Neurotrophic Keratoconjunctivitis
Patient Case Overview
A 71-year-old male patient presents for a painless red eye OS with decreased vision. It started approx. 1 month ago. The condition is constant and the onset progressive. Started on Sulfacetamide eye drops QID by MD and then Ciprofloxacin ophthalmic solution QID by NP a short time after. Patient states no improvement with either medication.
Initial Presentation: BCVA HM OD (previous CRVO), CF5 OS. Significant conjunctival injection. Large geographic epithelial defect. Decreased corneal sensitivity. No infiltrate/stromal involvement.
Systemic History: Hypertension, Type 2 IDDM, MI with quintuple bypass, Hypercholesteremia, Renal failure.
Assessment/Plan: Neurotrophic Keratoconjunctivitis. AMT applied with pressure patch and instructions to remove in 6 hours. Started on Preservative Free ATs Q2H. Lid hygiene regimen for associated Blepharitis. Continue Ciprofloxacin due to open epithelial defect. Instructed to wait at least 5 mins in between drops.
1 week after 1st treatment: VA 20/400. 1 week after 2nd treatment: VA 20/80.
This case demonstrates the effectiveness of amniotic membrane therapy in managing neurotrophic keratoconjunctivitis in a complex systemic patient. Despite a large epithelial defect and lack of response to prior treatments, repeated AMT applications supported progressive epithelial healing and restoration of corneal integrity. The patient showed significant visual improvement from CF to 20/80, highlighting the value of regenerative therapy in challenging, non-healing corneal conditions.