Post-Surgical Neurotrophic Corneal Ulcer Following Trigeminal Neuralgia Treatment: A Case Report

Abstract

Introduction: Neurotrophic keratopathy is a rare degenerative corneal disease caused by partial or complete impairment of trigeminal nerve innervation. Loss of corneal sensitivity results in epithelial instability, impaired healing, and progressive damage to the corneal surface. In advanced stages, persistent epithelial defects may evolve into stromal ulceration and even corneal perforation, potentially leading to severe visual impairment. Various etiologies have been reported, including herpetic infections, diabetes mellitus, intracranial tumors, trauma, and neurosurgical procedures involving the trigeminal nerve. Case Presentation: We report the case of a 61-year-old woman with a history of trigeminal neuralgia treated by thermocoagulation of the Gasserian ganglion eight months prior to presentation. The patient consulted for a painless red right eye associated with progressive visual impairment for 15 days. Ophthalmological examination revealed a best-corrected visual acuity limited to near finger counting. Slit-lamp examination demonstrated marked conjunctival hyperemia and a large central epithelial–stromal ulcer measuring 9 × 6 mm with intense fluorescein staining and peri-lesional stromal edema. Corneal sensitivity testing revealed a complete loss of sensitivity in the affected eye. Fundus examination was limited due to corneal opacity. The contralateral eye examination was unremarkable. Management and Outcome: The patient was managed conservatively with intensive ocular surface lubrication, autologous serum eye drops, frequent ocular lavage, and the placement of a therapeutic soft contact lens with close daily monitoring. Clinical evolution was favorable, with the onset of corneal re-epithelialization observed by the fifth day of treatment and complete epithelial healing achieved by day 30. At the two-month follow-up, a para-axial corneal scar persisted, and the final best-corrected visual acuity was 2/10. Conclusion: Neurotrophic corneal ulcers following trigeminal nerve procedures represent a potentially sight-threatening complication. Early diagnosis based on careful clinical history and systematic assessment of corneal sensitivity is essential. Prompt initiation of aggressive ocular surface therapy can promote epithelial healing and prevent serious complications such as corneal melting or perforation.