Title : Painful neurotrophic keratopathy
Abstract:
Neurotrophic keratopathy (NK) is a degenerative corneal disease that is the result of impaired corneal innervation by the ophthalmic branch of the trigeminal nerve. Though NK is associated with decreased corneal mechanosensation, recent studies indicate that spontaneous pain can also occur in such patients. This presentation will review the state of the field regarding the relationship between symptoms of pain and the clinical ophthalmological measures in patients with NK, including an emphasis on in vivo corneal microscopy findings. NK is associated with decreased measures of corneal nerve density, but also can demonstrate clinically significant pain along with increased dendritiform cell density, a marker of localized peripheral inflammation. Chronic ocular pain may develop with NK, with nerve damage and inflammation playing roles as contributing factors. Increased ocular pain with decreased corneal nerve fibers is suggestive of a sensitization and/or dysregulation of central nervous system circuits related to nociceptive processing.
Audience Takeaway Notes:
- Neurotrophic keratopathy is usually underdiagnosed because of the misconception of being painless. Our paper will emphasize that pain is not an exclusionary symptom, and we hope this knowledge will reduce the likelihood of underdiagnosis of NK.
- NK patients are usually diagnosed in very late stage of this disease when all the corneal nerves are gone and patients are completely painless. The audience will keep NK in mind as a differential diagnosis in patients with a painful ulcer or epi defect, so management will be more appropriate and timely.
- NK management and follow up are completely different than other eye diseases, so it is important to diagnose the disease in the early stage to prevent corneal melting perforation and permanent vision loss.
