Risk Stratification and Classification of NK

EP: 1.Differential Diagnosis of NK

EP: 2.Assessing NK Corneal Sensitivity

EP: 3.Early Recognition of NK

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EP: 4.Risk Stratification and Classification of NK

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Multiple staging systems exist for neurotrophic keratitis (NK) classification, with Francis Mah, MD, and Lauren McLoughlin, OD, favoring simplified approaches over complex schemes. Mah utilizes the American Academy of Ophthalmology's preferred practice pattern classification of mild, moderate, and severe, which essentially corresponds to the traditional Mackie 3-stage system. This straightforward approach facilitates communication among practitioners and provides clear treatment guidance based on disease severity.

McLoughlin employs the Mackie staging system directly, describing stage 1 as punctate keratitis, stage 2 as epithelial defects, and stage 3 as ulceration or perforation. She emphasizes teaching students that filamentary keratitis should always prompt consideration of NK, as filaments frequently occur in patients with NK and typically demonstrate reduced corneal sensitivity upon testing. This additional clinical pearl helps identify NK cases that might otherwise be misdiagnosed.

The key principle underlying any staging approach involves consistent documentation and systematic evaluation rather than rigid adherence to specific classification schemes. Practitioners should record their observations, document corneal sensitivity findings, and note relevant historical factors. This comprehensive approach enables appropriate treatment selection and provides baseline documentation for monitoring disease progression and treatment response over time.