Neurotrophic keratopathy: Case report

Neurotrophic keratopathy is a degenerative disease characterized by decreased corneal sensitivity and poor corneal healing. This often results as corneal ulceration with a high risk of corneal perforation. A 36-year-old female presented with perforated neurotrophic corneal ulcer and eyelash in the anterior chamber of the right eye and non-perforated corneal ulcer in the left eye, decreased corneal sensitivity, absent corneal reflex and normal lacrimation. History of previous herpetic keratitis episodes was positive. Medical record review showed heredodegenerative encephalopathy with localized brain atrophy and internal hydrocephalus. The patient has mild mental retardation. Eyelash from the anterior chamber of the right eye was surgically removed through limbai incision using a viscoelastic solution. On the first postoperative day the depth of anterior chamber was normal. Treatment was continued with eye patching and application of antibiotic and vitamin ointments. Perforation and ulcers healed ten days after the surgery and visual acuity improved. After the treatment residual corneal scarring remained on both eyes. The pathophysiology of the neurotrophic ulcer in our patient could be explained by corneal denervation caused by previous herpetic keratitis. Denervation results in decreased cell metabolism, levels of acetylcholine and mitosis. Sensory nerves have a favorable effect on corneal epithelialization via neuromediators such as acetylcholine, substance P and calcitonin gene-related peptide. This can lead to an epithelial defect even in the absence of direct injury. Early diagnosis and prompt treatment of neurotrophic keratopathy are mandatory to prevent corneal complications such as scarring and perforation.