Neurotrophic Keratitis Medication

Updated: Sep 13, 2018
  • Author: Robert H Graham, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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Medication

Medication Summary

The first recombinant nerve growth factor, cenegermin, was approved by the FDA in August 2018 for treatment of neurotrophic keratitis. Cenegermin targets the nerve pathology. [28, 29, 30, 22]

Other medications used in the treatment of neurotrophic keratitis, including antibiotics and cycloplegics, are adjunctive to lubrication and surgical intervention. The number and types of medications vary according to the disease stage.

Future treatments [31] for neurotrophic keratitis may include the following:

  • Aldose reductase inhibitor, CT-112 - Has been shown to reverse abnormal morphology of corneal epithelial cells and to increase corneal sensitivity [32]
  • Topical pindolol - Has been reported to speed the healing of epithelial defects in rabbits
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Recombinant Human Nerve Growth Factor

Class Summary

The first recombinant form of human nerve growth factor was approved by the FDA in August 2018. Nerve growth factor is an endogenous protein involved in the differentiation and maintenance of neurons, which acts through specific high-affinity (ie, TrkA) and low-affinity (ie, p75NTR) nerve growth factor receptors in the anterior segment of the eye to support corneal innervation and integrity.

Cenegermin (Oxervate)

Cenegermin is indicated for treatment of neurotrophic keratitis. It is an ophthalmic solution instilled in affected eye(s) 6 times each day at 2-hr intervals for 8 weeks.

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Antibiotics

Class Summary

The tetracyclines have shown anti-inflammatory and anticollagenolytic activity.

Tetracycline

Tetracycline may have anticollagenolytic properties that improve symptoms.

Doxycycline (Doryx, Vibramycin, Alodox, Adoxa)

This agent also may have anticollagenolytic properties that improve symptoms.

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Ophthalmic Lubricants

Class Summary

The goal of a lubricant is to keep as much moisture in the eye as possible and to reduce irritation. [33]

Artificial tears (Advanced Eye Relief, Murine, Bion Tears, Tears Again, Tears Naturale)

Artificial tears contain the equivalent of 0.9% NaCl and are used to maintain ocular tonicity. They stabilize and thicken precorneal tear film and prolong tear film breakup time, which occurs with dry eye states.

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Cycloplegics/Mydriatics

Class Summary

These agents relieve pain associated with iridocyclitis.

Atropine ophthalmic (Isopto, Atropine Care)

This agent acts at parasympathetic sites in smooth muscle to block the response of the sphincter muscle of the iris and the muscle of the ciliary body to acetylcholine, causing mydriasis and cycloplegia.

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