Neurotrophic keratopathy is corneal disease caused by reduced corneal sensation and impaired healing, leading to persistent epithelial defects, ulceration, and potential perforation.
Causes and Features
Damage to the trigeminal nerve from herpes simplex or zoster, neurosurgery, diabetes, or tumours can reduce corneal innervation.
- Patients may have surprisingly few symptoms despite significant surface damage because sensation is reduced.
- Signs range from punctate erosions to non‑healing ulcers and stromal melting.
- Associated lagophthalmos or dry eye can worsen exposure.
- Loss of blink reflex further compromises tear distribution.
Treatment
Management aims to protect and heal the cornea while addressing underlying nerve dysfunction where possible.
- Frequent preservative‑free lubricants, therapeutic contact lenses, and tarsorrhaphy are common measures.
- Biologic treatments such as autologous serum or recombinant nerve growth factor may be considered in specialised centres.
- Regular follow‑up is essential because ulcers can progress rapidly without pain warning.
- Concurrent conditions like lagophthalmos or exposure require targeted surgical or medical therapy.
