Online Photo Diagnosis

By Gregory W. DeNaeyer, OD, FAAO

This photograph shows the right eye of a 41-year-old female patient who has band keratopathy. She reported previous trauma to her eye at the age of 3. The patient complained of longstanding irritation and discomfort in her right eye. She was using a beta blocker once daily OD and also GenTeal (Novartis) q.i.d. OD. Her right eye measured light perception vision.

Band keratopathy is a calcium deposition of the anterior cornea that can occur after an ocular trauma, keratitis, inflammation, glaucoma, or juvenile rheumatoid arthritis. It is usually white or yellow in color with a reticular or swiss-cheese pattern in the area of the palpebral fissure. Depending on its severity, it can cause decreased vision, erosions, and irritation. Band keratopathy can also become a cosmetic concern for the patient if it is visibly noticeable.

First line management involves prescribing lubrication. For more severe cases, consider chelation with EDTA or phototherapeutic keratoplasty (PTK). A bandage contact lens or prosthetic contact lens may be beneficial for some cases.

After discussing possible treatment options, the patient opted to try a prosthetic bandage contact lens. Her right cornea was extremely steep, so she was initially fit with a soft keratoconic contact lens design in methafilcon material (6.5mm base curve, 7.0mm secondary curve, and 14.8mm diameter). The lens, along with a photograph of her left eye, was sent to a lab for hand painting. The finished lens (Figure 2) not only successfully managed her ocular irritation, but improved her cosmetic appearance as well.

References

Catania, LJ. Primary Care of the Anterior Segment 2nd Ed. Appleton & Lange 1995. p. 242-243.