Neurotrophic Keratopathy: Background
Neurotrophic Keratopathy: Background
Neurotrophic Keratopathy: Background
Background
Neurotrophic keratopathy is a degenerative disease characterized by decreased corneal sensitivity and
poor corneal healing. This disorder leaves the cornea susceptible to injury and decreases reflex tearing.
Epithelial breakdown can lead to ulceration, infection, melting, and perforation secondary to poor healing.
(See Etiology and Pathophysiology.) [1, 2, 3]
Prognostic indicators in neurotrophic keratopathy include the degree of sensory loss, the duration of the
condition, and the presence of other ocular surface disease. The incidence of neurotrophic keratopathy
increases with age. (See Presentation and Workup.)
Complications
Fifteen percent of anesthetic corneas in the United States develop serious complications; these can include
the following (see Etiology and Pathophysiology, Presentation, Workup, Treatment, and Medication):
Mackie classification
Stage 1 of neurotrophic keratopathy demonstrates the following:
Stromal lysis/melting
May result in perforation
Patient education
Educate all patients with corneal hypesthesia about their condition. Instruct patients to seek evaluation
immediately if the eye becomes red or if their vision changes. Patients need to understand that serious
conditions may not cause them any pain.
Causes
The causes of neurotrophic keratopathy are conditions that decrease corneal sensitivity. The most common
of these are herpetic infections of the cornea, surgery for trigeminal neuralgia, and surgery for acoustic
neuroma.[6]
Herpes simplex
Herpes zoster [7]
Leprosy
Of the 40,000-60,000 cases of herpes zoster ophthalmicus occurring each year in the United States, 50%
have ocular involvement. Of these, 16% demonstrate some form of neurotrophic keratopathy.
Causes associated with fifth-nerve palsy are as follows:
Anesthetics
Timolol
Betaxolol
Sulfacetamide
Diclofenac sodium
Ketorolac
Corneal dystrophies include the following:
Lattice
Granular
Systemic diseases that can cause neurotrophic keratopathy are as follows:
Chemical burns
Carbon disulfide exposure
Hydrogen sulfide exposure
Miscellaneous causes are as follows:
Increasing age
Dark eye color
Adie syndrome