Topical Insulin Eye Drops For The Treatment Of Neurotropic Ulcers And More

Neurotrophic keratopathy is a degenerative condition of the cornea related to reduced innervation by the trigeminal nerve. The treatment includes corneal lubrication, therapeutic contact lenses, amniotic membrane grafts, and tarsorrhaphy. Refractory neurotrophic corneal ulcers have poor response to traditional treatment and are a challenge for ophthalmologists. Topical Insulin eye drops are widely available and relatively safe medication for neurotrophic keratitis. It's proven to be effective in corneal healing but has limited clinical use for non-healing corneal wounds. The purpose of this study is to share the outcomes of topical insulin treatment in neurotrophic corneal ulcers and to show the other uses of topical insulin eye drops.

Topical insulin treatment was prescribed in six cases of different pathologies of cornea out of which 3 cases were neurotrophic corneal ulcers of different origins. The other cases were corneal perforation, bullous keratopathy, and recurrent erosion syndrome. Insulin eye drops were used at concentrations of 1 lU/mL. All patients were prescribed insulin eye drops after failure of traditional treatment.

Case 1. A 63 y/o female with terminal glaucoma presented with infectious keratitis. After 6 weeks of antibacterial treatment, the patient remained with neurotrophic ulcer unresponsive to traditional treatment.
Case 2. A 56 y/o female with neurotrophic keratitis after several episodes of herpetic keratitis.
Case 3. A 61 y/o male presented with a 1-week history of chemical injury with hypopyon and epithelial defect.
Case 4. A 52 y/o patient with one year of history of recurrent erosions treated with diamond burr polishing.
Case 5. A 67 y/o male presented with corneal perforation after foreign body removal
Case 6. A 71 y/o female with terminal glaucoma and bullous keratopathy with intolerance to bandage contact lenses.

In 3 cases of neurotrophic keratitis with topical insulin eye drops epithelial regeneration and healing were reached within 2-3 weeks. The patient with recurrent erosion syndrome unresponsive to the traditional methods of treatment was prescribed Insulin eye drops for 2 months. 8 months of remission achieved so far. The patient with corneal perforation underwent amniotic membrane transplantation without significant improvement. Treatment was initiated with a bandage contact lens and Insulin eye drops. After 1 week of treatment, the anterior chamber was recovered. The patient with bullous keratopathy and intolerance to contact lenses was prescribed topical Insulin eye drops for 2 months. The bullae were resolved.

Topical insulin has been found to improve the healing of corneal ulcers. The mechanism of insulin in promoting cornea wound healing suggests that restoration of corneal nerves and/or improved epithelial cell migration may play key roles. Experience with insulin in corneal wound healing in humans is limited but represents an increased interest recently. Our case series demonstrate the effectiveness of topical insulin in neurotrophic keratitis as well as it can be an alternative approach to other corneal diseases requiring fast healing of corneal tissue.