CRU 2025: Neurotrophic keratitis and multidisciplinary approaches to enhance patient outcomes

Jennifer Li, MD, a professor of ophthalmology at UC Davis Eye Center, provides an in-depth overview of neurotrophic keratitis (NK), emphasizing its critical yet often overlooked nature in eye care. NK is a condition characterized by reduced corneal sensation that frequently goes undiagnosed. Li stresses the importance of healthcare providers keeping this condition in mind, especially when patients present with dry eye symptoms. The key to early detection is a simple corneal sensation test, which can be performed using a cotton wisp, comparing sensation between both eyes. The diagnostic approach involves checking corneal sensation in all quadrants, starting with the unaffected eye. Li advises against applying eye drops before testing, as this can interfere with accurate sensation assessment. She recommends testing with a small cotton wisp, not the entire cotton swab, to get precise results. Management of NK is multifaceted and patient-specific. Initial steps include:

• Lubrication
• Removing potential irritants
• Eliminating preservatives from eye drops

Advanced treatment options encompass:

• Nerve growth factor medications
• Scleral contact lens fitting
• Surgical interventions like neuronization

Li emphasizes a collaborative approach, working closely with optometrists and oculoplastic surgeons to provide comprehensive care. Each patient requires a tailored strategy, considering their unique underlying causes and symptoms. The overarching message is early detection and proactive management. By maintaining a high index of suspicion for NK, checking corneal sensation systematically, and adopting a stepwise treatment approach, healthcare providers can significantly improve patient outcomes. Key takeaways include the simplicity of diagnosis, the importance of thorough examination, and the need for personalized, collaborative treatment strategies in managing NK.