Neurotrophic Keratitis: Targeted Therapies to Restore Corneal Sensation

MIAMI — Physicians should routinely test corneal sensation to better understand nerve health and guide treatment for neurotrophic keratitis, according to Nandini Venkateswaran, MD, of Sunshine Eye & Retina, who presented at a lunch symposium on emerging therapies for the condition.

Neurotrophic keratitis is a degenerative corneal disease caused by damage to the trigeminal nerve, which impairs corneal sensation and disrupts the eye’s natural healing processes. Without adequate nerve signaling, the cornea becomes vulnerable to breakdown, ulceration, and vision loss. Early detection through sensory testing allows clinicians to assess the severity of nerve damage and tailor interventions before irreversible damage occurs.

Venkateswaran emphasized that evaluating corneal sensation is not merely diagnostic but foundational to staging the disease and selecting appropriate therapies. “We have so many therapies we can now implement in our practices to treat these conditions, ranging from medical therapies to surgical interventions,” she said during the symposium held in Miami on April 19, 2026.

Current treatment strategies include topical lubricants, autologous serum eye drops, and medications such as cenegermin-bkbj, a recombinant human nerve growth factor approved by the U.S. Food and Drug Administration for Stage 2 and 3 neurotrophic keratitis. For advanced cases, surgical options like tarsorrhaphy, amniotic membrane transplantation, or corneal neurotization may be considered to restore corneal integrity and sensation.

Corneal sensation testing, typically performed using a Cochet-Bonnet esthesiometer or non-contact esthesiometry, measures the threshold at which a patient perceives tactile stimulus on the cornea. Reduced sensitivity correlates with disease severity and helps differentiate neurotrophic keratitis from other ocular surface disorders such as dry eye disease or infectious keratitis.

Venkateswaran noted that underdiagnosis remains a challenge, as patients may present with mild symptoms despite significant nerve damage, or conversely, experience severe pain disproportionate to clinical findings. Objective sensory testing provides a quantifiable metric to track disease progression or improvement over time, particularly in response to regenerative therapies.

Research published in Ophthalmology and the British Journal of Ophthalmology supports the use of baseline and follow-up corneal esthesiometry in managing neurotrophic keratitis. Studies indicate that improvement in corneal sensation often precedes visible epithelial healing, making it a valuable biomarker for treatment efficacy.

The symposium, hosted by Sunshine Eye & Retina, highlighted a shift toward proactive management of neurotrophic keratitis, moving beyond reactive treatment of corneal defects toward preserving nerve function and promoting corneal resilience. Venkateswaran urged ophthalmologists to incorporate sensory testing into routine ocular surface evaluations, especially in patients with risk factors such as herpes zoster ophthalmicus, diabetes, prior ocular surgery, or chronic use of topical medications.

While no single test captures all aspects of corneal nerve function, esthesiometry remains the most accessible clinical tool for assessing sensory integrity. Ongoing research explores corneal confocal microscopy and tear biomarkers as complementary methods to evaluate nerve density and regeneration, though these are not yet standard in clinical practice.

As awareness grows and targeted therapies expand, early identification through corneal sensation testing may play an increasingly important role in preventing vision loss and improving long-term outcomes for patients with neurotrophic keratitis.