Cornea
Neurotrophic keratopathy
Also known as: neurotrophic keratitis, neurotrophic cornea, reduced corneal sensation, anaesthetic cornea, persistent epithelial defect, non-healing epithelial defect, post herpetic neurotrophic keratopathy
Filed as: Urgent
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
Corneal epithelial breakdown caused by impaired trigeminal innervation and reduced corneal sensation. Symptoms may be deceptively mild despite persistent epithelial defect, ulceration, stromal thinning, infection risk, or perforation. Optometry management is recognition, corneal sensation testing, epithelial risk assessment, surface protection, and urgent ophthalmology/cornea referral when epithelial compromise is present.
Recognition
Symptoms: what patients report
- Minimal pain despite significant corneal staining, epithelial defect, or ulceration.
- Blurred or fluctuating vision.
- Foreign-body sensation may be absent or mild.
- History of HSV keratitis, herpes zoster ophthalmicus, diabetes, trigeminal nerve disease/surgery, chronic topical medication toxicity, severe dry eye, or prior ocular surgery.
Signs: what the examination shows
- Reduced or absent corneal sensation compared with the fellow eye.
- Punctate epithelial erosions, poor epithelial healing, or persistent epithelial defect.
- Epithelial defect with smooth or rolled edges and relatively quiet conjunctiva.
- Stromal haze, ulceration, thinning, descemetocele, or perforation in advanced disease.
- Secondary infection may add infiltrate, discharge, anterior chamber reaction, hypopyon, or increasing pain.
What OptoGuide™ covers for neurotrophic keratopathy
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Neurotrophic Keratitis — EyeWiki
- Anterior Eye Disease and Therapeutics A-Z (Bruce & Loughnan) — standard reference text
- Differentiation of acanthamoeba keratitis from other non-acanthamoeba keratitis: Risk factors and clinical features. Alreshidi SO, Vargas JM, Ahmad K, et al. PloS One. 2024;19(3):e0299492.
- Medical and surgical interventions for neurotrophic keratopathy. Kruoch Z, Choo AY, Kemp A, et al. The Cochrane Database of Systematic Reviews. 2025;12:CD015723.
- Understanding the Pathogenesis of Neurotrophic Keratitis: The Role of Corneal Nerves. Mastropasqua L, Massaro-Giordano G, Nubile M, Sacchetti M. Journal of Cellular Physiology. 2017;232(4):717-724.
Standard texts: Kanski's Clinical Ophthalmology: A Systematic Approach, The Wills Eye Manual, Oxford Handbook of Ophthalmology, Oxford American Handbook of Ophthalmology, Signs in Ophthalmology: Causes & Differential Diagnosis.