Neurotrophic keratopathy: current concepts of the mechanisms of development and prospects for treatment

Abstract

Neurotrophic keratopathy (NK), also referred to as neurotrophic keratitis, is a rare degenerative corneal disease characterized by impaired corneal sensory innervation, resulting in epithelial defects with or without stromal ulceration (melting), accompanied by reduced or absent corneal sensitivity. The most common cause of NK is previous herpetic keratitis; however, any condition that disrupts the integrity or normal function of the corneal nerves may lead to the development of this disorder. The pathogenesis of NK is associated with dysfunction of the corneal nerves originating from the first (ophthalmic) branch of the trigeminal nerve, leading to impaired corneal epithelial homeostasis and the formation of non-healing erosions. NK is classified according to the severity of corneal damage: stage 1 — epitheliopathy, stage 2 — persistent corneal erosion, and stage 3 — corneal ulcer and its complications. A variety of conservative and surgical treatment strategies are currently available to stabilize disease progression, improve patient outcomes, and prevent vision loss. This review provides a comprehensive overview of NK, summarizing current knowledge on its pathogenesis, diagnosis, therapeutic approaches, and emerging treatment modalities that may offer improved efficacy and safety compared with conventional management. KEYWORDS: neurotrophic keratitis, neurotrophic keratopathy, corneal nerves, corneal ulcer, corneal neurotization. FOR CITATION: Surov A.V., Lebedev O.I., Bolgova D.E. Neurotrophic keratopathy: current concepts of the mechanisms of development and prospects for treatment. Russian Journal of Clinical Ophthalmology. 2026;26(3):262–267 (in Russ.). DOI: 10.32364/2311-7729-2026-26-3-10