Neurotrophic keratopathy: Update in diagnosis and management

The cornea is the most densely sensory innervated tissue in the body. Sensory corneal nerves are essential to maintain ocular surface homeostasis and are involved in the blink reflex, tear production, and the release of trophic factors that are key in the wound healing process. Compromise of corneal sensory nerves leads to neurotrophic keratopathy (NK), an uncommon degenerative disorder that may lead to corneal epithelial breakdown, ulceration, corneal opacification, and even perforation. Management of this condition is difficult and visual disability often ensues in affected patients. While treatment has been traditionally focused in promoting epithelial healing, the past decade has seen a breakthrough in new medical and surgical therapies geared toward promoting corneal reinnervation. This review presents a comprehensive update on NK, focusing on current as well as potential new strategies for its diagnosis and management.