Purpose: To investigate the causative diseases, corneal findings, and treatment course for neurotrophic keratopathy (NK) caused by central trigeminal nerve paralysis
Subjects and methods: This study involved 9 cases (9 eyes) of corneal epithelial and stromal disorder thought to be caused by central NK encountered in the Department of Ophthalmology at Kyoto Prefectural University of Medicine, Kyoto, Japan from 2008 to 2019. We compared and examined the causes of trigeminal nerve palsy and corneal findings at first visit, the presence and position of residual corneal opacity during treatment and post-recovery, and the presence/absence of superficial neovascularization and conjunctival penetration into the corneal limbus.
Results: Upon examination, the causative diseases in the 9 cases were (a) auditory nerve tumor removal (n=5), (b) Wallenberg syndrome (n=2), (c) removal of an acoustic neurinoma (n=1), and (d) brain tumor removal with a gamma knife (n=1). The corneal findings during the initial visit included corneal epithelial defect (n=4), superficial punctate keratitis (n=3), necrotizing keratitis (n=1), and corneal perforation (n=1). The treatments included topical ophthalmic eye drops and ointment administration in 1 case, topical eye drops and ointment administration combined with eyelid surgery in 1 case, punctal plug insertion and topical eye-drop administration in 1 case, punctal plug insertion with therapeutic soft contact lens (SCL) wear and topical eye-drop administration in 2 cases, and post lid closure eye patch wear in 1 case. After the treatment, corneal opacity from the central area to the temporal region of the cornea was observed in 5 of the 9 cases, and conjunctival penetration into the corneal limbus was observed in 7 of the 9 cases.
Conclusions: The findings in this study showed that in many cases, a disease-stage-related combination therapy, such as therapeutic SCL wear and punctal plug insertion, result in successful healing. However, careful observation is vital as corneal opacity and conjunctival penetration into the corneal limbus can often occur after the treatment of epithelial disorders.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 125: 431-437, 2021.