REVIEW   

Minerva Oftalmologica 2017 September;59(3):77-88

DOI: 10.23736/S0026-4903.17.01778-0

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Update on pathogenesis of neurotrophic keratitis

Marta SACCHETTI, Alice BRUSCOLINI, Irene ABICCA, Alessandro LAMBIASE ✉

Department of Sense Organs, University Sapienza of Rome, Rome, Italy

Neurotrophic keratitis (NK) is a rare, degenerative corneal condition associated with impairment of corneal sensory innervation. It is characterized by decrease or absence of corneal sensitivity and corneal epithelial changes that may lead to development of non-healing epithelial defects and ulcers. Trigeminal corneal nerves provide corneal sensitivity and trophic support to all corneal structures by releasing growth factor and neuromediators including substance P, neuropeptide Y, calcitonin gene-related peptide (CGRP) that are able to stimulate corneal epithelial renewal and healing. Corneal cells, in turn, release soluble mediators that may support corneal nerves’ survival such as nerve growth factor (NGF), brain derived neurotrophic factor (BDNF) and ciliary neurotrophic factor (CNTF). Management of NK requires early identification and diagnosis, close monitoring of the patients, and prompt treatment in order to stimulate corneal healing and prevent the progression of the disease. Current treatments of NK include discontinuation of all topical treatments and administration of preservative-free ocular lubricants. The use of therapeutic contact lens in the early stages may improve corneal epithelial healing. More severe forms of NK will require surgical approach with tarsorraphy, amniotic membrane transplantation or conjunctival flap to achieve a complete corneal healing and to maintain ocular integrity. Novel treatments aiming at stimulating corneal nerve regeneration and improving corneal sensitivity are under investigation in order to target the pathogenic mechanisms of NK and to provide new agents able to cure this challenging disease.

KEY WORDS: Keratitis - Trigeminal nerve - Cornea - Corneal ulcer