Looking for clues of underlying disease in neurotrophic keratopathy

Professor Dalia Said, Queen’s Medical Centre, Nottingham, UK, shared her knowledge of the clinical presentation and diagnosis of neurotrophic keratopathy (NK) during an EuCornea Focus Session. “The clinical presentation of NK is that of the NK itself as well as those of the underlying disease,” said Prof Said. The well known symptoms, including dryness and photophobia, are unresponsive to both lubricants and steroids, and they decrease as the disease progresses. Prof Said advised delegates to look for clues of the underlying disease when examining a patient with NK. “As herpetic eye disease is the most common cause of NK, we should always ask the patient for a history of herpes, and look for clues such as lipid keratopathy and corneal vascularisation. Analysis of the intracorneal nerves themselves can also give very useful clues. “Thickened corneal nerves can suggest leprosy, while radial keratoneuritis suggests acanthamoeba infection,” she said. In the absence of corneal clues, retinal examination may display diabetic retinopathy, which is often associated with decreased corneal sensitivity. There are, however, problems with the Mackie classification, which is based solely on disease severity and does not consider crucial aspects such as corneal sensitivity. “In ‘real-life’ clinical practice, a classification strategy with mild, moderate and severe subtypes, and the incorporation of corneal sensitivity measurements using either the Cochet-Bonnet or Belmonte corneal aesthesiometer, may be more descriptive of disease stages,” said Prof Said.