Neuro-ophthalmic considerations in trigeminal neuralgia and its surgical treatment

Bhatti, Michael; Patel, Rachana

doi:10.1097/01.icu.0000183859.67294.c6

Cited by 22 publications

(16 citation statements)

References 36 publications

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“…More specifically, NK develops in an average of 6% of herpetic keratitis cases, which has a prevalence of 149/100,000 (Labetoulle et al, 2005) and in 12.8% of herpes zoster keratitis cases, which has a prevalence of 26/100,000 (Dworkin et al, 2007). Other than herpetic keratitis, the most common cause of NK is neurosurgical intervention to treat trigeminal neuralgia that damages the trigeminal nerve (post-surgical incidence of 2.8%), which has a prevalence of 1.5/10,000, and an estimated prevalence of NK after neurosurgical procedure of 0.02/10,000 (Bhatti and Patel, 2005…”

Section: Incidence and Prevalencementioning

confidence: 99%

Neurotrophic keratopathy

Dua

Said

Messmer

et al. 2018

Progress in Retinal and Eye Research

289

356

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Neurotrophic Keratopathy (NK) refers to a condition where corneal epitheliopathy leading to frank epithelial defect with or without stromal ulceration (melting) is associated with reduced or absent corneal sensations. Sensory nerves serve nociceptor and trophic functions, which can be affected independently or simultaneously. Loss of trophic function and consequent epithelial breakdown exposes the stroma making it susceptible to enzymatic degradation. Nerve pathology can range from attrition to aberrant re-generation with corresponding symptoms from anaesthesia to hyperaesthesia/allodynia. Many systemic and ocular conditions, including surgery and preserved medications can lead to NK. NK can be mild (epithelium and tear film changes), moderate (non-healing epithelial defect) or severe (stromal melting and perforation). Moderate and severe NK can profoundly affect vision and adversely impact on the quality of life. Medical management with lubricating agents from artificial tears to serum/plasma drops, anti-inflammatory agents, antibiotics and anti-proteases all provide non-specific relief, which may be temporary. Contact lenses, punctal plugs, lid closure with botulinum toxin and surgical interventions like tarsorrhaphy, conjunctival flaps and amniotic membrane provide greater success but often at the cost of obscuring sight. Corneal surgery in a dry ocular surface with reduced sensation is at high risk of failure. The recent advent of biologicals such as biopolymers mimicking heparan sulfate; coenzyme Q10 and antisense oligonucleotide that suppress connexin 43 expression, all offer promise. Recombinant nerve growth factor (cenegermin), recently approved for human use targets the nerve pathology and has the potential of addressing the underlying deficit and becoming a specific therapy for NK.

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Section: Incidence and Prevalencementioning

confidence: 99%

Neurotrophic keratopathy

Dua

Said

Messmer

et al. 2018

Progress in Retinal and Eye Research

289

356

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“…In addition, 2.8% of patients who underwent surgical procedures for trigeminal neuralgia, developed NK. Given that the prevalence of trigeminal neuralgia is 1.5/10,000, the prevalence of NK for trigeminal neuralgia procedures can be estimated as 0.02/10,000 7. The percentage of NK cases caused by other conditions, such as diabetes, multiple sclerosis, acoustic neuroma, and congenital diseases, cannot be estimated because no data are available in the literature.…”

Section: Epidemiologymentioning

confidence: 99%

Diagnosis and management of neurotrophic keratitis

Sacchetti¹,

Lambìase²

2014

OPTH

204

246

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Neurotrophic keratitis (NK) is a degenerative disease characterized by corneal sensitivity reduction, spontaneous epithelium breakdown, and impairment of corneal healing. Several causes of NK, including herpetic keratitis, diabetes, and ophthalmic and neurosurgical procedures, share the common mechanism of trigeminal damage. Diagnosis of NK requires accurate investigation of clinical ocular and systemic history, complete eye examination, and assessment of corneal sensitivity. All diagnostic procedures to achieve correct diagnosis and classification of NK, including additional examinations such as in vivo confocal microscopy, are reviewed. NK can be classified according to severity of corneal damage, ie, epithelial alterations (stage 1), persistent epithelial defect (stage 2), and corneal ulcer (stage 3). Management of NK should be based on clinical severity, and aimed at promoting corneal healing and preventing progression of the disease to stromal melting and perforation. Concomitant ocular diseases, such as exposure keratitis, dry eye, and limbal stem cell deficiency, negatively influence the outcome of NK and should be treated. Currently, no specific medical treatment exists, and surgical approaches, such as amniotic membrane transplantation and conjunctival flap, are effective in preserving eye integrity, without ameliorating corneal sensitivity or visual function. This review describes experimental and clinical reports showing several novel and potential therapies for NK, including growth factors and metalloprotease inhibitors, as well as three ongoing Phase II clinical trials.

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“…AD and neurotrophic keratitis are exceptionally rare, but it is feared that a serious complication of trigeminal nerve manipulation usually occurs weeks to months after surgery to the trigeminal sensory root or any of its branches [4, 7, 8]. …”

Section: Discussionmentioning

confidence: 99%

“…Patients with absent corneal sensation should wear a protective shield, attached to the side of spectacles, when out of doors. Otherwise, the corneal surface becomes hazy, ulcerated and infected, and blindness may follow [7]. …”

Section: Discussionmentioning

confidence: 99%

Anesthesia Dolorosa Caused by Penetrating Cranial Injury

et al. 2006

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Anesthesia dolorosa (AD) is an uncommon complication of surgical treatments for trigeminal neuralgia. Its incidence is around 0.8%. To our best knowledge, AD caused by a penetrating cranial injury has not been reported previously. We report the case of a 31-year-old male patient with left-sided neuropathic keratitis and AD that began 18 years earlier, following a penetrating cranial injury with a knife to the left postauricular area. The patient was successfully treated by a carbamazepine and gabapentin combination. In conclusion, penetrating cranial injury is uncommon but may cause a serious neurologic disturbance. In the differential diagnosis of AD, a penetrating injury should be kept in mind. In these cases, treatments should be effective and immediate; otherwise, this may result in catastrophic consequences such as neurotrophic keratitis and blindness. Ophthalmologists should be aware of these potential problems.

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Neuro-ophthalmic considerations in trigeminal neuralgia and its surgical treatment

Cited by 22 publications

References 36 publications

Neurotrophic keratopathy

Neurotrophic keratopathy

Diagnosis and management of neurotrophic keratitis

Anesthesia Dolorosa Caused by Penetrating Cranial Injury

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