0:01

As you can see by this slide,

0:03

the differential diagnosis for things that

0:06

cause ocular calcification is very broad.

0:10

I've labeled them in part under groupings

0:14

of degenerative hypercalcemic states,

0:19

neoplastic and infectious etiologies.

0:23

The most common cause for an ocular calcification is what

0:28

we call senescent calcifications at muscular

0:31

tenderness insertion sites on the globe.

0:35

These are normal phenomenon and should not even be

0:38

reported as abnormalities within the findings of a report.

0:43

Similarly,

0:44

optic nerve head drusen

0:48

are also degenerative processes that are very common,

0:54

that are asymptomatic. We already mentioned

0:58

the entity of phthisis bulbi.

1:00

And phthisis bulbi is associated with the microphthalmia.

1:04

So if we think about those things that were on both the

1:09

previous slide of the causes of microphthalmus,

1:13

as well as those with ocular calcification,

1:16

one may see some of these include things like retinopathy

1:19

of prematurity or a late stage of retinal detachment.

1:23

But phthisis bulbi is going to be very common.

1:27

Cataracts

1:29

may eventually calcify if they get too ripe,

1:35

and this is lens degenerative phenomenon

1:40

seen in the elderly.

1:42

Anything that causes dysmetabolism of the calcium

1:45

phosphorus balance can lead to ocular calcification

1:51

of the ocular membranes. Within the neoplastic category,

1:56

far and away, the most common is going to be the

1:59

retinoblastoma, that childhood neoplasm,

2:04

the other entities are very uncommon.

2:08

Finally, we have infection,

2:10

and I mentioned previously that TORCH

2:12

infections may lead to microphthalmos as well,

2:17

and you can see some of them here.

2:19

However,

2:20

toxocara infection, sarcoidosis, things that can cause

2:24

granulomas of the globe,

2:26

may also cause ocular calcification.

2:30

I mentioned optic nerve head drusen.

2:33

Although these are typically asymptomatic,

2:36

they can lead to some difficulty from the standpoint

2:40

of the ophthalmologic finding.

2:43

This is because, although the ophthalmologists note that

2:46

there is an abnormality at the optic nerve head insertion,

2:50

they cannot tell that this is calcification,

2:53

and therefore,

2:53

it may simulate papilledema and be

2:57

a cause of what is known as pseudopapilledema,

3:00

that is the protrusion of the optic nerve head.

3:03

On CT scan,

3:05

this is identified by the calcification

3:07

as a normal phenomenon of aging.

3:10

Far and away, the entity that is most concerning with

3:14

regard to ocular calcification is retinoblastoma.