A patient with a history of acoustic neuroma surgery develops reduced corneal sensation and a persistent central corneal epithelial defect with a smooth, rolled, greyish edge. There is minimal surrounding stromal infiltrate. What is the most appropriate initial management?
- A Fortified topical antibiotics every hour
- B Preservative-free lubricants, patching or tarsorrhaphy, and avoidance of toxic topical medications ✓
- C Topical antiviral therapy with ganciclovir
- D Corneal collagen cross-linking
Correct answer: B. Preservative-free lubricants, patching or tarsorrhaphy, and avoidance of toxic topical medications
Explanation
This describes neurotrophic keratopathy secondary to trigeminal (5th nerve) damage. Management focuses on protecting the ocular surface with lubrication, patching, lateral tarsorrhaphy, and avoiding toxic medications. Antibiotics and antivirals do not address the pathophysiology. Cross-linking is contraindicated as it would worsen epithelial breakdown.
Reference: Basic and Clinical Science Course, Section 8: External Disease and Cornea, AAO 2023-2024 ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.