In-Depth Thinking About the Diagnostic Methods and Treatment Strategies for the Corneal Nerves in Ocular Surface Disorders

Abstract

We summarize recent developments in modern diagnostic tools for the corneal nerves, the diseased status reflected in corneal nerve changes, and the possible corneal nerve regenerative treatments. In vivo confocal microscopy (IVCM) and en face optical coherence tomography (EFOCT) are reliable tools for detecting the morphological changes of corneal nerves; while the esthesiometry is useful for studying the functional status of the corneal nerves. Corneal tortuosity increases in dry eye disease (DED) and neuropathic pain. Decreased of corneal nerve density in neurotrophic keratopathy (NK) is a marker of disease progression. Topical treatments of corneal nerve regeneration include substance P/insulin-like growth factor-1 combination and nerve growth factor. Blood-derived products rich in neurotrophic factors are also under investigation. For refractory NK, surgical corneal neurotization could be considered. With the development of technology in detecting corneal nerves, we can quantify the disease progression by which greatly benefits the development of corneal regenerative treatment.