Neurotrophic Keratitis Workup

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

Lab 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, while conjunctival epithelium is negative for cytokeratin 3 and positive for cytokeratin 19. If impression cytology from the limbal area shows significant cytokeratin 19 (indicative of conjunctival epithelium) and little cytokeratin 3 (which indicates little corneal epithelium), then the impression cytology would indicate limbal stem cell deficiency.


A magnetic resonance imaging (MRI) scan of the brain and orbits is obtained when any associated neurologic deficit or the etiology of corneal hypesthesia is in doubt.


Histologic Findings

Histologic findings in neurotrophic keratitis are as follows:

  • 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