Therapeutic Advances In Neurotrophic Keratitis -The Role Of Insulin Eye Drops In Thailand

To evaluate clinical outcomes of topical insulin eye drops for treatment of neurotrophic keratitis (NK) and refractory epithelial defects (ED).

Single-center observational series at a Thammasat university hospital (October 2024–present)

This retrospective chart review included 49 patients diagnosed with NK or refractory ED who were treated with compounded topical insulin eye drops (1 IU/mL) administered four times daily.

Demographics, etiologies, baseline ED size, time to epithelial improvement, visual acuity (VA) outcomes, and adverse events were reviewed. Subgroup analyses were performed for NK (n = 20) and refractory ED (n = 29).

Participants included 29 males and 20 females with a mean age of 58 years (range 7–88). Diabetes mellitus was present in 24.5% and prior brain tumor surgery in 10.2%. Baseline ED ranged from 5–100% (mean 48%). Overall epithelial improvement occurred within 4–60 days (mean 16.7 days). Visual acuity remained stable or improved in all cases, and no adverse effects were observed. Subgroup analyses showed variable healing times depending on etiology, with generally faster improvement in systemic disease and cranial nerve injury groups.

Topical insulin eye drops demonstrated favorable safety and consistent epithelial healing across diverse etiologies of NK and refractory ED. The therapy appears to be an effective, accessible treatment option, with relatively rapid recovery times and universal visual stability or improvement. Further controlled studies are warranted to confirm efficacy and optimize protocols.