Neurotrophic keratitis is a degenerative corneal disease that is characterized by decreased corneal sensitivity as well as poor corneal healing. Left untreated this disorder worsens over time, leaving the cornea susceptible to injury along with desensitized corneal nerves that cause a decrease in reflex tearing. Along with progressively worsening vision, other corneal health conditions can arise such as epithelial breakdown leading to corneal ulceration, corneal infections, corneal melting, and perforations secondary to poor healing.
Prognostic indicators of this disease include the degree of sensory loss, length of time the condition existed, and the presence of other contributory ocular diseases (blepharitis, MGD, etc). Untreated ocular surface disease does worsen with time and the incidence of neurotrophic keratitis increases with age.
Neurotrophic keratopathy management depends on the severity of the ocular surface condition and the degree of sensory denervation. Sensory denervation increases the longer the ocular surface disease exists on the eye. Treatment should be based on not only subjective symptoms reported by the patient but, more importantly, in lieu of symptoms, based on objective findings. Stage 1 neurotrophic keratopathy can be treated with aggressive topical lubricants such as preservative-free artificial tears, gels, and ointments. Eyelid abnormalities such as MGD and blepharitis must be carefully assessed and treated so that exposure keratopathy (corneal surface defects) does not progress to stage 2 neurotrophic keratopathy. Later stages of this disease may require punctual occlusion to increase the tear volume as well as amniotic membranes to help heal the corneal epithelial defects.