Neurotrophic Keratitis

A patient presented to the Bascom Palmer Eye Institute’s emergency room with acute on chronic left eye pain. The history was notable for a left petroclival chondrosarcoma that had been resected with post-operative, left-sided cranial nerve 5, 6, 7 and 8 palsies. The patient had a history of multiple ED visits for corneal erosions and ulcers, for which they had undergone multiple related treatments, including amniotic membrane disc placement, superficial keratectomy with EDTA, Botox tarsorrhaphy, and retractor reinsertion with lateral canthal tendon plication. The eye exam was notable for visual acuity of 20/20 in the right eye and count fingers in the left eye. Slit lamp exam revealed band keratopathy, neovascularization, central stromal scarring, and 80% central thinning of the left cornea. The posterior exam was normal in both eyes. The patient underwent corneal neurotization with indirect nerve transfer using a processed nerve allograft coapted to the contralateral supraorbital nerve. At post-op month four, the patient’s vision had improved to 20/100. Corneal sensation had begun to return, with the patient reporting pain in the left eye. The slit lamp exam at this time showed no epithelial defect. Today, the patient’s vision is 20/70, and their corneal sensation is significantly improved. The slit lamp exam reveals no epithelial defect and improved corneal clarity, and the patient continues on artificial tears only.

Presentation Date: 11/03/2022

Issue Date: 12/16/2022