A 58-year-old diabetic woman reports minimal eye discomfort despite a persistent corneal epithelial defect. Corneal sensation is markedly reduced. The ulcer is an oval epithelial defect with thickened rolled grey edges in the interpalpebral zone. This picture is diagnostic of:
- A Herpes simplex geographic ulcer
- B Persistent epithelial defect from dry eye
- C Neurotrophic keratopathy, stage 2 ✓
- D Exposure keratopathy with secondary infection
Correct answer: C. Neurotrophic keratopathy, stage 2
Explanation
Neurotrophic keratopathy results from loss of trigeminal innervation, as in diabetes, herpes infection or surgery. Stage 2 is a persistent epithelial defect with rolled heaped edges and strikingly little pain because sensory loss abolishes the usual symptom burden. Geographic ulcer implies active viral replication and would be painful with dendritic ancestry.
Reference: Yanoff and Duker Ophthalmology, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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