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Severe form of epithelial defect needs early detection, treatment
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THOROFARE, N.J. — Neurotrophic keratitis is a severe condition that requires early detection and treatment to preserve the patient's sight, said Sadeer Hannush, MD, of Philadelphia. He spoke about diagnosis and treatment of the condition at a symposium on corneal surgery and pathology at the European Society of Cataract and Refractive Surgeons’ mid-winter meeting in Barcelona, Spain.
Neurotrophic keratitis is a degenerative disorder of the corneal epithelium secondary to herpes virus infection, trigeminal nerve damage or systemic diseases such as diabetes, Dr. Hannush said. Other causes may include inadvertent medication abuse or anesthetic abuse, he added.
"It is obviously impossible to heal a cornea when it is constantly poisoned by so many toxic substances," Dr. Hannush said.
Detection of the disease is imperative, Dr. Hannush said, and a typical clinical feature of the disease is a marked decrease in corneal sensitivity.
"The very first evaluation you should do is corneal sensation, with a Cochet-Bonnet or by simply touching the cornea with a wisp of cotton. You'll immediately know the degree of hypoesthesia or anesthesia, as these patients have very little or no response when you touch them," Dr. Hannush said.
To help identify proper treatment, Dr. Hannush divided the disease into three stages. In stage 1, the patient presents with a persistent punctate epitheliopathy. In stage 2, the epithelial defect persists despite efforts to create a wetter surface. If the epithelial defect does not heal, the patient is in stage 3, and runs a high risk of perforation, Dr. Hannush said.
More about the disease and Dr. Hannush's treatment techniques will be published in the March 15 print edition of Ocular Surgery News.