Corneal Calcification in Dry Eye Disorders Associated with Retinoic Acid Therapy

Acute Corneal Calcification Following Chemical Injury

“…Severe dry eye, ocular surface inflammation, and persistent epithelial defect have all been identified as risk factors. 8,[12][13][14][15] Exposure to medications has also been implicated, including the preservatives phenylmercuric nitrate 29,30 and thiomersal, 12 retinoic acid, 15 dexamethasone, 17 and timolol. 18 The presence of phosphate, either as part of the active agent or as the buffer system, has been a common feature in some series in which topical treatment is used 11,[17][18][19] or when it was injected intraocularly with viscoelastic.…”

“…[7][8][9][10][11] Dry eye, an epithelial defect, and chronic inflammation have been identified as particular risk factors for both patterns of calcium deposition. 8,9,[12][13][14][15] Concern has also been expressed that corneal calcium deposition may inadvertently be caused by some therapies, particularly if they contain a drug that has a phosphate base or they use a phosphate-based buffering system. 11,[16][17][18][19][20][21] We describe 3 patients who presented following ocular injury with a pressurized fire retardant who rapidly developed a permanent dense corneal opacity.…”

Bilateral Recurrent Calcareous Degeneration of the Cornea

“…It has been described in patients with persistent epithelial defects, severe keratoconjunctivitis sicca, alkali burns, and necrotizing intraocular tumors; following ocular trauma; and in patients with acquired immunodeficiency syndrome. 3,4,6,[12][13][14][15] Corneal calcification was reported after topical steroid-phosphate therapy 5,16 and intracameral chondroitin sulfate use. 17,18 Our patient had severe keratoconjunctivitis sicca and persistent corneal epithelial defects associated with GVHD after bone marrow transplantation for chronic myelogenous leukemia.…”

“…20 The high incidence of keratoconjunctivitis sicca and persistent epithelial defects in patients with corneal calcification may indicate the importance of these theories. 2,3,5,6,12 However, research in other fields of medicine emphasizes the role of cytokines as possible initiating factors in corneal calcification. Tumor necrosis factor-a (TNF-a), a pleiotropic cytokine, has been shown to be important in ectopic calcification and bone pathophysiology.…”

Intracranial hypertension secondary to all-trans retinoic acid treatment for leukemia: diagnosis and management

“…5 Ocular manifestations of ATRA toxicity have been reported and include skin (eyelid) dryness and corneal deposits secondary to hypercalcemia. 6,7 One case of vitreous hemorrhage (Terson syndrome) was reported in association with ATRA, but the cause of intracranial pressure was cerebral hemorrhage secondary to ATRA-related thrombocytopenia. 8 Intracranial hypertension is an uncommon complication of ATRA therapy that predominately has been recognized in pediatric patients, particularly patients taking doses between 45 and 80 mg/m 2 /d.…”