Case Report: Scleral Lens Management in a Case of Neurotrophic Keratitis Caused by Acoustic Neuroma

Introduction Neurotrophic keratitis is an ocular surface disease caused by decreased or absent corneal sensory innervation, which can lead to epithelial breakdown, delayed cornea healing, and ultimately corneal ulceration and perforation. The current treatment and management strategies for neurotrophic keratitis focus on promoting corneal healing and preventing corneal ulceration and perforation. Scleral lenses are an an effective noninvasive treatment option for neurotrophic keratitis that can lead to many desired treatment outcomes, including enhanced corneal healing, improved visual acuity, and reduced total number of ocular medications. Case Report A White woman aged 57 years presented for scleral lens fitting with longstanding unilateral neurotrophic keratitis in the right eye following acoustic neuroma removal. The distance best corrected visual acuity was 20/60- in the right eye. The initial evaluation revealed moderate stage neurotrophic keratitis with several oval-shaped epithelial defects and a large area of horizontal corneal scar tissue across the visual axis. After 1 year of successful scleral lens wear, all the large epithelial defects healed, and the severity of neurotrophic keratitis improved with significantly less corneal haze in the horizontal scar tissue. The patient reported having clear and comfortable vision all day, with 20/25 best corrected visual acuity in the right eye. Conclusion This case report demonstrates that scleral lenses are highly effective for the management of neurotrophic keratopathy. Its visual correction and therapeutic effects can lead to a less burdensome management plan and improved patient outcomes, supporting adding scleral lens to the current treatment protocol for early stages of neurotrophic keratitis.