What Do You Need To Know About Neurotrophic Keratitis
Neurotrophic keratitis is an underdiagnosed degenerative condition induced by impairment to the corneal nerves which may lead to persistent epithelial defects and corneal blindness.
- Corneal nerves damage include herpetic keratitis, chemical burns, physical injuries
- Corneal surgery
- Long-term use of contact lenses
- Prolonged use of topical medications.
- Intracranial mass such as neuroma, meningioma, and aneurysms may compress the trigeminal nerve or ganglion and produce impairment of corneal sensitivity.
- Systemic diseases such as diabetes and multiple sclerosis may damage sensory fibers leading to corneal hypoesthesia.
- Dry eye can also cause corneal nerve damage
Stages Of Neurotrophic Keratitis
Based on the severity, neurotrophic keratitis is classified into three overlapping stages;
- Epithelial alterations (Stage 1)
- Persistent epithelial defects (Stage 2),
- Corneal ulcers (stage 3)
Management Of Neurotrophic Keratitis
Management of neurotrophic keratitis can be divided into;
- Medical management, non-surgical intervention
- Surgical management.
For stage 1 aims to prevent epithelial breakdown, generally by administering lubricating agents such as preservative-free artificial tears, autologous serum drops, and discontinuing toxic topical medications specifically unnecessary use of antibiotics and anti-inflammatory agents. However, they all provide
Non-specific symptomatic relief, which may be temporary.
Stage 2 and 3 therapies aim to facilitate corneal healing and prevent corneal melting and perforation; these include procedures such as tarsorrhaphy, botulinum-induced ptosis, conjunctival flap, and amniotic membrane transplantation to restore ocular surface integrity. However, these procedures
are usually performed late and therefore carry the risk of corneal scarring and poor vision.
Collectively, current medical and surgical treatments poorly tackle the essential problem of corneal anesthesia and hence fail to provide a permanent cure.
Substantial evidence supports the use of neurotrophic factors to fulfill the unmet need in the treatment of neurotrophic keratitis. Specifically, the role of Nerve Growth Factor (NGF) in maintaining corneal homeostasis. Recombinant Human NGF (rhNGF) suitable for clinical use. Recently, an Escherichia coli–derived rhNGF formulation for topical ophthalmic use has been introduced and demonstrated safety and efficacy in treating moderate-to severe neurotrophic keratitis
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Clinical Ophthalmology 2019:13 1973–1980