Abstract Conjunctival and corneal calcification (CCC), particularly its severe manifestation band keratopathy, represents a prevalent yet frequently overlooked form of metastatic calcification in End-Stage Kidney Disease (ESKD). This review integrates current evidence on the epidemiology, pathophysiology, and interdisciplinary management of uremic ocular calcification. The pathogenesis is conceptualized through a ‘two-hit’ model: the systemic ‘first hit’ involves the specific milieu of CKD-Mineral and Bone Disorder (CKD-MBD)—driven by hyperphosphatemia, calcium load, secondary hyperparathyroidism, and a critical deficiency in calcification inhibitors such as Fetuin-A and Klotho. The ‘second hit’ comprises local ocular triggers, including tear film instability, inflammation, and localized alkalosis, which precipitate mineral deposition in the supersaturated environment. Diagnostically, while slit-lamp biomicroscopy remains the clinical gold standard, we discuss the emerging role of Anterior Segment Optical Coherence Tomography (AS-OCT). This high-resolution modality detects sub-clinical deposits missed by traditional exams and allows for the objective monitoring of therapeutic responses. Prognostically, severe CCC serves as a visible biomarker of systemic metabolic dysregulation and has been associated with all-cause mortality in dialysis populations. Management requires a coordinated, dual-pronged strategy. Systemically, nephrologists must optimize phosphate control and strictly regulate calcium loading, specifically through the individualization of dialysate calcium concentrations. Locally, ophthalmologists can employ ethylenediaminetetraacetic acid (EDTA) chelation for symptomatic relief. Crucially, this review highlights a significant iatrogenic risk: the prescription of phosphate-containing eye drops, which can trigger rapid, vision-threatening calcification in the uremic eye. Closer collaboration between nephrology and ophthalmology is essential to improve patient outcomes.
Liu et al. (Wed,) studied this question.