Neurotrophic Keratitis: MD Winner

Case Information

A seven-year-old boy was referred to our cornea service for the treatment of Neurotrophic Keratitis in his left eye. The right eye was within normal limits, whereas the left eye showed decreased corneal sensitivity, absent corneal reflex, mild ptosis and decreased tear production.

Medical History:

He reported a history of frontal headache, enlarged stride and slurred speech. His medical records indicated a recent diagnosis of pediatric glioma. One month prior to the development of the Neurotrophic Keratitis, he underwent a brainstem biopsy, which revealed a diffuse midline glioma with the H3K27M mutation.

Concomitant Medications:

Chemotherapy and radiotherapy for a brain tumor located in the pons region.

Diagnosis:

Neurotrophic Keratitis

Treatment:

Initially started with preservative-free artificial tears, a therapeutic contact lens, and levofloxacin 0.5% eye drops three times a day. Subsequently administered topical autologous serum at a concentration of 40%, six times a day for six weeks, but there was no improvement in the condition. After receiving approval from the Italian Medicines Agency for pediatric use in this case, we switched the therapy to Cenegermin 0.002% eye drops, which were administered six times a day for eight weeks. Complete reepithelialization was achieved within three weeks of starting this treatment.