Management of persistent corneal epithelial defects: role of insulin

PED are corneal epithelial defects that fail to heal after 2 weeks and pose a significant therapeutic challenge. In recent years, insulin has emerged as a promising and effective therapy for promoting reepithelialization of the ocular surface, playing a role in the management of PED. The purpose of this article is to provide a summary of the role of topical insulin for persistent corneal epithelial defects (PED) management.

Based on current evidence, topical insulin merits an early placement within the therapeutic pathway and may be considered after conventional therapy, before the use of autologous serum. Several studies suggest that insulin eye drops can facilitate faster and more consistent epithelial healing, potentially offering greater efficacy than autologous serum in some cases. Moreover, patients who do not respond to insulin often require escalation to surgical interventions such as amniotic membrane transplantation. Overall, topical insulin appears to represent a well tolerated, cost-effective, and promising option that could serve as an intermediate step between standard medical treatments and surgical management in PED.

The evidence summarized in this review demonstrates that insulin shows considerable promise in managing PED, reinforcing the importance of further investigations to clarify its place in clinical practice. Ongoing clinical trials aim to validate the effectiveness of topical insulin for a range of ocular diseases and to benchmark its performance against other established treatment options.