Eyeworld

WINTER 2026 | EYEWORLD | 67 C TO THE MOON AND BACK by Ellen Stodola Editorial Co-Director About the physicians Brandon Ayres, MD Cornea Service Wills Eye Hospital Philadelphia, Pennsylvania Preeya K. Gupta, MD Managing Director Triangle Eye Consultants Raleigh, North Carolina Christopher J. Rapuano, MD Chief of the Cornea Service Wills Eye Hospital Professor Sidney Kimmel Medical College Thomas Jefferson University Philadelphia, Pennsylvania N eurotrophic keratitis (NK) remains a challenging disease to treat. While treatment options are growing, phy- sicians must pay particular attention when evaluating for this condition and identifying the correct stage. Three physi- cians discussed the evaluation of NK, what they use to aid in the process, and the wide array of approaches to address these patients. Evaluating for neurotrophic keratitis The toughest thing about NK, Dr. Gupta said, is that it's not always the easiest diagnosis to rec- ognize. If you have someone in the early stages, it might look more like severe dry eye and can often be undiagnosed. If you have a patient who could be in an early stage of NK, who doesn't have an ulcer but a lot of corneal staining, Dr. Gupta said checking corneal sensation can easily be done in the clinic with a piece of dental floss or a cotton wisp. "It's important to check corne- al sensitivity in all four quadrants of the eye, as well as centrally," she added. Dr. Gupta stressed her high degree of suspicion for these patients and noted she looks for triggers. It's important to diagnose patients early to have more time to treat, she said. Those are patients who aren't as much of an emergen- cy. "They still need treatment, but they might have diffuse punctate staining that we don't always classically associate with neurotrophic keratitis. I think if clinicians paired that Stage 1 NK picture with the diagnosis of NK as opposed to dry eye or some other cause of keratitis, we would catch these patients sooner," she said. Tests for NK are still on the cruder side, Dr. Gupta said, and corneal sensitivity is the most accessible test. Having a high clinical suspicion A growing constellation of care for NK continued on page 68 Stage 2 NK with a central corneal epithelial defect with heaped edges but no corneal ulceration from herpes zoster Source: Christopher J. Rapuano, MD

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