Treating Corneal Anesthesia and Neurotrophic Keratitis

Corneal anesthesia is a rare condition defined as a loss or decrease of corneal sensation. Your cornea is the clear “window” layer that encapsulates each eye. Corneal anesthesia leads to a clinical condition known as neurotrophic keratitis, also referred to as neurotrophic keratopathy. Any one of these diagnoses will prevent patients from feeling pain in an affected eye or recognizing when it has been scratched or infected. Over time, this loss of sensation leads to corneal scarring, corneal ulcers, and presents a significant threat of vision loss.

What Causes Corneal Anesthesia?

Corneal anesthesia is caused by impairment to the ophthalmic division of the trigeminal nerve, which provides sensation to the cornea. Corneal anesthesia, the loss of sensation in the eye, is commonly caused by infection, diabetes, trauma or surgery, and can be very difficult to manage. The causes of Neurotrophic Keratitis are the same, with corneal anesthesia being the primary symptom for Keratitis.

What Are The Symptoms Of Neurotrophic Keratitis?

While corneal anesthesia is one of the hallmark signs of neurotrophic keratopathy, you may feel discomfort before your keratitis proceeds to the point of total numbness. Other symptoms include extreme dryness and failure to produce tears, swelling or inability to comfortably close the eye, visible and constant redness, strain and pain inside the eye, blurred or decreased vision, and light sensitivity. If your eyes are constantly feeling uncomfortable, it’s imperative to get them checked by an ophthalmologist before this condition becomes unmanageable.

Treatment Options For Corneal Anesthesia

There are a wide range of available treatment options for both congenital corneal anesthesia and keratitis including:

  • Artificial tears 
  • Topical antibiotic eye drops 
  • Cenegermin also referred to as Oxervate 
  • Corneal neurotization surgery 

Some treatments for corneal keratopathy such as artificial tears and topical antibiotic eye drops may be used to help improve the corneal surface and prevent infection. Unfortunately, most treatments address the complications of corneal keratitis and corneal anesthesia but not the underlying cause. To restore nerve function in a cornea that has been affected by anesthetic keratitis, you will need to advance to an oral medication such as Oxervate, or most likely to surgery.

What Does Corneal Neurotization Surgery Entail?

Corneal neurotization surgery or corneal reinnervation is a minimally invasive nerve transplant procedure that addresses the underlying nerve damage causing corneal anesthesia and returns feeling to a patient’s eye.This surgery uses a sural nerve graft either from the patient’s own leg or a cadaver, transplanting it onto an existing nerve within the side of the face that has retained nerve function. This grafted nerve runs across the forehead, and new nerve endings are routed to the damaged cornea. This procedure utilizes established nerve surgery techniques to provide a new promising approach to corneal anesthesia.

Corneal neurotization surgery is currently offered by only a few surgeons in the United States and around the world. We are one of a very few providers of this procedure.

What Are The Potential Benefits Of Corneal Neurotization Surgery?

In a majority of cases, neurotization surgery has fully reinstated feeling and nerve function in the affected eye. This surgery has the power to restore protective corneal sensation, prevent further scarring of the cornea and ultimately, reinstate a patient’s vision. Corneal neurotization surgery offers a promising option to patients affected by corneal anesthesia.

Nerve Graft Fascicles

Fig. 2. Illustration of nerve graft fascicles regenerating into the damaged cornea.

Treatment for Corneal Anesthesia at The Institute for Advanced Reconstruction

Fig. 1. Illustration of sural nerve graft tunneled across the bridge of the nose and inserted around the affected cornea.

Protect Your Eyes From Neurotrophic Keratitis And Corneal Anesthesia

At The Institute for Advanced Reconstruction, we pride ourselves on being the ‘go to’ center for revolutionary nerve procedures with comprehensive surgeries and treatments for neurotrophic keratitis and congenital corneal anesthesia. Our nerve specialists and doctors provide keratitis eye exams so you can have a proper diagnosis and get the best treatment plan for you. For diagnosis and treatment alike, our team of experts is here to help you make the best decision for your eyes. 

Contact us to learn more about the different treatment options available for corneal anesthesia and neurotrophic keratitis.

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