The eyeball has a lot of nerve endings. The cornea, or the clear dome in the front of your eyeball, is about 300 to 500 times more sensitive than your skin. When a child is born without feeling in the cornea – a condition called corneal congenital neurotrophic keratopathy—their eyes cannot feel any sensation.
Why eye sensation is important
While you might not think much about how much your eyes feel, your eyeball is using those nerves to protect itself. These nerves signal your eyes to close before they get poked with a finger or to keep out sand when the wind blows. If you have dust stuck in your eye, these nerves will alert you. If these nerves are not working, they cannot protect the eye from harm or help it to heal. It can be challenging to notice neurotrophic keratopathy in babies.
“Observing the behavior in kids is really important,” said Dr. Gregory Borschel, a plastic surgeon at Riley Children’s Health. “In children, there can be an absence of symptoms. Children with neurotrophic keratopathy often completely lack pain. These kids won’t get your attention by crying because the irritant in their eye doesn’t hurt them. So we have to watch for other behaviors.”
Neurotrophic keratopathy in babies
In babies, neurotrophic keratopathy, or NK, can appear as if the child does not feel something poking their eye. They may not close their eyes in the bath when water runs over their face. Over time, scratches from dirt, dust or other irritants cause scarring or ulcers on the cornea. This scarring causes the cornea to become cloudy and difficult to see through. If left untreated, it can lead to blindness.
When to repair nerve damage using corneal neurotization
A child with NK is more likely to develop corneal ulcers, or open wounds that develop on the front of their eye after an injury or scrape. With each ulcer, the child’s eye clouds over more. It’s important to treat NK before the eye becomes too damaged. Drs. Borschel and Boente regularly perform corneal neurotization surgery on infants and have treated children as young as seven months old.
“The cornea needs to clear, like seeing through the windshield of your car. If the windshield of your car becomes opaque and you can’t see through it, the rest of your car may be working fine, but you can’t drive it,” said Dr. Charline Boente, a pediatric ophthalmologist at Riley Children’s Health. “We want to stop the disease from progressing and intervene before the cornea becomes fully opaque. If that happens, we can still do neurotization, but the child will still have some permanent cloudiness after the surgery.”
In young children with NK, corneal neurotization can save their vision.
How corneal neurotization works
When a child does not have any working nerves in the eye’s cornea, corneal neurotization surgery is the only effective treatment option. In this procedure, doctors implant a healthy nerve into the cornea. Riley Children’s Health is a major center providing corneal neurotization for children worldwide.
What to expect from corneal neurotization surgery
In this procedure, a plastic surgeon like Dr. Borschel locates and removes a nerve from your child’s leg. This does not affect your child’s ability to run or walk. Next, an ophthalmologist like Dr. Boente transplants the nerve on the eye. Surgeons connect the new nerve to existing nerves in the face to “power” sensation in the cornea. Finally, the surgeon sews your child’s eyelid shut temporarily to protect the new nerves.
Your child will spend the night in the hospital. The eyes stay closed for a week, and the sutures are removed painlessly at a follow-up appointment. Patients receive antibiotic steroid ointments after surgery and should avoid a lot of activity for about six weeks. A few months after surgery, the child will begin the early stages of regaining feeling in the eyes.
Outcomes from corneal neurotization surgery
This surgery has a low risk of complications. Dr. Borschel pioneered corneal neurotization, and his research shows that it significantly recovers sensation in a child’s cornea. This procedure dramatically reduces the risk for ulcers in the future and prevents loss of eyesight because the brain can now sense problems in the eye.
“Corneal neurotization rewires the brain,” Dr. Borschel said. “We’ve scanned patients before and after surgery, and we observed that the brain remapped sensation because of this nerve operation on the eye.”
When corneal neurotization is right for your child
If you think your child might have neurotrophic keratopathy or loss of eye sensation, talk to your child’s pediatrician or eye doctor. Even if multiple eye ulcers have damaged the cornea, corneal neurotization can make a difference.
“No matter how badly scarred the cornea is, these children are still at risk for perforation and losing the eye,” said Dr. Boente. “Even in those cases, there’s an argument for trying to preserve the globe and prevent the progression to perforation.”
If you are concerned about your child’s eye, talk with your pediatrician or eye doctor. Be sure to address these problems as soon as you have concerns so that your child has the opportunity to develop healthy vision.
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