Kaleb Abbott and Andrew Pucker are joined by Jeff Banas, an OD from Wisconsin specializing in glaucoma and dry eye, to discuss neurotrophic keratitis (NK).

The trio begin by trying to clarify what, specifically, NK is and how it develops. While classically associated with herpetic infections (HSV/HZV), the panel emphasizes that other significant causes include diabetes, ocular or neuro surgery, chronic glaucoma medication use, and severe ocular surface disease. All can damage the trigeminal nerve, leading to loss of tearing and other functions that help sustain corneal health, resulting in formation of corneal epitheliopathy or even a persistent corneal epithelial defect. Left untreated, this has the potential to progress to stromal ulceration or even perforation.

A hallmark warning sign is “stain without pain”—significant corneal sta ...