Corneal Management with Fifth Nerve Dysfunction

Neurotrophic keratitis follows a profound decrease in corneal and conjunctival sensation. As the cornea and conjunctiva are innervated by the ophthalmic division of the trigeminal nerve, ~ is not surprising that the two most common etiologies of neurotrophic keratitis are paresis of the trigeminal nerve (from any cause) and herpes zoster ophthalrnicus.' Other causes of decreased corneal sensation less likely to produce neurotrophic keratitis include ocular herpes simplex, chronic anterior segment inflammation, prolonged contact lens wear, cataract and corneal surgery, cyclocryotherapy, chemical Injury (e.g. alkaline and acid burns) corneal dystrophies, leprosy and some congenital syndromes (e.g. Riley-Day syndrome).