Contact Lens in Cases of Neuroparalytic Keratitis

Klein, M.

doi:10.1136/bjo.27.5.221

Cited by 5 publications

(3 citation statements)

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“…This leads to the accumulation of metabolites which in turn cause tissue swelling, loss of vitality and desquamation with the formation of a trophic ulcer. The term used to describe this condition was neuroparalytic keratitis (Klein, 1943).…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Neurotrophic keratopathy

Dua

Said

Messmer

et al. 2018

Progress in Retinal and Eye Research

278

356

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Neurotrophic Keratopathy (NK) refers to a condition where corneal epitheliopathy leading to frank epithelial defect with or without stromal ulceration (melting) is associated with reduced or absent corneal sensations. Sensory nerves serve nociceptor and trophic functions, which can be affected independently or simultaneously. Loss of trophic function and consequent epithelial breakdown exposes the stroma making it susceptible to enzymatic degradation. Nerve pathology can range from attrition to aberrant re-generation with corresponding symptoms from anaesthesia to hyperaesthesia/allodynia. Many systemic and ocular conditions, including surgery and preserved medications can lead to NK. NK can be mild (epithelium and tear film changes), moderate (non-healing epithelial defect) or severe (stromal melting and perforation). Moderate and severe NK can profoundly affect vision and adversely impact on the quality of life. Medical management with lubricating agents from artificial tears to serum/plasma drops, anti-inflammatory agents, antibiotics and anti-proteases all provide non-specific relief, which may be temporary. Contact lenses, punctal plugs, lid closure with botulinum toxin and surgical interventions like tarsorrhaphy, conjunctival flaps and amniotic membrane provide greater success but often at the cost of obscuring sight. Corneal surgery in a dry ocular surface with reduced sensation is at high risk of failure. The recent advent of biologicals such as biopolymers mimicking heparan sulfate; coenzyme Q10 and antisense oligonucleotide that suppress connexin 43 expression, all offer promise. Recombinant nerve growth factor (cenegermin), recently approved for human use targets the nerve pathology and has the potential of addressing the underlying deficit and becoming a specific therapy for NK.

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Section: Accepted Manuscriptmentioning

confidence: 99%

Neurotrophic keratopathy

Dua

Said

Messmer

et al. 2018

Progress in Retinal and Eye Research

278

356

View full text Add to dashboard Cite

show abstract

“…5,6,[8][9][10][11]27,34,49 Indications for lens wear presented in these case series included management of severe ocular surface disease, 5,8,9,11,27,49 corneal irregularity or ectasia, 6,10 and correction of ametropia. 5,6,[8][9][10][11]27,34,49 Indications for lens wear presented in these case series included management of severe ocular surface disease, 5,8,9,11,27,49 corneal irregularity or ectasia, 6,10 and correction of ametropia.…”

Section: Early Scleral Lensesmentioning

confidence: 99%

“…English translations of these early works by Mueller, Fick, and Kalt were published in the 1980s. The development of impression molding techniques and materials in the 1930s led to an increase in interest in scleral contact lenses, both for management of ocular disease 5,6 and for correction of refractive error. 4 These devices did not achieve widespread acceptance because of the corneal hypoxia that they induced and challenges of lens manufacturing.…”

mentioning

confidence: 99%