Differential Diagnosis of NK

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EP: 1.Differential Diagnosis of NK

EP: 2.Assessing NK Corneal Sensitivity

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NK frequently mimics dry eye disease, making an accurate diagnosis challenging for ophthalmologists. Lauren McLoughlin, OD, emphasizes that successful identification begins with careful attention to patient history and chief complaints, particularly noting symptoms such as photophobia and blurred vision in high-risk patients such as diabetics or those using topical medications. The key differentiating factor lies in corneal sensitivity testing, which remains the only definitive method to distinguish NK from other ocular surface diseases.

Corneal sensitivity testing has gained prominence in clinical practice over the past decade, particularly as effective treatments for NK have become available. McLoughlin and Francis Mah, MD, have incorporated this testing into their routine dry eye workups, recognizing that many patients with severe dry eye disease may have early-stage NK. The testing has become standard practice not only in specialized clinics but also during routine eye examinations when specific historical factors or symptoms suggest possible NK.

A crucial clinical pearl for differentiation involves examining conjunctival staining patterns. While dry eye syndrome typically presents with both conjunctival and corneal staining, patients with NK characteristically show corneal staining without significant conjunctival involvement. This distinction, combined with the classic presentation of "stain without pain," serves as an important diagnostic clue that should prompt immediate corneal sensitivity evaluation in any patient presenting with unexplained corneal epithelial defects.