Corneal stromal calcification after topical steroid-phosphate therapy

Secondary conceal calcification involving the full thickness of the stroma is a rare potential complication of severe dry eye conditions, recurrent co rneal ulcerations, chronic ocular inflammation, or multiple surgical proced ures. We describe on a patient with unusual, hitherto unreported calcareous degeneration of the corneal stroma after topical steroid-phosphate therapy for chronic keratoconjunctivitis after Stevens-Johnson syndrome. The patie nt's serum levels of calcium and phosphorus were normal. Histopathologic an d electron microscopic el;amination. of the corneal button revealed mainly intracellularly located crystalline calcium deposits throughout all layers of the corneal stroma but sparing the Bowmen layer. Energy-dispersive x-ray analysis confirmed the presence of calcium phosphate. The calcium deposits were closely associated with intracellular and pericellular accumulations of glycosaminoglycans. Our findings indicate that corneal stromal calcifica tion may develop after topical steroid-phosphate medication, and suggest a possible role of alterations in the glycosaminoglycan metabolism of stromal keratocytes in the calcification process.