March 2012 Online Photo Diagnosis

By Gregory W. DeNaeyer, OD, FAAO

Pictured is the right eye of a 69-year-old patient who had corneal scarring, neovascularization, and neurotrophic keratopathy secondary to previous Herpes Zoster ophthalmicus. Unaided visual acuity of his right eye is count fingers. The patient was currently using Genteal gel q.i.d. and Optive (Allergan) t.i.d. in his right eye. He also takes Acyclovir 400mg b.i.d. after having previous Zoster-related uveitis.

Neurotrophic keratopathy occurs after loss of nervous innervation to the cornea that can result from a viral infection such as Herpes Simplex or Herpes Zoster. Neurotrophic keratopathy can also manifest after radiation treatment or directly from a tumor. Corneas that have lost innervation may develop superficial punctate keratitis (SPK) or a persistent epithelial defect (PED). Treatment depends on severity but may include lubrication, bandage contact lens, tarsorrhaphy, or amniotic membrane transplantation. A full-thickness corneal transplant in a patient who has a neurotrophic cornea is often avoided secondary to an increased risk of graft failure.

This patient initially had severe SPK that had mostly resolved after starting Genteal and Optive, but his epithelium remained significantly irregular. He unfortunately did not have much success after a ProKera amniotic membrane treatment. The patient continues to use lubrication therapy and is followed closely to monitor for changes.