Neurotrophic Keratopathy As Manifestion Of Vitamin B12 Deficiency

Neurotrophic keratitis, formerly known as neuroparalytic keratitis, is a degenerative corneal disease characterized by decreased or absent corneal sensation, leading to epithelial breakdown, impairment of healing, and ultimately corneal ulceration, melting and perforation.Ocular and systemic conditions associated with damage at any level to the fifth cranial nerve, from the Trigeminal nucleus to the corneal nerve endings may lead to the development of neurotrophic keratitis

20 Aout 1953 university hospital, ophtalmology department, Casablanca, Morocco.

We report the case of a patient presenting with neurotrophic keratopathy caused by vitamin B12 deficiency.

A 83 year old female patient presented to the ophtalmology department with progressive decreasing in visual acuity and eye redness.
The slit lamp examination revealed  a 5×6 mm axial epithelial defect  with mild sub-epithelial infiltration in the right eye. The corneal sensation was abolished in the concerned eye. The Shirmer test was normal.
On general evaluation, the patient showed pallor and tachycardia. The blood cell count showed macrocytic anemia. Further explorations revealed vitamin B12 deficiency. The neurological examination was normal.
We started vitamin B12 at 1000mg/d for the patient.
The patient was started on lubricanting eye drops and topical tobramycin.  After 2 weeks she showed a good response with corneal sensation reversal.

It seems that B12 deficiency might be a cause of neurotrophic keratopathy