Therapeutic options for the management of early neurotrophic keratopathy: a case report and review.

BACKGROUND: Neurotrophic keratopathy is caused by the loss of corneal sensation secondary to impaired trigeminal nerve function. Timely and appropriate action is required in the management of this condition to prevent serious complications such as corneal ulceration, perforation, and loss of vision. The role of immunomodulating agents such as cyclosporine as a therapeutic option and a review of several future treatment modalities are discussed.

CASE REPORT: A 46-year-old black woman with a noted history of recurrent herpes simplex virus-1 keratitis and secondary neurotrophic keratopathy in the left eye was examined. She reported that another physician had treated her for this condition over the last 6 months. Her treatment regimen consisted of a bandage contact lens, antibiotic solution, and artificial tears. Best-corrected visual acuities were 20/20 in the right eye and 20/25 in the left eye. Biomicroscopy evaluation found punctate keratitis in both eyes and neurotrophic keratopathy with an area of pinpoint epithelial defect in the left eye. Restasis (0.05% cyclosporine ophthalmic emulsion; Allergan, Irvine, California) bid was added to her medical regimen. Within 4 weeks of starting Restasis therapy, the epithelial defect had resolved, and she was advised to discontinue both the bandage lens and antibiotic solution. She was ultimately discharged on a continued regimen of Restasis twice a day and lubricating drops as needed with scheduled follow-up every 3 months.

CONCLUSION: Management of neurotrophic keratopathy requires decisive action. Early treatment intervention is important to help avoid severe complications. The use of immunomodulating agents (topical cyclosporine) in the early stage of management should be considered.