Eyeworld

68 | EYEWORLD | SEPTEMBER 2021 C ORNEA by Clara Chan, MD Cornea Editor in a month. Cases of neurotrophic keratitis can be some of the most challenging eyes to man- age. The first priority is to diagnose early. In this issue of EyeWorld, we explore the new classifi- cation proposed and etiologies for neurotrophic keratitis and review methods for treatment. Another topic discussed in this issue is very relevant as we see an uptick of COVID-19 cases internationally due to the spread of the Delta variant. While the vaccines are excellent in reducing morbidity and mortality rates, the in- creasing case counts will certainly influence the supply of cornea donor tissue once again. This will have an international impact, as the U.S. is the greatest exporter of corneal donor tissue. At this time, the Eye Bank Association of America has guidelines in place that anyone who died from COVID-19, who was exposed to COVID-19 within the prior month, or displayed any symp- toms related to COVID-19 cannot be a donor for corneal tissue. Recipients can be reassured that there are no confirmed cases of COVID-19 transmission from a cornea whose donor was positive. Eye banks and medical directors con- tinue to take the utmost precaution to ensure the safety of donor tissue. I invite you to read on to understand more about the various chal- lenges and issues surrounding COVID-19 and corneal donation. Finally, congratulations to EyeWorld on cele- brating its 25th anniversary. It has been an hon- or to serve as the Cornea editor and work with all the like-minded professionals who value quality medical education and ongoing ophthal- mic innovation. Here's to another 25 years! Challenging and relevant topics explored Y ou examine a diabetic patient who has presented with a corneal abrasion in a quiet eye. You start to feel a pit in your stomach as the pa- tient is complaining of no pain and only upon questioning states that she may feel a mild foreign body sensation. To be certain, you use a curled corner of tissue paper to test the corneal sensation of the patient in four quadrants and centrally, and she does not flinch at all. You know this patient is going to have a tough time healing given the neurotroph- ic status of the eye and is at risk for developing a persistent epithelial defect, stromal thinning, and worst case, a corneal perforation. I vividly recall a 70-something-year-old gen- tleman who was referred to me by his optom- etrist for monocular severe dry eye for the last 2 months. He had no pain but complained of blurry vision and foreign body sensation in just his left eye, and on examination, he had diffuse limbus to limbus superficial punctate erosions that lit up with fluorescein staining. I ques- tioned him about whether he ever developed cold sores on his lip or nose, and he answered that only twice in his life he had. The light bulb should go off anytime the clinical picture does not match the symptoms in a patient. Amaz- ingly, once initiating preservative-free artificial tears, autologous serum tears, and oral antiviral treatment, the patient's cornea cleared up with- 25 Celebrang OU R S I LVE R AN N IVE R SARY

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