What Causes a Corneal Defect that Won’t Heal (Neurotrophic Keratitis)?

Neurotrophic keratitis occurs when a large corneal defect does not have the appropriate sensation to heal on its own. This condition is usually secondary to another medical condition and is frequently a chronic or recurrent condition.

Defects in the Cornea

The cornea is the clear front structure of the eye and is responsible for bending light to focus into the eyes.

As the cornea is the front of the eye, it is susceptible to damage from scratches or abrasions such as when an object scrapes the cornea. This is one way which a corneal defect can form.

Another way that a corneal defect can form is by physiological damage to the cornea like in diseases such as herpes or diabetes.

These cases lead to a corneal defect without any physical trauma.

If there is a defect in the cornea, it will typically be extremely painful as the cornea has many pain sensitive nerves.

However, if the defect also impacts these nerves, no pain will be felt, and healing will be impaired. This leads to the condition of neurotrophic keratitis.
 

Neurotrophic Keratitis

If the cornea develops a non-healing, painless defect, neurotrophic keratitis has occurred and will persist without appropriate treatment options.

Neurotrophic keratitis leads to impaired healing from the cornea as the nerves are not functioning properly. These nerves are responsible for signaling the damage or defect and initiating the healing process.

Since the healing process is not engaged properly, the corneal defect will usually grow large and become more severe than it began.

Diseases that Lead to Neurotrophic Keratitis

Neurotrophic keratitis does not usually occur on its own without an underlying condition that makes the individual more susceptible to neurotrophic keratitis.

The two most common conditions which can lead to neurotrophic keratitis are herpes virus infections and diabetes.

The herpes virus can infect the cornea and damage the corneal nerves as well as the corneal epithelium and thus lead to a neurotrophic keratitis.

Diabetes can lead to neuropathy throughout the body and is often seen in the toes and fingers, this neuropathy can also lead to damage to the corneal nerves making the cornea susceptible to developing neurotrophic keratitis.

Treating Neurotrophic Keratitis

To treat neurotrophic keratitis, there are both medications and physical treatments available which may be used in tandem. The medication treatment includes a new medication, oxervate, which has been shown to help replenish the corneal nerves and lead to corneal healing. Additionally, an antibiotic with a broad spectrum of coverage will be used to prevent an additional bacterial infection of the damaged cornea. Physical treatments of neurotrophic keratitis include scleral contact lenses, amniotic membranes, and surgery if necessary. These treatments aim to prevent further injury to the already damaged cornea.

Scleral contact lenses and amniotic membranes are used to protect the cornea directly. While a corneal transplant is a last resort, it is a potential treatment option if the neurotrophic keratitis has developed into a severe stage and is beyond other treatment options. 

Our eye doctor at The Optical Centre in Longmont, CO excels in prescription of glasses, contact lenses and the diagnosis of a variety of eye diseases. Call our optometrist at 303-772-6650 or schedule an eye exam appointment online if you would like to learn more about neurotrophic keratitis. Our eye doctor, Dr. Erica Whitmire provides the highest quality optometry services and eye exams in Longmont, Colorado and its surrounding areas.