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General
- Loss of trigeminal innervation, leading to partial or complete absence of corneal sensation, worsening of epithelial wound healing, ulceration.
Causes
- 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
Findings
- 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
Therapy
- 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.
Sources
- 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)