Abstract
About this talk
Neurotrophic keratitis is a degenerative corneal disorder caused by impairment of corneal sensory innervation, resulting in reduced healing capacity and progressive ocular surface disease. The hallmark feature is decreased or absent corneal sensation, which predisposes the cornea to epithelial breakdown, persistent epithelial defects, stromal ulceration, corneal melting and, in severe cases, perforation. Early diagnosis is essential to prevent irreversible visual loss and preserve ocular integrity.
The condition may result from a variety of ocular and systemic disorders affecting the trigeminal nerve pathway. Herpes simplex and herpes zoster infections remain the most common causes, followed by surgical or traumatic nerve injury. Other recognised causes include diabetes mellitus, topical medication toxicity, corneal surgery, contact lens wear, chemical injury and congenital neurological disorders. Loss of neural trophic support disrupts epithelial homeostasis, reduces blink reflexes and tear secretion, and impairs wound healing, ultimately leading to corneal surface breakdown.
Clinically, neurotrophic keratitis progresses through three stages. Stage 1 is characterised by punctate epithelial keratopathy, tear film instability and reduced tear break-up time. Stage 2 involves persistent epithelial defects with smooth, rolled edges and surrounding loose epithelium. Stage 3 is associated with stromal thinning, melting and potential perforation. Comprehensive evaluation includes assessment of corneal sensitivity, ocular surface integrity and identification of the underlying aetiology.
Management aims to protect the ocular surface, promote epithelial healing and prevent progression. Treatment options include preservative-free lubrication, punctal occlusion, therapeutic contact lenses, autologous serum eye drops, amniotic membrane transplantation and tarsorrhaphy. Emerging biologic therapies targeting corneal nerve regeneration and epithelial repair offer additional therapeutic potential. In advanced cases with progressive stromal melting or perforation, tissue adhesives or keratoplasty may be required to maintain globe integrity. A structured approach to diagnosis and timely escalation of treatment is crucial for optimising outcomes in this challenging condition.
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