Hyperplastic precorneal membranes. Extending the spectrum of neurotrophic keratitis

Neurotrophic keratitis is a recognized complication of the neurosurgical treatment of trigeminal neuralgia. Following a retrogasserian rhizotomy, our patient developed, in addition to the anterior segment abnormalities anticipated with neurotrophic keratitis, an actively growing hyperplastic precorneal membrane originating from the limbal area and overlying intact corneal epithelium. Growth of the membrane continued towards the visual axis until all but the central 3 mm of the corneal epithelium was covered. This previously undescribed observation may indicate that the epithelium of the conjunctival and limbal areas are maintained and regulated by a different physiologic mechanism than that of the central corneal epithelium following sensory deafferentation. The significance of the membrane is discussed in context with the X, Y, Z hypothesis of corneal epithelial maintenance.