Exuberant Scleral Calcification from Secondary Hyperparathyroidism

Abstract

A 38-year-old man with chronic end-stage renal disease and secondary hyperparathyroidism presented with bilateral ocular inflammation. Visual acuity was 20/40 in the right eye and 20/60 in the left eye with normal intraocular pressure and full extraocular motility in both eyes. Examination was notable for keratoconjunctivitis and proptosis in both eyes. Testing revealed normal thyroid function and stimulating immunoglobulin levels, but elevated phosphate (12.4 mg/ml). Computed tomography was unremarkable for orbital inflammation yet demonstrated diffuse scleral calcification (Fig A-B) confirmed on ultrasonography (Fig C).