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JA King, JC Affeldt, M Agarwal; Central Corneal Hypoesthesia Secondary to Peripheral Corneal Inflammatory Disease . Invest. Ophthalmol. Vis. Sci. 2002;43(13):34.
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Purpose: A case of non-NSAIDs Stage III (stromal melt) neurotrophic keratitis with near perforation was recently documented following LASIK. Associated peripheral phlyctenular disease was suspected of creating preoperative corneal hypoesthesia which when coupled with LASIK generated nerve injury resulting in manifest neurotrophic disease. The purpose of this report was to document corneal sensation in a series of patients with peripheral inflammatory corneal disease. Methods: Central corneal sensation was measured by Cochet-Bonnet esthesiometer in a series of 14 nondiabetic unoperated eyes with peripheral inflammatory corneal disease evidenced by superficial scarring and/or vascularization. Disease categories included phlyctenular keratoconjunctivitis (12 eyes), and rosacea keratitis (2 eyes). Results were compared to 32 normal control eyes. Results: Average corneal sensation was significantly reduced in the diseased eyes (mean = 28.4 mm) as compared to controls (mean = 56.3 mm; P=0.005). Correlation between degree of sensation loss and clock hours of peripheral involvement was identified. Conclusion: Peripheral corneal inflammatory disease resulting in superficial scarring and/or vascularization can significantly reduce central corneal sensation; probably by damaging peripheral stromal nerve trunks. Under most circumstances, this reduction is clinically insignificant. If however, additional nerve injury is superimposed such as that created by excimer refractive surgery, manifest neurotrophic disease can result. Increased risk of neurotrophic related postoperative complications should therefore be anticipated in refractive surgical candidates demonstrating active or inactive peripheral corneal disease.
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