Profile and Management Outcomes of Neurotrophic Keratitis at A Tertiary Eye Hospital in Saudi Arabia: A Cohort Study

To evaluate the neurotrophic keratitis (NK) profile, management outcomes, and determinants at a tertiary eye hospital in Saudi Arabia.

This historical cohort comprised patients with the ICD-10 code of H16.239 who presented and were treated from 2014 to 2024. The classification of NK based on Mackie's criteria; NK was classified into stages 1-3. Demographic data, NK etiology, and both medical and surgical therapeutic interventions were analyzed. We correlated these outcomes with the etiology, stages, and treatment modalities.

The cohort had 94 eyes of 80 NK patients in stage 1 (6, 6%), stage 2 (69, 74%), and stage 3 (19, 20%). Seventy-Three (77.7%) eyes showed reduced corneal sensation, 14 (15%) eyes showed intact corneal sensation, and 7 (7.4%) eyes showed no discernible corneal sensation. Herpes zoster (22.5%) was the most common infectious etiology followed by herpes simplex (2.5%). Trigeminal palsy was observed in 24 (30%) eyes. Iatrogenic NK was present in 12 (15%) eyes. Decreased vision (88.1%), redness of the eyes (47.6%), and swollen lids (34.5%) were the main symptoms. The most frequently performed procedures included amniotic membrane transplantation (AMT) (45.7%), tarsorrhaphy (36.2%), and corneal gluing (17%). At the last follow-up after management, the Best Corrected Visual Acuity (BCVA) was 1.5 logMAR in eyes affected by NK. At presentation (78.2%) and after treatment (38.2%), eyes with NK had severe visual impairment (SVI).

The management of NK presents significant challenges but offers potential rewards, as it facilitates ocular preservation and may enable visual restoration following initial therapeutic intervention.