CRU 2025: The importance of comanagement and thorough examination in neurotrophic keratitis cases

Neurotrophic keratitis (NK) is a critical eye condition that is often misdiagnosed and misunderstood, according to Cecelia Koetting, OD, FAAO, DipABO. In her presentation "Neurotrophic Keratitis: Multidisciplinary Approaches to Enhance Patient Outcomes," presented alongside Melissa Barnett, OD, FAAO, FSLS, FBCLA; Jennifer Li, MD; and Quan Đông Nguyễn, MD, MSc; an overview of what to look out for in diagnosing neurotrophic keratitis was given.

Unlike typical dry eye, NK can progress to serious complications such as persistent epithelial defects, corneal ulcers, and potentially requiring a corneal transplant. The key to effective management lies in early detection through careful corneal sensitivity testing.

Practitioners can use various tools to check corneal sensitivity, including cotton tip applicators, crochet bins, or even dental floss. The primary challenge is recognizing that what appears to be standard ocular surface disease may actually be NK. Misdiagnosis can lead to ineffective treatments, making accurate identification crucial.

The approach to NK management is multifaceted and collaborative. Successful treatment often involves co-management across different medical specialties. For instance, oncology patients experiencing side effects from cancer medications frequently present with NK symptoms. Similarly, rheumatology patients with conditions like lupus, sarcoidosis, or Sjogren's syndrome may also develop NK.

Each patient's NK management is unique. Some practitioners may take a more aggressive approach, treating the condition comprehensively, while others might refer to specialists for specific interventions. The goal is to create an approachable and flexible treatment strategy that addresses the individual patient's needs.

Referral to a cornea specialist becomes necessary when surgical interventions are required. However, many stages of NK can be effectively managed through careful monitoring, appropriate treatments, and interdisciplinary collaboration. The most critical takeaway is the importance of thorough examination and corneal sensitivity testing. By recognizing NK early and understanding its potential progression, healthcare providers can prevent more severe complications and provide targeted, effective care for patients experiencing this complex eye condition.