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Neurotrophic Keratopathy: Ophthalmology's Diabetic Foot Problem.

Todd P Margolis¹

¹John F. Hardesty, MD Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, St. Louis, MO.

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|February 18, 2021

Summary

Neurotrophic keratopathy requires a shift in perspective, viewing it as a chronic condition manageable through prevention, akin to diabetic foot issues. Early intervention and protective measures are crucial for healing the ocular surface.

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Adenoviral Gene Therapy for Diabetic Keratopathy: Effects on Wound Healing and Stem Cell Marker Expression in Human Organ-cultured Corneas and Limbal Epithelial Cells

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Published on: April 7, 2016

Area of Science:

Ophthalmology
Corneal Disease
Ocular Surface Disease

Background:

Neurotrophic keratopathy is often mismanaged as an inflammatory condition.
Epitheliopathy results from denervation-induced dysregulation of ocular surface homeostasis.
Most affected eyes are not dry and do not require lubrication.

Purpose of the Study:

To reframe the understanding and management of neurotrophic keratopathy.
To emphasize prevention and protective strategies for the ocular surface.
To highlight the risks associated with topical agent use in this condition.

Main Methods:

Review of key concepts from the 2020 Harold A. Stein Lecture.
Analysis of the pathophysiology of neurotrophic epitheliopathy.
Discussion of traditional and alternative protective measures.

Main Results:

Neurotrophic keratopathy is a chronic condition best managed by prevention.
Inflammation is not the primary driver; dysregulated epithelial cell function is.
Topical agents can cause iatrogenic injury and delay healing.

Conclusions:

Ophthalmology should treat neurotrophic keratopathy like diabetic foot problems, focusing on prevention.
Minimizing topical agents, patient education, and protective eyewear are key.
Tarsorrhaphy remains a valuable method for protecting the neurotrophic cornea.