Neurotrophic keratitis outcomes improve with early, stage-based care

A historical cohort study was recently undertaken to evaluate the neurotrophic keratitis (NK) profile, management outcomes, and determinants at a tertiary eye hospital, ultimately noting that effective treatment of keratitis has the potential to restore vision, making it important for corneal surgeons to embrace innovative treatment approaches, and provide follow-up care for their patients.

The authors, led by Rand Al Azaz, MD, of the Ophthalmology Department at King Khaled Eye Specialist Hospital and Research Center, in Riyadh, Saudi Arabia, presented the profile and management outcomes of patients with NK who were treated between 2014 and 2024 at their institution in central Saudi Arabia.

Al Azaz et al concluded that proper management of NK “facilitates ocular preservation and may enable visual restoration following initial therapeutic intervention.” The researchers identified patients using electronic medical records, including those with the ICD-10 code of H16.239 (neurotrophic keratoconjunctivitis, unspecified eye) who presented and were treated at KKESH&RC during the study period. The cohort included 94 eyes from 80 patients.

NK epidemiological and incidence findings

In the study, which was published in Clinical Ophthalmology,¹ the group detailed that NK is a relatively uncommon condition, with a prevalence of less than 11 per 10,000, and it is associated with several systemic and ocular disorders. The annual incidence of NK was 2.84 per 10 million in the Saudi population. This study observed male predominance and a younger age of presentation among NK patients, which the authors said warrants further investigation because if differs from other studies.

The information on patients with NK before diagnosis was retrospectively collected, while the details of management and their outcomes were prospectively collected. Cases of Herpes zoster keratoconjunctivitis, herpes simplex keratitis, and trigeminal nerve palsy were also reviewed to determine if any exhibited features of NK.

NK management, medical therapy, and complications

The authors noted that management of NK attempts to preserve the anatomic configuration of the eyeball and restore vision once the keratitis has healed. Different approaches are used depending on the stage of NK at presentation:

• Mild NK: Preventing epithelial defect formation and accelerating the healing process
• Moderate NK: Halting further damage to the corneal stroma and reepithelialization of the defect
• Severe NK: preventing perforation, restoring the anatomical contour of the globe, and providing alternatives for future visual rehabilitation

Medical therapy—including topical and systemic antivirals, topical antibiotics, or oral doxycycline—was initiated for mild cases of NK, and a combination of medical and surgical procedures (tarsorrhaphy, amniotic membrane transplantation, therapeutic penetrating keratoplasty, corneal gluing, or corneal neurotization) was initiated for moderate and severe NK cases. If complications were seen, the patient was hospitalized.

Complications that were observed during NK management included corneal scarring, corneal neovascularization, corneal thinning, secondary bacterial keratitis, vision loss, corneal perforation, corneal melting, and glaucoma.

The authors wrote that early diagnosis, adherence to prolonged management, and constant monitoring can allow the cornea to heal, giving the patients the possibility of being candidates for low-vision rehabilitation.

Further insights on NK

In collaboration with Ophthalmology Times, Physicians’ Education Resource recently hosted an educational podcast with NK experts John D. Gelles, OD, FAAO, FIAOMC, FCLSA, FSLS, FBCLA; and John Hovanesian, MD, FACS; who discussed the importance of comprehensive strategies when performing corneal sensitivity testing in patients suspected of having NK. This comprehensive workshop is aimed at preparing listeners to summarize the importance of a timely and accurate diagnosis of neurotrophic keratitis and integrate corneal sensitivity testing into the assessment of ocular surface disease.

Editor’s Note: This activity expires on August 30, 2026.

Listen Now>> NK Insights: An Interactive Corneal Sensitivity Testing Workshop

REFERENCE

1. Al Azaz R, Khandekar R, Al Ghadeer H. Profile and management outcomes of neurotrophic keratitis at a tertiary eye hospital in Saudi Arabia: a cohort study. Clin Ophthalmol. 2025;19:3815-3826. Published 2025 Oct 15. https://www.dovepress.com/profile-and-management-outcomes-of-neurotrophic-keratitis-at-a-tertiar-peer-reviewed-fulltext-article-OPTH