neurotrophic keratitis


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Related to neurotrophic keratitis: neuroparalytic keratitis

neu·ro·tro·phic ker·a·ti·tis

inflammation of the cornea after corneal anesthesia.

neu·ro·tro·phic ker·a·ti·tis

(nūr'ō-trō'fik ker'ă-tī'tis)
Inflammation or decreased corneal sensation of the cornea after corneal anesthesia.
Synonym(s): neuroparalytic keratitis.

keratitis

(ker-a-tit'is) [ kerato- + -itis]
Inflammation of the cornea, usually associated with decreased visual acuity and, if untreated, sometimes resulting in blindness. Eye pain, tearing, light sensitivity, and low vision are the most common symptoms.

Etiology

It is often caused by contact lenses, but it may also result from drugs, microorganisms, immunodeficiency, trauma, or vitamin A deficiency.

Treatment

Therapy depends upon the underlying cause. Bacterial infections respond to antibacterial medications (typically administered in drops); herpes simplex viral infection requires antiviral agents; fungal keratitis is treated with antifungal agents; exposure keratitis, as in Bell's palsy, is preventable with topical lubricants.

Patient care

Because of the seriousness of keratitis, patients experiencing eye inflammation or pain should seek immediate medical attention. The patient is assessed for a history of recent upper respiratory infection accompanied by cold sores, pain, central vision loss, the sensation of a foreign body in the eye, contact lens use, photophobia, and blurred vision. The eye is inspected for loss of normal corneal luster and inflammation. A slit lamp examination is often used for optimal viewing of the eye to confirm the condition. Fluorescein staining helps determine the extent and depth of corneal ulcerations. The patient should refrain from rubbing the eye, which can cause complications. Prescribed therapies are administered, and the patient is instructed in their use. Warm compresses are applied as prescribed to relieve pain. If the patient complains of photophobia, the use of dim lighting or sunglasses is recommended. The patient should follow the prescribed treatment regimen carefully for the entire course and return for follow-up examination.

Patient education: the correct instillation of prescribed eye medications and the importance of thorough handwashing before and after touching the eye are emphasized. Contact lenses are removed and are not replaced until infectious forms of keratitis are cured. Any potentially contaminated lenses or lens solutions should be discarded. Stress, traumatic injury, fever, colds, and overexposure to the sun may trigger flare-ups. Both patient and family are taught about safety precautions pertaining to visual sensory or perceptual alterations. They are encouraged to verbalize their fears and concerns. Appropriate information and emotional support and reassurance are provided.

CAUTION!

Because many common forms of keratitis are infectious, examiners should use standard precautions during the evaluation of the eye.

chlamydial keratitis

Corneal ulcerations that accompany chlamydial infection of the conjuctiva.

dendritic keratitis

Superficial branching corneal ulcers.

keratitis disciformis

A gray, disk-shaped opacity in the middle of the cornea.

exposure keratitis

Epithelial defects of the cornea that result from inadequate protection of the eye by the eyelids, as in Bell's palsy.

fascicular keratitis

A corneal ulcer resulting from phlyctenules that spread from limbus to the center of cornea accompanied by fascicle of blood vessels.

herpetic keratitis

Dendritic keratitis in herpes zoster or herpes simplex infections.

hypopyon keratitis

A serpent-like ulcer with pus in the anterior chamber of the eye.

interstitial keratitis

A deep form of nonsuppurative keratitis with vascularization, occurring usually in syphilis and rarely in tuberculosis. It commonly occurs between ages 5 and 15. Symptoms include pain, photophobia, lacrimation, and loss of vision.
Synonym: parenchymatous keratitis

lagophthalmic keratitis

Drying due to air exposure of the cornea resulting from a defective closure of the eyelids.

microbial keratitis

Keratitis due to bacterial infection, often in patients who wear contaminated contact lenses.

mycotic keratitis

Keratitis produced by fungi.

neuroparalytic keratitis

The dull and slightly cloudy insensitive cornea seen in lesions of the fifth nerve.
Synonym: neurotrophic keratitis

neurotrophic keratitis

Neuroparalytic keratitis.

parenchymatous keratitis

Interstitial keratitis.

phlyctenular keratitis

Circumscribed inflammation of the conjunctiva and cornea accompanied by the formation of small projections called phlyctenules, which consist of accumulations of lymphoid cells. The phlyctenules soften at the apices, forming ulcers. See: phlyctenular keratoconjunctivitis

punctate keratitis

Punctate epithelial defects on the cornea epithelium, often seen in dry eye.
Synonym: superficial punctate keratitis

purulent keratitis

Keratitis with the formation of pus.

reapers' keratitis

Corneal inflammation caused by grain dust.

sclerosing keratitis

A triangular opacity in the deeper layers of the cornea, associated with scleritis.

superficial punctate keratitis

Punctate keratitis See: Thygeson disease

thermal keratitis

Damage to the cornea resulting from a burn.

trachomatous keratitis

A form of chlamydial keratitis.
See: pannus

traumatic keratitis

Keratitis caused by a wound of the cornea.

