Neurotrophic Keratitis: Check Corneal Sensation, Consider Oxervate | Healio

WAIKOLOA, Hawaii — Awareness of neurotrophic keratitis, a potentially serious corneal nerve dysfunction, needs to be heightened among clinicians, according to insights shared at Hawaiian Eye 2026. The condition, often overlooked, can present with significant corneal findings that are mistakenly attributed to more common issues like dry eye. Early detection and intervention are crucial for preserving vision.

Richard S. Davidson, MD, of University of Colorado Anschutz, emphasized the importance of assessing corneal sensitivity in any patient presenting with concerning corneal abnormalities. “If a patient has significant corneal findings, don’t just assume it’s dry eye,” Dr. Davidson told Healio. “Check the corneal sensation and treat for neurotrophic keratitis.”

Understanding Neurotrophic Keratitis

Neurotrophic keratitis occurs when the corneal nerves are damaged, leading to a loss of sensitivity. This diminished sensation impairs the cornea’s ability to heal, making it vulnerable to abrasions, infections, and vision loss. The condition can stem from a variety of causes, including diabetes, herpes simplex virus infection, systemic autoimmune diseases, and even certain surgical procedures. Research published in Eye details the complex pathophysiology and diverse etiology of neurotrophic keratitis, highlighting the challenges in diagnosis and management.

The key to diagnosis, as Dr. Davidson points out, lies in evaluating corneal sensitivity. Standard diagnostic tests include corneal topography, which maps the corneal surface, and corneal confocal microscopy, which allows for visualization of the nerve fiber layer. Reduced nerve fiber density is a hallmark of neurotrophic keratitis.

Oxervate: A Treatment Option

Dr. Davidson highlighted Oxervate (cenegermin-bkbj, Dompé) as a well-tolerated treatment option for neurotrophic keratitis. Oxervate is a recombinant human nerve growth factor (rhNGF) that aims to promote corneal nerve regeneration and healing. Dompé’s website provides detailed information about the medication, including its mechanism of action and clinical trial data. The drug received FDA approval in 2018, offering a targeted therapy for this challenging condition.

Clinical trials have demonstrated Oxervate’s efficacy in improving corneal healing and reducing pain in patients with neurotrophic keratitis. While, it’s important to note that the treatment is not a cure and requires ongoing monitoring. Potential side effects, while generally mild, can include conjunctival hyperemia (redness) and transient stinging.

Beyond Oxervate: A Multifaceted Approach

While Oxervate represents a significant advancement, managing neurotrophic keratitis often requires a multifaceted approach. This may include:

• Artificial tears: To lubricate the cornea and protect it from further damage.
• Topical antibiotics: To prevent or treat secondary infections.
• Bandage contact lenses: To provide a protective barrier and promote healing.
• Surgical interventions: In severe cases, procedures like corneal debridement or even corneal transplantation may be necessary.

The Importance of Early Detection and Differential Diagnosis

The challenge with neurotrophic keratitis often lies in its subtle presentation and overlap with other corneal conditions. Dry eye disease, for example, can mimic some of the symptoms, leading to misdiagnosis and delayed treatment. A thorough evaluation of corneal sensation is therefore paramount. The American Academy of Ophthalmology’s EyeNet magazine offers a comprehensive overview of the diagnostic and treatment strategies for neurotrophic keratitis, emphasizing the importance of a high index of suspicion.

it’s crucial to identify and address the underlying cause of the nerve damage. For patients with diabetes, strict glycemic control is essential. For those with herpes simplex virus infection, antiviral medications may be necessary. Managing the underlying condition can help slow the progression of neurotrophic keratitis and improve treatment outcomes.

Public Health Implications and Ongoing Research

The prevalence of neurotrophic keratitis is difficult to ascertain precisely, but it is believed to be increasing due to the rising incidence of diabetes and other associated conditions. Improved awareness among healthcare professionals and the development of more effective treatments are crucial for mitigating the public health impact of this sight-threatening condition.

Ongoing research is focused on developing novel therapies for neurotrophic keratitis, including gene therapy and stem cell-based approaches. These emerging technologies hold promise for restoring corneal nerve function and promoting long-term healing. Clinical trials are underway to evaluate the safety and efficacy of these innovative treatments.

What comes next: Continued surveillance of neurotrophic keratitis cases, coupled with ongoing research into novel therapies, will be essential for improving patient outcomes. Healthcare providers should remain vigilant for signs of corneal nerve dysfunction and prioritize early diagnosis and intervention. Further studies are needed to refine diagnostic criteria and optimize treatment strategies for this complex condition.