Eye numbness, also known as corneal anesthesia or neurotrophic keratopathy, is a condition that affects the cornea. It happens when the nerves in the cornea are damaged or missing which can lead to serious problems, including blindness. Corneal neurotization is a surgical procedure offered by Dr. Leon Rafailov, a board-certified, fellowship-trained ophthalmic plastic surgeon at SightMD. This innovative surgery aims to restore these nerves, providing protection to the eye against future damage and the risk of permanent blindness.

Understanding Neurotrophic Keratitis (NK)

Neurotrophic keratitis is a rare condition. It happens when the corneal nerves are damaged which causes a loss of feeling in the cornea. This impairment disrupts corneal healing and leaves the eye susceptible to injuries and infections. NK progresses in three stages:

• Stage 3 – Severe complications, including corneal perforation.

• Stage 1 – Superficial punctate keratitis with mild discomfort.

• Stage 2 – Persistent epithelial defects and corneal ulcers.

What are the symptoms of Neurotrophic Keratitis

Neurotrophic Keratitis is characterized by impaired corneal sensory innervation, which often leads patients to overlook ocular surface symptoms. This lack of awareness can make diagnosing Neurotrophic Keratitis particularly challenging, as individuals may seek medical attention months or even years after the onset of the condition. In the early stages, patients may not exhibit any noticeable symptoms due to reduced corneal sensitivity. Consequently, they often do not report pain or discomfort in the eye. However, symptoms such as blurred vision, redness, dryness, and decreased visual clarity may eventually develop. Additionally, affected individuals may become highly sensitive to light.

The compromised cornea is more prone to injury and heals at a slower rate compared to a healthy cornea, increasing its vulnerability to damage. Patients may also experience frequent or recurrent corneal erosions, which occur when an opening forms in the epithelial layer. Since this layer serves as the cornea’s protective barrier, any epithelial defect can heighten the risk of infection.

What causes Neurotrophic Keratitis

Neurotrophic keratitis can be caused by any condition or disorder that affects the nerves that serve the cornea. The main nerve that serves the cornea is called the trigeminal nerve, which is also called the fifth cranial nerve. Damage to the ophthalmic division of the trigeminal nerve, which serves the cornea, can cause neurotrophic keratitis. When the nerves that serve the cornea are damaged this causes reduced sensitivity of the cornea and can lead to neurotrophic keratitis.

How is Neurotrophic Keratitis Diagnosed

Testing corneal sensation is crucial for accurate diagnosis, typically utilizing tools such as the Cochet-Bonnet esthesiometer or more informal methods like cotton wisp tests. Advanced imaging techniques, slit lamp evaluations, and fluorescein staining may also be used to assess the cornea’s condition. Diagnosing neurotrophic keratopathy is generally straightforward, relying on patient history and examination findings. It is essential to note that a decrease in corneal sensation is a common finding across all cases.

In stage 1 of the disease, punctate epithelial staining with fluorescein is a nonspecific indicator and may also be present in other conditions, including dry eye syndrome, blepharitis, chronic eye rubbing, exposure keratopathy, topical drug toxicity, ultraviolet keratopathy, mild chemical injury, contact lens-related disorders, and corneal limbal stem cell deficiency. A thorough medical and surgical history is vital for differentiating among these potential diagnoses.

If the cornea exhibits an ulcerated appearance, it is important to consider other underlying causes, including infectious and immune-related conditions. Appropriate cultures should be obtained, and an immune work-up may be warranted.

Treatment Options for Neurotrophic Keratitis

NK treatment focuses on protecting the cornea, preventing infections, and promoting healing. The approach depends on the stage and severity of the condition:

Non-Surgical Treatments for Neurotrophic Keratitis

• Artificial Tears and Lubricants: Preservative-free drops, gels, or ointments to maintain moisture.

• Autologous Serum Tears: Rich in regenerative components like growth factors, they aid healing.

• Topical Medications: Include cyclosporine, lifitegrast, or recombinant human nerve growth factor (Oxervate) to stimulate nerve regeneration and healing.

• Amniotic Membrane Therapy: A biological scaffold that promotes healing and reduces inflammation.

• Bandage or Scleral Contact Lenses: Protect the cornea from trauma and support epithelial healing.

• Punctal Occlusion: Retains natural tears by blocking tear drainage.

Surgical Treatments for Neurotrophic Keratitis

• Tarsorrhaphy: Temporarily or permanently narrows the eyelid opening to protect the cornea.

• Corneal Neurotization: A cutting-edge surgical technique that restores corneal nerve function by grafting healthy nerve tissue. While highly specialized, this procedure has shown promising results in nerve regeneration.

Advanced Therapies for Neurotrophic Keratitis

Oxervate (cenegermin) is a groundbreaking treatment is the first of its kind to receive FDA approval specifically aimed at addressing the underlying cause of neurotrophic keratitis (NK). It works by stimulating epithelial healing through the action of nerve growth factors, promoting recovery and restoration.

Why Early Treatment for Neurotrophic Keratitis Matters

Timely intervention in NK is critical to prevent permanent vision loss and manage complications. Patients with conditions such as diabetes, herpes infections, or those who’ve undergone surgeries like LASIK are at higher risk and should be vigilant about symptoms.

Meet Our Corneal Neurotization Surgery Expert

SightMD provides expert care for neurotrophic keratitis, utilizing the latest diagnostic tools and tailored treatment plans, including innovative therapies like Oxervate and advanced surgical options. Our dedicated team of specialists is committed to preserving your vision and enhancing your quality of life.

Leon Rafailov, MD is a board-certified, fellowship-trained ophthalmic plastic surgeon specializing in a comprehensive range of plastic and reconstructive surgeries around the eyes. His expertise encompasses the eyelids, forehead, mid-face, orbit, and tear ducts. Dr. Rafailov has successfully performed thousands of reconstructive, cosmetic, functional, and orbital surgeries. He has also published numerous journal articles, abstracts, and book chapters on various topics within oculoplastics.

Trained in advanced techniques for minimally invasive endoscopic surgery, facial reconstruction, trauma surgery, orbital surgery, oncologic surgery, and cosmetic surgery, Dr. Rafailov is well-equipped to provide exceptional care. During his fellowship at Duke, he contributed to research on corneal neurotization and was honored with the “Fellow of the Year” award for his teaching contributions. He takes pride in delivering specialized, patient-centered care, employing a customized approach for each individual. His patients appreciate his personalized and attentive care.

Sources: American Academy of Ophthalmology, NIH, Ophthalmology Management.【8】【9】【10】