Neurotrophic Keratopathy

What is neurotrophic keratopathy?

When patients have corneal anesthesia due to dysfunction of the 5th cranial nerve (called the trigeminal nerve), ulcers and destruction of the cornea can occur. When this happens, the blink reflex is absent and cannot protect the eye. The cascade of changes that the cornea encounters ultimately results in irreversible blindness.

There are a number of known causes. Careful exam and studies may be needed to identify the precise reason.

Who gets neurotrophic keratopathy?

Neurotrophic keratopathy can occur for a number of reasons. The most common source is viral infection due to herpes simplex and herpes zoster. Any cause of dysfunction of the trigeminal nerve or its branches can also lead to neurotrophic keratopathy.

An acoustic neuroma is a tumor arising from the 8th cranial nerve near the brainstem. This also happens to be in close proximity to the trigeminal nerve nucleus. Enlarging tumors such as an acoustic neuroma or surgery to remove such tumors or other brain masses can also damage the nerve and ultimately lead to neurotrophic keratopathy.

Other causes can include diabetes and toxicity from chronic use of topical ocular medications.

What is the treatment for neurotrophic keratopathy?

There are different stages of neurotrophic keratopathy from mild to severe. Depending on the stage, treatment will vary. For mild or Stage 1 disease, artificial tears and ointments may suffice to keep the eye moisturized.

In Stage 2, prophylactic antibiotic drops are used in conjunction with preservative-free artificial tears. It may also be necessary to perform a small procedure called a lateral tarsorrhaphy to bring together the outer part of the eyelids. This will help keep moisture over the eye. In some cases, a small piece of amniotic membrane may be transplanted over the corneal ulcer.

In Stage 3, enzyme inhibitors and growth factors may be needed to prevent further breakdown of the corneal lining. More aggressive measures may be required to shut the eyelids to prevent drying and further breakdown.

In cases that have progressed beyond Stage 3, there may be irreversible damage. Corneal neurotization is a promising new procedure that may reverse neurotrophic keratopathy to varying degrees. Dr. Panossian is one of only a few surgeons in the world performing this unique surgery. Call us today if you have been diagnosed with neurotrophic keratopathy.