Case Report: Neurotrophic Ulcer Secondary to a Hypoplastic Trigeminal Nerve in a Three-Year-Old Boy

Introduction We present a challenging case of a boy aged 3 years with a refractory neurotrophic ulcer secondary to congenital trigeminal anesthesia treated with recombinant human nerve growth factor and corneal neurotization surgery. Case Report A boy aged 3 years presented with a nonresolving neurotrophic corneal ulcer after unsuccessful treatment consisting of topical antibiotics, steroids, and lubricating eye drops. Prior magnetic resonance imaging revealed a congenital hypoplastic trigeminal nerve. After no improvement with amniotic membrane transplantation and tarsorrhaphy, and minimal improvement with allogenic serum eye drops, recombinant human nerve growth factor resolved the neurotrophic ulcer in 1 week. Because of repeated corneal injury and high risk of progression, the boy underwent corneal neurotization surgery, which was successful. Conclusion This case adds to the growing body of literature supporting the use of recombinant human nerve growth factor for acute neurotrophic ulcers and neurotization in the long-term treatment of congenital neurotrophic keratitis.