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Associated Neurotrophic Keratopathy in Complex Regional Pain Syndrome
Matias Soifer1,2, Maria Gomez-Caraballo1, Nandini Venkateswaran1,2,3
1Duke Eye Center, Duke University, Durham, NC.
Cornea
|February 16, 2021
Summary
This case report details neurotrophic keratopathy (NK) in a patient with complex regional pain syndrome (CRPS). Ocular surface treatments stimulated corneal nerve growth, successfully healing the eye and improving vision.
Area of Science:
- Ophthalmology
- Neurology
- Regenerative Medicine
Background:
- Complex regional pain syndrome (CRPS) is a neuropathic disorder that can involve facial structures.
- Neurotrophic keratopathy (NK) is a degenerative corneal disease caused by impaired corneal innervation.
Observation:
- An 18-year-old female with CRPS type I and right facial involvement presented with blurred vision and right eye pain.
- Ocular examination revealed reduced corneal sensation, recurrent epithelial defects, and superficial epitheliopathy.
- In vivo confocal microscopy (IVCM) confirmed NK by showing rarefaction of the subbasal nerve plexus.
Findings:
- A combination therapy including plasma rich in growth factors, amniotic membrane graft, and cenegermin 0.002% was administered.
- This treatment led to successful epithelial closure and vision improvement within 8 weeks.
- IVCM demonstrated significant corneal nerve regeneration, with no recurrence of NK for 11 months.
Implications:
- This is the first reported case of NK associated with CRPS and ipsilateral facial pain.
- IVCM is a valuable tool for diagnosing NK and monitoring corneal nerve health.
- Targeted ocular surface treatments can promote corneal nerve regeneration and improve outcomes in patients with NK secondary to neuropathic conditions.
