CRU 2025: Exploring neurotrophic keratitis cases with Dr Melissa Barnett

In their presentation "Neurotrophic Keratitis: Multidisciplinary Approaches to Enhance Patient Outcomes," Melissa Barnett, OD, FAAO, FSLS, FBCLA; Cecelia Koetting, OD, FAAO, DipABO; Jennifer Li, MD; and Quan Đông Nguyễn, MD, MSc, emphasized the importance of corneal sensitivity testing before any anesthetics, considering various conditions like preservatives, artificial tears, and eye surgeries that can lead to neurotrophic keratitis (NK). Treatment options include bandage lenses, sclera lenses, topical nerve growth factor, medications, occlusion, and corneal neurotization.

Barnett and Li also gave the presentation "Restoring Connections in Neurotrophic Keratitis," which covered patient cases, stressing the need for early diagnosis and treatment to preserve vision. Patients were advised to monitor for symptoms like redness, pain, and loss of vision and to seek immediate medical attention. The sessions were interactive and appreciated by both in-person and virtual audiences.

Video Transcript:

Editor's note: The below transcript has been lightly edited for clarity.

Melissa Barnett, OD, FAAO, FSLS, FBCLA:

We had 2 lectures on neurotropic keratitis. So the first lecture really went into the diagnosis of NK. So the importance of checking corneal sensitivity, checking corneal sensitivity in all quadrants of the cornea, checking the eye that is not affected, the unaffected eye first, and then the affected eye, and checking corneal sensitivity prior to any topical anesthetics, for example, that would numb the cornea. We spoke about all the different conditions that are associated with NK, those like preservatives and artificial tears, any topical anesthetic drugs used chronically, any sort of history of eye surgery. So it could be cataract surgery done many years ago, retinal surgery, glaucoma surgery, refractive surgery, all sorts of autoimmune conditions, multiple sclerosis, diabetes and, of course, herpetic disease. So there are many, many conditions associated with NK. So when you have a patient, and if you're unsure, maybe it's dry eye, maybe it's NK, checking coronal sensitivity is key. We also covered all sorts of treatment options for NK, so those including bandage lenses, scleral lenses, topical nerve growth factor medications for NK, punctal occlusion, and even corneal neurotization. So many different options to treat NK, important to diagnose early, treat patients, and really save their vision.

In the second lecture, we covered all sorts of different patient cases ranging from mild to quite severe, and the complications that can occur with NK. So since patients cannot feel their corneas, informing them to look in the mirror or see if their eyes are red, have someone look at them to see if they have any redness, any pain, loss of vision, and then to come back and giving appropriate information on how to contact you anytime, day or night. So these sessions have been great, very interactive. We appreciate the in-person and the virtual audiences and all the questions that are being asked in the interaction from the sessions.