Neurotrophic Keratopathy

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  • Loss of trigeminal innervation, leading to partial or complete absence of corneal sensation, worsening of epithelial wound healing, ulceration.


  • Surgical ablation (trigeminal neuralgia)
  • Damage to the trigeminal nerve or trigeminal ganglion due to stroke, aneurysm, tumour (e.g. acoustic neuroma or neurofibroma) or multiple sclerosis
  • Peripheral neuropathy e.g. in diabetes mellitus.
  • Eye diseases:
    • Herpes simplex/zoster keratitis
    • Abuse of local anaesthetics
    • Chemical burns
    • Refractive corneal surgery
  • Congenital: Riley-Day syndrome, Möbius syndrome, Goldenhar syndrome, congenital corneal anaesthesia


  • persistent or poorly healing epithelial defects
  • Stroma in the area of the defect with greyish opacity and thinning; in advanced stages also corneal ulceration with melting and perforation possible
  • Reduced or absent corneal sensation (might be only sectorial in HSV/ VZV)
  • Secondary infection possible


  • analogous to Exposure Keratopathy
  • Lubricating therapy:
    • Lacrycon gtt / Lacrinorm ointment/ Vitamin A ointment several times daily to hourly (depending on corneal findings)
    • Ointment at night (Vitamin A, Bepanthen Eye and Nose ointment)
    • Autologous serum eye drops
  • Corneal protection: watch glass bandage, taping/ointment bandage, bandage contact lenses, Botox-ptosis, tarsorrhaphy, amniotic membrane covering
  • Consider Tetracycline p.o. (because of the anti-collagenase effect) if melting is imminent.


  • EyeWiki Neurotrophic Keratitis
  • The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Nika Bagheri MD, Brynn Wajda MD, et al; Lippincott Williams&Wilkins; 7th Edition (2016)
  • Kanski’s Clinical Ophthalmology: A Systematic Approach; Jack J. Kanski MD, Brad Bowling MD; Saunders Ltd.; 8th Edition (2015)