Neurotrophic keratitis: current challenges and future prospects

Abstract

Neurotrophic keratitis (NK) is a degenerative corneal disease caused by damage of trigeminal corneal innervation, which leads to spontaneous epithelial breakdown and corneal ulceration. The impairment of corneal sensory innervation causes the reduction of both protective reflexes and trophic neuromodulators that are essential for the vitality, metabolism, and wound healing of ocular surface tissues. A wide range of ocular and systemic conditions, including herpetic keratitis, ocular chemical burns, corneal surgery, diabetes, multiple sclerosis, and neurosurgical procedures, can cause NK by damaging trigeminal innervation. Diagnosis of NK requires careful investigation of any ocular and systemic condition associated with the disease, complete ocular surface examination, and quantitative measurement of corneal sensitivity. The clinical stages of NK range from corneal epithelial alterations (stage 1) to persistent epithelial defect (stage 2) and ulcer (stage 3), which may progress to corneal perforation. Management of NK is based on clinical severity, and the aim of the therapy is to halt the progression of corneal damage and promote epithelial healing. Although several medical and surgical treatments have been proposed, no therapies are currently available to restore corneal sensitivity, and thus, NK remains difficult and challenging to treat. The purpose of this review is to summarize available evidence on the pathogenesis, diagnosis, and treatment of NK. Novel medical and surgical therapies including the topical administration of nerve growth factor and corneal neurotization are also described.

The Role of Nutrition and Nutritional Supplements in Ocular Surface Diseases

“…In fact, corneal nerves are essential for tear production, protective blink reflex and release of trophic neuromodulators that maintain the vitality and metabolism of ocular surface tissues. Damage to corneal nerve plexus results in a degenerative corneal disease known as neurotrophic keratitis, characterized by spontaneous epithelial breakdown, impaired wound healing and corneal ulceration [37]. In addition, there is increasing evidence in support of a role of neurosensory abnormalities in the etiology of DED [38,39].…”

Therapeutic Effects of Lactoferrin in Ocular Diseases: From Dry Eye Disease to Infections

“…This condition is a degenerative disease affecting corneal nerves that amplifies the detrimental effect of HSV infection on the ocular surface by reducing both protective reflexes and the release of trophic neuromodulators that are essential for the vitality, metabolism and wound healing of surface tissues. As a result, impaired corneal innervation leads to spontaneous epithelial breakdown, persistent epithelial defects and ulceration with subsequent onset of vision issues [44]. Both in vivo and ex vivo anti-herpetic activities of lactoferrin have been investigated.…”

Umbilical Cord Blood and Serum for the Treatment of Ocular Diseases: A Comprehensive Review

“…The rationale for applying serum to the ocular surface is that, compared to conventional lubricant treatments, it more closely resembles natural tears due to several of its biochemical constituents [3]. UCBS has been extensively used in the setting of ocular surface diseases and has produced satisfactory results in terms of efficacy and safety [3,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43]. Yoon and coauthors were among the first to test the use of UCBS in the management of several ocular surface disorders, such as dry eye with or without SS, oGVHD, persistent epithelial defects, neurotrophic keratitis, and ocular chemical injury.…”