Diagnosis and advanced treatment options including Oxervate and Prokera
Neurotrophic keratitis (NK) is a rare but serious degenerative corneal condition caused by damage to the corneal sensory nerves, leading to loss of corneal sensation and impaired healing. Without proper innervation, the cornea may develop persistent epithelial defects, ulcers, thinning, or even perforation, often with surprisingly few symptoms such as pain. Early recognition and targeted treatment are critical to prevent vision-threatening complications. Patients seeking Neurotrophic Keratitis Treatment in Miami Beach often benefit from an evaluation that focuses on both corneal surface integrity and nerve function. If you’ve been searching for Neurotrophic Keratitis TreatmentNear Me, specialized care is available locally.
At our Miami Beach optometry clinic, Dr. Rachel Shlomov, OD provides specialized evaluation and treatment for neurotrophic keratitis, including advanced therapies such as Oxervate™ and Prokera® amniotic membrane therapy.
What is Neurotrophic Keratitis?
Neurotrophic keratitis is a disease of the cornea resulting from damage to the trigeminal nerve (cranial nerve V), which provides sensory input and “trophic” support necessary for corneal health. Corneal nerves are essential not just for sensation, but also for maintaining tear production, blink reflexes, and epithelial healing , so when they are disrupted, the cornea becomes vulnerable to breakdown and slow or absent healing.
Common ocular and systemic causes include:
- Herpes simplex or zoster infection
- Chemical burns or trauma
- Prior ocular surgery or nerve injury
- Chronic topical medication toxicity
- Diabetes and other systemic neuropathies
- Intracranial or neurosurgical damage
- Contact lens-associated nerve damage
Because corneal sensation is reduced or absent, patients may not feel pain despite significant corneal damage , making careful clinical evaluation essential.
How Neurotrophic Keratitis Affects the Cornea
Without normal nerve input, the corneal epithelium, the outermost layer of the cornea, loses its ability to repair itself. The result can progress in severity:
Stage 1- Early epithelial irregularity: subtle breakdown and superficial punctate staining.
Stage 2- Persistent epithelial defect (PED): a defect that fails to heal over time.
Stage 3- Ulceration and potential stromal melting: deep tissue breakdown with risk of perforation.
How Neurotrophic Keratitis Is Diagnosed
Diagnosing NK requires more than routine eye chart testing. Dr. Shlomov conducts a detailed ocular surface and nerve function exam, including:
Corneal sensitivity testing:
This is done using gentle stimulation (such as a light touch with a cotton wisp or unscented/flavored dental floss) in multiple zones of the cornea to assess sensation. Diminished or absent sensation in any corneal region strongly supports a diagnosis of NK. Patients who arrive after searching Neurotrophic Keratitis TreatmentNear Me are often surprised to learn how central nerve testing is to accurate diagnosis.
Slit-lamp evaluation:
Under high magnification, the corneal surface is assessed for epithelial irregularities, persistent wounds, or early ulcers.
Fluorescein staining:
A vital dye highlights areas of corneal surface compromise, revealing defects that may be otherwise invisible.
Additional assessment of tear production and overall ocular health helps tailor treatment based on disease stage, which is essential when planning Neurotrophic Keratitis Treatment in Miami Beach.
How Neurotrophic Keratitis Is Treated
Treatment depends on severity and aims to promote corneal healing, protect the ocular surface, and prevent progression. Early intervention often leads to better outcomes. Patients looking for Neurotrophic Keratitis TreatmentNear Me may need a staged plan that combines biologic healing support with surface protection based on the severity of epithelial breakdown.
Prescription Therapy: Oxervate™ (cenegermin-bkbj)
Oxervate is the first and only FDA-approved eye drop specifically for neurotrophic keratitis. It contains a recombinant human nerve growth factor (NGF), designed to support corneal nerve-mediated healing. Oxervate is typically used multiple times daily over an 8-week course to stimulate epithelial repair and improve corneal integrity.
Clinical studies show that Oxervate significantly increases the likelihood of corneal epithelial healing in moderate-to-severe NK compared with placebo.
Amniotic Membrane Therapy: Prokera®
Prokera is a biologic corneal bandage made from preserved human amniotic membrane. It provides a protective, anti-inflammatory, healing environment to support the corneal surface in more advanced or persistent epithelial defects. Prokera can be used in-office and is particularly helpful when conventional lubrication and drops are insufficient.
Adjunctive and Supportive Care
Depending on severity and individual patient needs, treatment may also include:
- Autologous serum or growth factor-rich tears
- Punctal occlusion with Lacrifill to improve tear retention
- IPL or Radio Frequency to prevent tear evaporation and reduce inflammation
- Protective strategies such as copious lubrication with artificial tears, moisture chambers, or lid taping at night
Why Early Detection Matters
Unlike most corneal conditions, neurotrophic keratitis can progress without significant discomfort or pain, putting patients at risk for advanced ulcers or corneal thinning before they realize the severity. Consistent follow-up and careful corneal examination , particularly for those with prior ocular surgery, viral keratitis, systemic neuropathy, or decreased sensation , allows intervention before irreversible damage occurs.
Why Choose Dr. Rachel Shlomov for NK Evaluation in Miami
Dr. Rachel Shlomov, OD provides specialized evaluation and management of neurotrophic keratitis with a focus on accurate nerve function assessment, early intervention, and advanced therapies tailored to each patient’s needs. Patients experiencing unexplained corneal defects, persistent wounds, or diminished corneal sensitivity from Miami Beach, Surfside, Bal Harbour, and the greater Miami area benefit from her comprehensive approach, including Neurotrophic Keratitis Treatment in Miami Beach guided by careful staging and follow-up.
Neurotrophic Keratitis Care Near Surfside, Bal Harbour & Miami Beach
If you have persistent corneal defects, poor healing, or a history of nerve-related ocular conditions, specialized assessment for neurotrophic keratitis is available locally in Miami Beach. Early diagnosis and customized treatment significantly improve outcomes. This is especially helpful for patients who have been searching Neurotrophic Keratitis TreatmentNear Me and need a clear plan based on disease stage and corneal healing risk.
Schedule a Neurotrophic Keratitis Evaluation
If your cornea isn’t healing properly or you have diminished corneal sensation with surface irregularities, schedule a comprehensive evaluation with Dr. Rachel Shlomov to determine the cause, assess disease stage, and discuss Neurotrophic Keratitis Treatment in Miami Beach options tailored to your clinical findings.