AQUEOUS TEAR PRODUCTION IN PATIENTS WITH NEUROTROPHIC KERATITIS

The purpose of this study was to determine whether corneal epithelial defects and epitheliopathy in patients with unilateral dysfunction of the ophthalmic division of the trigeminal nerve (neurotrophic keratiti s) is associated with reduced aqueous tear production, Sensation of th e skin, cornea, and nasal mucosa, aqueous tear production by Schirmer 1 testing, nasal-lacrimal reflex, and exposure zone rose bengal staini ng were evaluated in the affected and fellow eyes of subjects with neu rotrophic keratitis (n = 5), eyes of subjects who had recent herpes te ster ophthalmicus (HZO) and who did not develop neurotrophic keratitis (n = 4), and normal controls (n = 10). Sensation in the brow and uppe r lid skin and nasal mucosa was absent on the affected side of patient s with neurotrophic keratitis, but was intact in all other groups. Cor neal sensation and Schirmer 1 test values were significantly reduced ( p less than or equal to 0.05) in eyes with neurotrophic keratitis comp ared with the other groups. The nasal-lacrimal reflex was absent on th e involved side of subjects with neurotrophic keratitis but was intact in subjects with HZO without keratopathy, and in normal controls (p l ess than or equal to 0.008). Rose bengal keratitis staining scores wer e significantly increased in eyes with neurotrophic keratitis compared with the other groups (p less than or equal to 0.05). We conclude tha t neurotrophic keratitis is associated with reduced cutaneous, nasal m ucosal, and corneal sensation on the affected side, as well as marked reduction in aqueous tear production with loss of the nasal-lacrimal r eflex. It is possible that the corneal epithelial pathology in neurotr ophic keratitis is due in part to aqueous tear deficiency.