A 65-year-old diabetic man with a prior acoustic neuroma surgery develops reduced corneal sensation, punctate epithelial erosions, and later a large oval epithelial defect with rolled grey edges but minimal pain and inflammation. Stage 3 neurotrophic keratopathy is diagnosed. The most appropriate specific therapy is:

• A Topical broad-spectrum antibiotics hourly
• B Topical cenegermin eye drops eight times daily ✓
• C Topical acyclovir ophthalmic ointment five times daily
• D Lamellar keratectomy with amniotic membrane excision

Explanation

Stage 3 neurotrophic keratopathy denotes a persistent epithelial defect with stromal involvement. Cenegermin, a recombinant human nerve growth factor, promotes corneal reinnervation and healing and is the approved specific therapy for neurotrophic keratitis. Antivirals treat herpetic epithelial disease, antibiotics address bacterial infection, and the lesion here is trophic rather than infectious, so antimicrobial escalation alone will not heal the defect.

Reference: American Academy of Ophthalmology Basic and Clinical Science Course, External Disease and Cornea, BCSC Section 8 ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.