Corneal innervation and neurotisation: a review of current concepts

Abstract

The cornea is the most richly innervated tissue within the body, the complexity of which reflects the critical role of visual preservation to survival. Sensation is provided almost solely by innervation of the ophthalmic nerve, where any insult along the afferent sensory pathway may result in the development of neurotrophic keratopathy, a vision-threatening condition. We review the current model of corneal sensory and autonomic innervation and explore the typical aetiologic and pathogenic features of neurotrophic keratopathy. Special attention is given to corneal neurotisation, an effective microsurgical treatment for moderate to severe neurotrophic keratopathy refractory to non-surgical management techniques, and its role in the reinnervation of the asensate cornea by direct or indirect transplantation of healthy nerve tissue.