Neurotrophic keratopathy is a disease of the eye, particularly its cornea (cornea). It is caused by damage to the very sensitive nerve tissue there, with serious consequences for the entire eye. In science, the term keratitis neuroparalytica is usually used. The ICD-10 classification is H16.2.
What is Neurotrophic Keratopathy?
The focus of neurotrophic keratopathy is the cornea. It is part of the outer skin of the eye and thus at the same time closes off the entire eyeball. It usually shows up clearly with a full layer of tear fluid. Their curvature ensures that the incident light is broken and is therefore important for correct vision. See definitionexplorer for Hemarthrosis Definitions.
The cornea is traversed by a multitude of nerves and is therefore considered one of the most sensitive structures in the body in terms of temperature, pain and touch. The nerves have their origin in the eyeball nerve (medical Nervus ophthalmicus), a side branch of the Nervus trigeminalus.
If this or the individual nerves in the cornea are directly damaged, neurotrophic keratopathy can develop. However, only a few patients are affected. In Europe alone, just 0.05 percent of the entire population has been diagnosed with one of the three defined degrees of severity of the disease.
The main cause of neurotrophic keratopathy is the reduced secretion of tear fluid caused by nerve damage, which normally supplies the cornea with sufficient nutrients and at the same time forms a secure protective shield. If there is a disturbance in this area, degenerative changes occur.
Various degenerations, functional limitations, regressions and, in severe cases, corneal ulcers (medical Ulcus corneae) are possible. At the same time, the wound healing of the cornea is disturbed. In almost twenty percent of all cases, nerve damage is triggered by herpes viruses and the infections they cause.
Physical injuries, chemical burns, misuse of contact lenses, or mistakes in surgical procedures can also be considered. On the other hand, underlying diseases such as diabetes mellitus, multiple sclerosis or leprosy are less frequently responsible for the disease. The same also applies to various tumors, cysts and abscesses. Congenital eye diseases, on the other hand, hardly play a role in the formation of a neurotrophic keratopathy.
Symptoms, Ailments & Signs
Neurotrophic keratopathy is generally expressed in a rather vague manner. Most of the symptoms also occur with other diseases of the eye and cannot be clearly assigned to neurotrophic keratopathy. The most obvious sign of the disease, however, is the reduced sensitivity of the cornea.
As a result, certain stimuli, such as touch or temperature differences, are hardly or not at all perceived by the patient. Those affected are therefore pain-free even in a severe stage of the disease. The neurotrophic keratopathy becomes visible through a pronounced clouding of the otherwise clear cornea.
Furthermore, a conspicuous reddening of the eye and a reduced blink reflex can be seen. The visual acuity of the patients can fluctuate somewhat in the beginning. However, the more severe the course of the disease progresses, the weaker the visual acuity of the affected eye becomes.
Diagnosis & course of disease
In order to diagnose a neurotrophic keratopathy, a thorough medical history should be taken to investigate the causes. On the other hand, various medical examinations, such as a sensitivity test of the cornea or a function test of the tear film, are necessary. Due to the ambiguous symptoms, a particularly careful examination is mandatory in order to prevent the progression of the disease as early as possible.
Left untreated, neurotrophic keratopathy can lead to corneal ulcers, loss or at least perforation of the cornea, or so-called aseptic necrosis. Even if it is mild, it can cause accompanying changes in the conjunctiva and, at a later stage, pose a danger to the entire eye.
Neurotrophic keratopathy, especially in the third stage, can lead to serious complications. Since the disease is not accompanied by pain, it is often recognized too late. Therefore, even occasional fluctuations in visual acuity should give reason to urgently consult a doctor in order to avoid the complete destruction of the cornea. As part of the disease, there is always a risk of bacterial superinfection.
In addition to viruses, the cornea is also attacked by bacteria and fungi. As a result, a so-called Ulcus corneae can develop. Ulcus corneae is a corneal ulcer, which is characterized by painful and constantly watering eyes. The discharged secretion can even contain pus, which indicates a bacterial infection. The eye is then inflamed and very sensitive to light.
Sometimes an eyelid spasm is also observed, which becomes noticeable through excessive blinking on both sides when tired, emotionally stressed or bright light stimuli. Eyelid spasms can even cause the eyes to close for several hours. Overall, visual acuity (visual acuity) deteriorates in corneal ulcers. In severe cases, the cornea can be perforated. This poses a major threat to the eyes and can lead to blindness. To prevent this serious complication, surgical intervention is necessary in addition to comprehensive antibiotic treatment.
When should you go to the doctor?
If vision changes, eye pain, and other known signs of neurotrophic keratopathy are noticed, a doctor’s visit is indicated. If physical complaints occur without a clear cause being able to be found, a clarifying discussion with the family doctor is necessary. This applies in particular to increasing eye problems or increased sensitivity of the cornea. Repeated tears and swelling in the eye area are best clarified immediately. The doctor can diagnose neurotrophic keratopathy and, if necessary, start treatment directly or refer the patient to a specialist.