xerotic keratitis

Softening, desiccation, and ulceration of cornea resulting from dryness of the conjunctiva.

keratopathy

A non-inflammatory disease of the cornea. See corneal dystrophy.
actinic keratopathy A form of corneal degeneration characterized by white or yellowish stromal deposits consisting of cholesterol, fats and phospholipids, and in some cases corneal vascularization. The condition may be caused by exposure to sunlight (especially ultraviolet radiations) or trauma. The deposits are usually present within the pupillary area, often as elevated nodules distributed in a band-shaped configuration, and can have a dramatic effect on visual function. The damage is similar to that found in pterygium and pinguecula. Treatment consists of resorbing the lipid infiltrates and, in severe cases, keratoplasty. Syn. Bietti's band-shaped nodular dystrophy; climatic droplet keratopathy; Labrador keratopathy; lipid droplet degeneration.
band keratopathy A disorder characterized by the deposition of calcium salts in the anterior layers of the cornea, such as the basement membrane, Bowman's layer and the anterior stromal lamellae. They appear as opacities forming a more or less horizontal band with clear holes within the band giving it a Swiss cheese appearance. The causes may be systemic (e.g. hypercalcaemia, familial, old age, chronic renal failure) or ocular (e.g. chronic anterior uveitis, interstitial keratitis, silicone oil in the anterior chamber, phthisis bulbi). It is commonly associated with juvenile idiopathic arthritis and sarcoidosis. Symptoms include irritation and blurring of vision. Treatment may be necessary for cosmetic or visual reasons. It consists of removal of the calcium salts by scraping the corneal epithelium followed by irrigation with EDTA, or laser keratectomy. Syn. band-shaped corneal dystrophy. See juvenile idiopathic arthritis; ethylenediamine tetraacetic acid (EDTA).
bullous keratopathy Degenerative condition of the cornea characterized by the formation of epithelial blebs or bullae, which burst after a few days. This condition may follow cataract surgery, corneal trauma, severe corneal oedema, glaucoma, iridocyclitis, etc. Soft contact lenses have often been found useful to relieve pain in this condition by protecting the denuded nerve endings. See cornea guttata; Fuchs' endothelial dystrophy; therapeutic soft contact lens.
climatic droplet keratopathy; Labrador keratopathy See actinic keratopathy.
exposure keratopathy A disorder caused by the failure of the eyelids to cover the globe, resulting in improper wetting of the ocular surface by the tears with consequent desiccation of the corneal epithelium. This condition may be caused by facial nerve disorders in which the orbicularis oculi muscle is paralysed, or sleep lagophthalmos, or as a result of hard contact lens wear. The cornea presents punctate epithelial erosions, which may develop, into ulcers. Treatment is with frequent lubrication and if severe, lid surgery may be required. Syn. lagophthalmic keratitis; neuroparalytic keratopathy. See neuroparalytic keratitis; 3 and 9 o'clock staining.
neurotrophic keratopathy Condition characterized by an anaesthesia of the cornea. It results in a breakdown of the corneal epithelial layer allowing trauma, desiccation and infection. It is believed to occur as a result of the loss of trophic influence of the nerve supply to the cornea and/or of reduced blinking and the loss of lacrimation. Causes include herpes simplex virus, herpes zoster, lattice dystrophy, fifth nerve lesion and diabetes mellitus. Treatment mainly consists of tear substitute and intermittent or constant lid taping, but anti-infective regimen, punctal occlusion, tarsorrhaphy or neurosurgical intervention may be necessary. Syn. neurotrophic keratitis.
References in periodicals archive ?
Preliminary data from Phase I of the study, involving patients affected by moderate or severe neurotrophic keratitis, were presented at the ARVO Annual Meeting (Orlando, USA, 4-8 May 2014) and demonstrated that rhNGF is well tolerated.
The company plans to use the net proceeds from this proposed offering to support and fund several clinical trials, including a proposed Phase 2 clinical trial of its product candidate RGN-352 for the treatment of patients with acute myocardial infarction, an ongoing Phase 2 clinical trial of its product candidate RGN-137 in patients with the skin defect epidermolysis bullosa, compassionate use studies of its product candidate RGN-259 in patients with neurotrophic keratitis and a proposed physician-sponsored trial in patients with dry eye associated with graft versus host disease, as well as a proposed Phase 1/2 trial of RGN-352 in patients with multiple sclerosis.
Steven Dunn, a corneal specialist in Detroit, Michigan, in patients with neurotrophic keratitis caused primarily by the herpes zoster virus and previously reported by the Company.
Examples of such forward-looking statements include statements concerning the wound healing effects of RGN-257 in ophthalmic indications, including non-healing neurotrophic keratitis ulcers, the safety and efficacy of RGN-259, the company's ability to enter into any collaborations with respect to the development or commercialization of any of its product candidates, and the therapeutic potential of T4 for dermal, ophthalmic, and cardiovascular wounds and pulmonary indications.

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