The authors present an overview of the aetiology, diagnosis, current and future management options of neurotrophic keratitis. This is a degenerative corneal disease that occurs following the compromise of trigeminal innervation, leading to hypoesthesia 
and / or anaesthesia. The aetiology is variable and includes herpetic infections, chemical burns, contact lens wear, lasik, keratoplasty, topical anaesthetics, glaucoma medications, surgery and pathology involving the trigeminal nerve, diabetes, and hypovitaminosis A. It may be associated with the use of neuroleptics, antipsychotics, anti-histamines, etc. Mackie’s classification is used to grade the severity of the condition. Clinically the condition may vary from punctuate epithelial erosion to corneal ulceration and may result in stromal melt and silent perforation of the globe. Management options comprise of lubricants without preservatives, punctual plugs, antibiotics for infected ulcers, bandage contact lenses, tarsorraphy and botulinum toxin induced ptosis to help healing in refractory cases. The use of steroids remains controversial as although it may improve inflammation, it is associated with increased risk of perforation. Surgical options include conjunctival flaps, amniotic membrane grafts, cynoacrylate glue for perforating ulcers and keratoplasty. The newer medical therapies include autologous serum eye drops, umbilical cord serum eye drops. Some studies are proposing that the topical use of substance P (SP) insulin like growth factor -1 (IGF-1) and nerve growth factor (NGF) may play a key role in potential future treatment of neurotrophic keratitis.

Neurotrophic keratitis.
Semeraro F, Forbice E, Romano V, et al.
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Sofia Rokerya

MBBS MRCOphth FRCSI, King's College University Hospital, UK.

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