Risk groups include people who have recently contracted a viral infection or ocular herpes zoster. Victims of physical injuries and chemical burns should also consult their doctor if they experience these symptoms. If you suffer from the symptoms mentioned after a surgical or neurosurgical procedure, it is best to inform the responsible doctor. The same applies if the symptoms appear after the use of contact lenses or tropical medicines. Diabetes, leprosy, and multiple sclerosis patients should report any unusual eye symptoms to their healthcare professional. The neurotrophic keratopathy is diagnosed by the ophthalmologist or an internisttreated. Seriously ill patients must be treated in a specialist clinic.
Treatment & Therapy
The treatment of neurotrophic keratopathy is still difficult and depends entirely on the individual characteristics of the patient. Optimum success can only rarely be achieved with current therapies, so preventing the disease from spreading is the priority. This is mainly done by administering non-preserved artificial tears to provide the cornea with sufficient nutrients again.
In some cases, special eye drops made from the patient’s blood serum can be used for this purpose. Therapeutic contact lenses can be worn to protect the cornea. Alternatively, there are options to perform an operation to completely or partially close the eyelid gap or to sew an amnion transplant onto the cornea.
Inflammations running in parallel are generally treated with a special eye ointment or gel. Existing ulcers are often reduced by the administration of antibiotics. You can choose between tablet form and local use.
If the neurotrophic keratopathy is based on a specific underlying disease, a two-pronged therapy is necessary for the patient. Here it is necessary to stop the spread of the corneal damage and at the same time to combat the actual cause. This applies, for example, to diabetes mellitus or multiple sclerosis, as well as to the removal of tumors or cysts that have caused them.
Outlook & Forecast
The prognosis for patients with neurotrophic keratopathy depends on the underlying cause. In the case of chemical burns, the damage is usually irreversible and healing is no longer possible. If a viral disease is present, the virus must be prevented from spreading and killed at the same time by administering medication. Normally, the affected person suffers from other symptoms, which usually disappear completely afterwards.
Cysts and abscesses often require surgery to improve. If the affected person suffers from a tumor disease, the further course of the disease is shaped by the progress of the disease and the treatment options. In an advanced stage of the disease, the patient is threatened with premature death, despite all efforts. If the neurotrophic keratopathy is triggered by the incorrect use of visual aids, a change in the handling of the aids is necessary. Otherwise, an increase in complaints is possible.
Overall, the treatment options for those affected usually lead to an alleviation of existing irregularities, but not always to a complete cure. The best possible results are achieved if a diagnosis and treatment are initiated as soon as the first health irregularities appear. Doctors often try to stem the progression of the disease and minimize the risk of health complications. Without treatment, the symptoms will increase.
The most important preventive measure for neurotrophic keratopathy is to protect the cornea and avoid injury. Attention must be paid to the correct use of contact lenses, the wearing of protective goggles in dangerous situations and the risks of voluntary laser treatment in the case of ametropia. Careful hygiene and regular check-ups by the ophthalmologist are also important.
Since the damage to the nerves cannot usually be healed, neurotrophic keratopathy is lifelong. Therapy adapted to the stage of the disease is therefore usually part of the patient’s everyday life. Due to the lack of sensitivity of the cornea, exacerbations of neurotrophic keratopathy are not always noticed.
Regular checks by a specialist ophthalmologist are therefore mandatory. This can record and document the course of the disease by measuring the eyesight. If corneal injuries occur again and again, further therapeutic measures may be necessary. These protect the cornea and prevent the occurrence of tumors.
Since the cornea is no longer so resistant in neurotrophic keratopathy, it should be specially protected in the future. This includes wearing safety goggles for dangerous activities, avoiding bright light sources and using contact lenses appropriately. Patients should also ensure adequate rest periods between heavy eye loads.
This includes working in low light or constantly staring at a screen. Hydration logs help to control and optimize daily fluid intake. This ensures that the eye is supplied with sufficient tear fluid. All of these preventive measures can have a positive effect on the course of the disease, but do not replace regular visits to the doctor.
You can do that yourself
In everyday life, the eyes should not be exposed to bright light sources. You should avoid looking directly into the sun or bright spotlights from a lamp. The process can lead to injuries in the eye and further increase the already existing symptoms. In addition, when reading or working on the screen, care should be taken that the environment does not become too dark. This circumstance also leads to the fact that the optic nerve is overloaded and discomfort occurs.
If the person concerned notices that the eyes have been strained too much, they should take breaks immediately. The eye should be given the opportunity to regenerate during periods of rest. No activities such as reading, writing or watching TV should take place.
To ensure that the eye is always supplied with a sufficient amount of tear fluid, the daily intake of drinks must be checked and, if necessary, optimized. As soon as a dry eye is noticed, the person concerned should react. In the case of injuries to the eye, it is always necessary to consult a doctor. A control visit should also be initiated in the event of fluctuations in vision.
Self-help measures are not sufficient to adequately determine whether defects have occurred in the sensitive area. Anomalies and irregularities can only be detected and documented by precisely measuring the eyesight.