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

To present a rare case of neurotrophic keratopathy (NK) complicated by keratoconjunctivitis medicamentosa

in a patient with Trigeminal Trophic Syndrome (TTS), highlighting the vision-threatening implications and the importance

of early recognition

Iclinix advanced eye care, New Delhi India

A 55-year-old female with a four-year history of TTS presented with a persistent, non-healing corneal epithelial

defect in her right eye. Her symptoms had acutely worsened following self-administration of an Ayurvedic eye drop. A

comprehensive evaluation included clinical examination, corneal sensation testing, and neuroimaging (MRI). The

implicated eye drop underwent pharmacological analysis for pH and osmolarity.

 Examination revealed a 6x6.5 mm central corneal epithelial defect with significantly reduced corneal sensation.

MRI showed enhancement at Meckel’s cave, consistent with trigeminal nerve involvement. The Ayurvedic drop was found

to be highly acidic (pH 3) and hyperosmolar (>1500 mOsm/L), confirming its epithelial toxicity. Following a diagnosis of

NK exacerbated by medicamentosa keratoconjunctivitis, the patient was treated with preservative-free lubricants, topical

antibiotics, and a bandage contact lens. This regimen led to complete corneal re-epithelialization and visual recovery

within two weeks.

 Trigeminal Trophic Syndrome is a rare but significant cause of corneal hypoesthesia predisposing to NK.

This case underscores the severe risk of ocular surface toxicity from unregulated topical agents, which can dangerously

complicate the underlying neurotrophic state. Meticulous history-taking, patient education on avoiding irritants, and

prompt, appropriate management are crucial to prevent permanent ocular damage and preserve vision.