Abstract
A patient presented to a tertiary eye center with several weeks of poor vision in the left eye. He was found to have a moderate-sized epithelial defect without clear etiology, but several infectious and inflammatory conditions were considered. He re-presented several months later with a larger epithelial defect and involvement of the fellow eye. The presentation at that point was most consistent with neurotrophic keratopathy. In the months that followed, the persistent epithelial defects were treated aggressively with autologous serum tears, topical insulin, topical tacrolimus, topical antibiotics, topical cengermin, and numerous amniotic membrane transplantations, and tarsorrhaphy procedures. These strategies yielded temporary but never durable success. Over time, the vision continued to decline due to stromal opacity and decision was made to proceed with penetrating keratoplasty in the left eye. The post-operative course was complicated by neovascularization and epithelial defect, but the defect was noted to be closed a most recent follow up. Neurotrophic keratopathy (NK) is a spectrum of epithelial disfunction due to impaired corneal nerve function, both afferent and efferent. NK can be caused by numerous factors including viral infections and diabetes. In cases of refractory healing, nutritional deficiencies must also be considered. Current treatment of NK and new drug development mostly centers around the supplementation of the deficient factors that promote corneal epithelial healing.
Presentation Date: 01/08/2026
Issue Date: 03/20/2026
