Early Recognition of NK

EP: 1.Differential Diagnosis of NK

EP: 2.Assessing NK Corneal Sensitivity

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EP: 3.Early Recognition of NK

EP: 4.Risk Stratification and Classification of NK

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Early recognition of NK represents a paradigm shift from traditional teaching, which historically emphasized advanced stage 3 presentations with obvious corneal perforation or severe ulceration. Contemporary understanding recognizes NK as a chronic progressive disease in which stage 1 (punctate epitheliopathy) inevitably precedes more severe manifestations. Early detection allows for significantly more effective treatment interventions and substantially better patient outcomes compared with managing advanced disease stages.

Key historical risk factors require systematic evaluation during patient encounters. The people in the most significant risk categories include patients with a history of herpes simplex keratitis, diabetics (who should be routinely questioned about peripheral neuropathy), and individuals on chronic glaucoma medications. Lauren McLoughlin, OD, advocates for glaucoma laser procedures or surgery to eliminate topical medications when possible, as preservatives and active ingredients cause cumulative corneal nerve damage over time.

The classic presentation of "stain without pain" serves as the most important clinical recognition pattern for NK. When patients demonstrate significant corneal staining but report minimal discomfort, foreign body sensation, or grittiness, this discordance should immediately trigger corneal sensitivity testing. This presentation pattern, combined with relevant historical risk factors, provides the foundation for early NK diagnosis and intervention before progression to more challenging advanced stages.