Neurotrophic Keratitis: Exploring the Therapeutic Landscape

Abstract

Neurotrophic keratitis is a complex condition with a variety of aetiologies involving damage to the sensory nerves that innervate the cornea, resulting in potentially devastating ocular surface disease. Aetiologies include diabetes, prior herpesvirus keratitis, stroke or compressive damage to the trigeminal nerve, chronic ocular surface disease or contact lens overuse, among others. Management is multidisciplinary; of course, the underlying condition must be addressed and treated. The ocular surface must be stabilized, and depending on the severity, treatment options include artificial tears and lubrication, protective barriers (scleral lens, tarsorrhaphy), and growth factors that promote healing (serum tears, amniotic membrane). Finally, treatment can target restoration of corneal sensory innervation (cenegermin, corneal neurotization). Early recognition and treatment are important factors in reducing vision loss and long-term complications from neurotrophic keratitis.