eMedicine Specialties > Ophthalmology > Cornea

Keratopathy, Neurotrophic: Differential Diagnoses & Workup

Author: Robert H Graham, MD, Senior Associate Consultant, Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona
Coauthor(s): Mark A Hendrix, MD, Consulting Staff, Department of Ophthalmology, Suburban Hospital, Shady Grove Hospital
Contributor Information and Disclosures

Updated: Feb 3, 2009

Differential Diagnoses

Corneal Melt, Postoperative
Keratitis, Bacterial
Corneal Mucous Plaques
Keratitis, Herpes Simplex
Dry Eye Syndrome
Keratoconjunctivitis, Sicca
Herpes Simplex
Sjogren Syndrome
Herpes Zoster

Other Problems to Be Considered

Exposure keratopathy
Limbal deficiency
Topical anesthetic abuse

Workup

Laboratory Studies

  • Any dense stromal infiltrate should be cultured for bacterial keratitis prior to instituting antibiotic therapy.
  • Viral cultures or immunofluorescence staining may be necessary if herpes simplex or herpes zoster is suspected but is not distinguishable clinically.
  • Impression cytology may be necessary to rule out limbal deficiency. Corneal epithelium is positive for cytokeratin 3 and negative for cytokeratin 19. Conjunctival epithelium is negative for cytokeratin 3 and positive for cytokeratin 19.

Imaging Studies

  • An MRI of the brain and orbits is obtained when any associated neurologic deficit or the etiology of corneal hypesthesia is in doubt.

Procedures

  • Corneal esthesiometry: Measurement of corneal sensitivity is crucial for diagnosis and prognosis.

Histologic Findings

  • Decreased epithelial thickness with loss of surface desquamating layer
  • Decreased epithelial cell glycogen
  • Loss of surface cell microvilli
  • Intracellular swelling of remaining surface epithelial cells
  • Areas of abnormal basal lamina
  • Decreased goblet cell density in conjunctiva
  • Increased length of surface microvilli

More on Keratopathy, Neurotrophic

Overview: Keratopathy, Neurotrophic
Differential Diagnoses & Workup: Keratopathy, Neurotrophic
Treatment & Medication: Keratopathy, Neurotrophic
Follow-up: Keratopathy, Neurotrophic
References
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References

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  2. Bonini S, Lambiase A, Rama P, Caprioglio G, Aloe L. Topical treatment with nerve growth factor for neurotrophic keratitis. Ophthalmology. Jul 2000;107(7):1347-51; discussion 1351-2. [Medline].

  3. Bonini S, Rama P, Olzi D, Lambiase A. Neurotrophic keratitis. Eye. Nov 2003;17(8):989-95. [Medline].

  4. Cavanagh HD, Colley AM. The molecular basis of neurotrophic keratitis. Acta Ophthalmol Suppl. 1989;192:115-34. [Medline].

  5. Cohen EJ, Rapuano CJ. Neurotrophic keratopathy. In: Friedberg MA, Rapuano CJ, eds. Wills Eye Hospital office and emergency room diagnosis and treatment of eye. 54-55.

  6. Fogle JA, Kenyon KR, Foster CS. Tissue adhesive arrests stromal melting in the human cornea. Am J Ophthalmol. Jun 1980;89(6):795-802. [Medline].

  7. Goins KM. New insights into the diagnosis and treatment of neurotrophic keratopathy. Ocul Surf. Apr 2005;3(2):96-110. [Medline].

  8. Groos EB. Neurotrophic keratitis. In: Krachmer JH, ed. Cornea: Fundamentals of Corneal and External Disease. Mosby: St. Louis; 1997:1339-62.

  9. Hosotani H, Ohashi Y, Yamada M, Tsubota K. Reversal of abnormal corneal epithelial cell morphologic characteristics and reduced corneal sensitivity in diabetic patients by aldose reductase inhibitor, CT-112. Am J Ophthalmol. Mar 1995;119(3):288-94. [Medline].

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  11. Lambiase A, Rama P, Aloe L, Bonini S. Management of neurotrophic keratopathy. Curr Opin Ophthalmol. Aug 1999;10(4):270-6. [Medline].

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  15. Lugo M, Arentsen JJ. Treatment of neurotrophic ulcers with conjunctival flaps. Am J Ophthalmol. May 15 1987;103(5):711-2. [Medline].

  16. Mackie IA. Neuroparalytic keratitis. In: Fraunfelder F, Roy FH, eds. Current Ocular Therapy. 5th ed. Philadelphia: WB Saunders; 2000:369-371.

  17. Matsumoto Y, Dogru M, Goto E, et al. Autologous serum application in the treatment of neurotrophic keratopathy. Ophthalmology. Jun 2004;111(6):1115-20. [Medline].

  18. Nishida T, Chikama T, Morishige N, Yanai R, Yamada N, Saito J. Persistent epithelial defects due to neurotrophic keratopathy treated with a substance p-derived peptide and insulin-like growth factor 1. Jpn J Ophthalmol. Nov-Dec 2007;51(6):442-7. [Medline].

  19. Parmar DN, Alizadeh H, Awwad ST, et al. Ocular surface restoration using non-surgical transplantation of tissue-cultured human amniotic epithelial cells. Am J Ophthalmol. Feb 2006;141(2):299-307. [Medline].

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  22. Reynolds SA, Kabat AG. Therapeutic options for the management of early neurotrophic keratopathy: a case report and review. Optometry. Oct 2006;77(10):503-7. [Medline].

  23. Schrader S, Wedel T, Moll R, Geerling G. Combination of serum eye drops with hydrogel bandage contact lenses in the treatment of persistent epithelial defects. Graefes Arch Clin Exp Ophthalmol. Oct 2006;244(10):1345-9. [Medline].

  24. Solomon A, Meller D, Prabhasawat P, et al. Amniotic membrane grafts for nontraumatic corneal perforations, descemetoceles, and deep ulcers. Ophthalmology. Apr 2002;109(4):694-703. [Medline].

  25. Yamada N, Matsuda R, Morishige N, et al. Open clinical study of eye-drops containing tetrapeptides derived from substance P and insulin-like growth factor-1 for treatment of persistent corneal epithelial defects associated with neurotrophic keratopathy. Br J Ophthalmol. Jul 2008;92(7):896-900. [Medline].

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Further Reading

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Keywords

neurotrophic keratopathy, neurotrophic keratitis, neuroparalytic keratitis

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Contributor Information and Disclosures

Author

Robert H Graham, MD, Senior Associate Consultant, Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona
Robert H Graham, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, and Arizona Ophthalmological Society
Disclosure: WebMD/eMedicine Salary Employment

Coauthor(s)

Mark A Hendrix, MD, Consulting Staff, Department of Ophthalmology, Suburban Hospital, Shady Grove Hospital
Mark A Hendrix, MD is a member of the following medical societies: American Academy of Ophthalmology and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Stephen D Plager, MD, FACS, Chief, Department of Ophthalmology, Dominican Hospital; Assistant Clinical Professor, Department of Ophthalmology, Stanford University Hospital
Stephen D Plager, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, and California Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Christopher J Rapuano, MD, Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Co-Chairman of the Cornea Service, Co-Chairman of Refractive Surgery Department, Wills Eye Institute
Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Eye Bank Association of America, Pennsylvania Medical Society, and Philadelphia County Medical Society
Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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