[Conservative and surgical treatment of neurotrophic keratopathy]

Neurotrophic keratopathy is one of the most challenging conditions among the disorders of wound healing of the ocular surface. In addition to bilateral assessment of corneal sensitivity, tear status and lid function must be analyzed and treated by unpreserved artificial tears and adequate lid surgery. Further conservative treatment options include hyaluronic acid and dexpanthenol as well as autologous serum. Application of recombinant growth factors (especially NGF) represents an interesting perspective. Concerning surgical interventions, temporary or permanent occlusion of the lacrimal punctum may be accompanied by lateral tarsorrhaphy which is easy to perform, potentially reversible, and in most cases successful. Depending on the type of wound healing disorder amniotic membrane transplantation may be helpful either as basal membrane transplant (graft) or as a patch, or in combination (sandwich). A tectonic keratoplasty a chaud should typically be combined with a simultaneous amniotic membrane patch and/or a lateral tarsorrhaphy to avoid persistent epithelial defects.