Neurotrophic Keratopathy With Medicamentosa Keratoconjunctivitis In Trigeminal Trophic Syndrome : A Rare Case Report

To present a rare case of neurotrophic keratopathy and keratoconjunctivitis medicamentosa in a patient with Trigeminal Trophic Syndrome (TTS), highlighting the potential vision-threatening implications and the importance of early recognition and management.

A tertiary eye care center specializing in corneal disorders and neuro-ophthalmic conditions.

A 55-year-old female presented with persistent ocular irritation, redness, and blurred vision in the right eye for one week, unresponsive to prior treatment. She had a four-year history of TTS, characterized by episodes of tingling, pain, and ulcerative lesions on the right cheek and scalp. The symptoms worsened following self-administration of an Ayurvedic eye drop for mild irritation.

On examination, a central corneal epithelial defect (6x6.5 mm) with heaped-up irregular margins was noted, along with stromal edema and reduced corneal sensation. Fundus evaluation was unremarkable. Sensory deficits were present on the right side of the face, with associated crusted skin lesions. MRI revealed homogenous enhancement at Meckel’s cave, suggesting trigeminal nerve involvement. Pharmacological analysis of the Ayurvedic drop confirmed a highly acidic pH (3) and hyperosmolarity (>1500 mOsm/L), indicating potential epithelial toxicity.

A diagnosis of neurotrophic keratopathy secondary to TTS, compounded by medicamentosa keratoconjunctivitis, was established. The patient was treated with frequent preservative-free lubricants, topical antibiotics, and a bandage contact lens to facilitate epithelial healing. Over the next two weeks, progressive re-epithelialization was observed, and the patient regained visual function with complete resolution of epithelial defect. She was counseled to avoid irritant topical medications and educated about protective measures to prevent recurrence.

Trigeminal Trophic Syndrome is a rare yet significant cause of corneal hypoesthesia and neurotrophic keratopathy. Its association with medicamentosa keratoconjunctivitis, as seen in this case, underscores the need for careful history-taking and avoidance of potentially harmful topical agents. Timely diagnosis and intervention can prevent severe ocular damage and preserve visual function.