Eye numbness or corneal anesthesia is also known as neurotrophic keratopathy. This condition describes when the nerves in the eye’s cornea are absent or damaged, which can eventually lead to blindness. Riley Children’s Health is among a small number of centers worldwide with extensive experience performing corneal neurotization in children.
What is Neurotrophic Keratopathy?
What is Neurotrophic Keratopathy?
Neurotrophic keratopathy is an eye condition in children or adults. It affects the cornea, or the transparent, outermost portion of the eye. When children have neurotrophic keratopathy (NK) they cannot feel their cornea. With this loss of sensation, the eye can't protect the cornea, leaving it vulnerable to injury.
Typically, a scratch on the cornea would feel extremely painful. However, people with neurotrophic keratopathy don't notice debris in the eye, such as dirt, sand and other irritants, because they don’t have corneal nerves. Over time, these scratches cause scarring and clouding of the cornea. Once the cornea becomes cloudy, a decline in vision becomes permanent because the scarring blocks light from reaching the inside of the eye. The effects of neurotrophic keratopathy on the cornea create what we call neurotrophic keratitis, or injury to the surface of the cornea.
Children with NK are also much more likely to develop corneal ulcers. This lack of feeling makes it more difficult to heal corneal injuries. Ulcers can lead to corneal scarring, thinning or even perforation, which can all cause permanent damage to the vision and eye.
Symptoms
Common signs of NK to watch for in children are:
- Keeping their eyes open during shampooing, swimming or other activities where they would ordinarily close their eyes
- Placing fingers into their eyes or directly touching them
These are signs that a child has a lack of feeling in the cornea of the eye. Schedule an appointment with your child’s doctor to address these symptoms.
Causes for Neurotrophic Keratopathy
Some people cannot feel their corneas because the nerves that provide this sensation didn’t form during fetal development. This loss of sensation can also happen due to genetics, tumors, infections or other causes.
What is Corneal Neurotization?
What is Corneal Neurotization?
When possible, doctors at Riley Children’s Health will work to treat your child’s NK without surgery. However, if your child has advanced NK that will not get better without surgery, your child's doctor may recommend corneal neurotization. This is the first—and currently the only—surgical treatment that introduces new nerves into the cornea, rather than simply protecting an eye without feeling.
Corneal neurotization is a minimally invasive surgery where doctors take nerves from your child’s leg and graft them into the cornea to address the lack of nerves and sensation. The goal of this treatment is to prevent blindness and further damage to your child's sight.
Riley Children's Health is a global leader in developing and advancing corneal neurotization. Our multidisciplinary team has helped advance surgical techniques and research into long-term outcomes. Our highly skilled ophthalmologist (eye specialist) and pediatric plastic surgeon work together to treat your child by creating a custom treatment plan to match your child’s needs.
What to Expect with Corneal Neurotization
What to Expect with Corneal Neurotization
Your child will first visit a plastic surgeon and an ophthalmologist to develop a treatment plan. Our team will then meet with you to discuss how corneal neurotization works, what to expect and answer any questions you or your child may have. Your care team will likely ask you to continue any treatments your child uses for neurotrophic keratitis, such as eye drops.
Corneal neurotization begins by locating and removing a healthy nerve in your child's leg. Next, this nerve segment is used as an "extension cord" to allow nerve cells to grow into the eye. This nerve is then tunneled under the skin, under the lining of the outer eye and into the cornea.
The new nerve will grow into the eye and begin providing sensation to the eye. This will help prevent any further ulcerations or scarring that damage the cornea and limit vision.
After Surgery
After the surgery, your child will stay overnight at Riley Hospital for Children and return home the following day. Most families from out of town stay in Indianapolis for up to a week after surgery.
For a week following surgery, your child’s affected eyelids are temporarily closed to protect the newly grafted nerve. Your child will also have a bandage on their leg, where the nerve was removed. Removing this nerve does not affect your child’s ability to run or walk. Recovery from corneal neurotization surgery is typically smooth, and children usually tolerate the new nerves well.
For six weeks after corneal neurotization, your child must rest and avoid any physical activity, including sports, to allow the eye to heal completely. Over the next several months, your child will regain feeling in the cornea. Complete regrowth of the nerve can take up to one to two years.
Throughout your child’s preparation and surgery, our Child Life specialists are available to provide additional education and support to help reduce anxiety or concerns about the procedure.
Key Points to Remember
Key Points to Remember
- Corneal neurotization is a safe, reliable surgery to address vision loss and damage for children with corneal anesthesia.
- Children typically tolerate this surgery very well and recovery is often uneventful.
- When children are monitored many years after surgery, clinical studies show this surgery provides lasting protection against recurrent injury.
Frequently Asked Questions
Frequently Asked Questions
How do I schedule a consult?
To initiate a consultation, please contact the plastic surgery department at Riley Children’s Health by calling 317.948.0345.
What if I live outside of Indiana?
Our team has treated many patients from other states in the United States and even other countries. Our staff works with insurance companies to facilitate coverage for the surgery.
How is pain managed after surgery?
Our team uses a combination of local anesthesia and pain medications to keep your child comfortable. This procedure is well tolerated, and children typically do not experience much pain.
How does this operation help my child's vision?
Corneal neurotization helps prevent ulcers from forming and scarring as the ulcers heal. This surgery helps stabilize your child’s vision and prevent neurotrophic keratopathy from getting worse.
What is a good age to do this kind of surgery?
Our team has treated patients of all ages, from infancy to late teens. Once your child is diagnosed with NK, we feel it is best to intervene sooner rather than later. This helps prevent scarring of the cornea and allows your child to retain as much of their vision as possible.
Are there any side effects from the surgery? Will my child still have feelings in their leg?
The use of nerve grafts from the legs does not impact running, jumping or walking.
Corneal Neurotization Research
Corneal Neurotization Research
Riley Children's is actively involved in corneal neurotization research focused on:
- Understanding neurotrophic keratopathy and how corneal neurotization works
- Improving long-term outcomes for children with neurotrophic keratopathy
- Developing new therapies
Dr. Gregory Borschel and Dr. Charline Boente have led many of these research efforts focused on improving the outcomes of children with neurotrophic keratitis. Our team was involved in the early development of corneal neurotization surgery in children, including some of the first pediatric and bilateral procedures reported in medical literature.
Dr. Borschel and Dr. Boente have opened a global study to assess outcomes following corneal neurotization called CorNeA: Corneal Neurotization Assessment Registry. To learn more or receive enrollment information, email Dr. Pareena Sharma at pareshar@iu.edu.
Support Services & Resources
Support Services & Resources
We offer a broad range of supportive services to make life better for families who choose us for their children's care.
The Winks Foundation offers financial assistance to patients who must travel long distances for corneal neurotization surgery.
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