This photo shows the right eye of a 58-year-old female who has a neurotrophic cornea secondary to herpes zoster infection. Her cornea has punctate corneal erosions and a corneal scar (Figure 2). Previous examination revealed a marked decrease in corneal sensitivity. She recently underwent cataract surgery, but her visual acuity is limited to 20/200 secondary to corneal irregularity. The patient’s previous treatment regimen includes artificial tears, autologous serum, lifitegrast, cyclosporine, and amniotic membrane.

Neurotrophic cornea results in decreased corneal sensitivity, epithelial breakdown, and poor corneal healing. These changes cause decreased acuity, susceptibility to ulceration, and corneal melt. Palliative care with artificial tears is a first-line treatment. Amniotic membrane application can be a successful option for some patients.¹ Scleral lenses can effectively manage these patients by providing both protection and hydration to the compromised corneal surface.²

After failure with topical prescriptions and amniotic membrane, the patient was referred for a scleral lens fitting.

References:

1. Chen HJ, Pires RT, Tseng SC. Amniotic membrane transplantation for severe neurotrophic corneal ulcers. Br J Ophthalmol. 2000 Aug;84:826-833.
2. Grey F, Carley F, Biswas S, Tromans C. Scleral contact lens management of bilateral exposure and neurotrophic keratopathy. Cont Lens Anterior Eye. 2012 Dec;35:288-291.