John A. Moran Eye Center, Salt Lake City. Edited by Michael P. Kelly, CPT.

Photo by Krista I. Kinard, MD, John A. Moran Eye Center, Salt Lake City.

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Band Keratopathy in Sarcoid

A 68-year-old male with sarcoidosis complained of progressive ghosting of vision in the right eye. Visual acuity was 20/50 but improved to 20/20 with astigmatic correction. Corneal biomicroscopy revealed peripheral and midperipheral subepithelial opacification in a reverse-C pattern with sparing of the central visual axis. There was no ocular inflammation or other pathology, and metabolic work-up was normal.

Band keratopathy is typically due to deposits of gray-white calcium hydroxyapatite in Bowman’s layer. The deposition starts peripherally and moves centrally. Most cases are idiopathic, but known causes include chronic ocular inflammation, abnormalities of calcium and phosphate metabolism, silicone oil after retinal detachment repair and chronic mercury exposure.

This case is remarkable because of the reverse-C pattern as compared with the typical horizontal band. Should visual obstruction occur, topical chelation treatment with ethylenediaminetetraacetic acid (EDTA) is often effective.

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