Neurotrophic Keratopathy

Neurotrophic Keratopathy
SYMPTOMS Possible irritation | Blurry vision | Usually asymptomatic
SIGNS Epithelial punctate defects | Injection | Corneal ulcer with rolled edges | Corneal thinning
WORK-UP Thorough history and slit lamp examination with NaFl stain | Test corneal sensitivity (i.e. cotton wisp test)
TREATMENT Preservative-free artificial tears 1 gtt q1-3h | Topical vigamox or besivance 1 gtt q1-2h | Amniotic membrane placement | Oral vitamin C (1 g qd) | Oral doxycycline 100 mg bid may be considered | Corneal transplant may be required | Oxervate 1 gtt q2h, 6x/day for 8 weeks
FOLLOW-UP Daily
ADDITIONAL LAB | TESTS Corneal esthesiometry
ETIOLOGY Conditions that reduce corneal sensitivity may cause Neurotrophic Keratopathy, such as: Ocular surgery | Herpes virus | Acoustic neuroma | Topical anesthetic abuse | Chemical injury
DIFFERENTIAL DX SPK | Limbal stem cell deficiency | Exposure keratitis
NOTES Neurotrophic Keratopathy typically presents with diminished corneal sensation and therefore little to no symptoms

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