New report highlights early, hidden forms of neurotrophic keratopathy in children

A new report describes key clinical features of neurotrophic keratopathy (NK) in children, noting that the condition is frequently congenital or inherited and may present before any visible corneal abnormalities are detected. The authors highlight that some children demonstrate absent corneal sensation despite a normal ocular examination, a presentation that is not currently captured by existing staging systems.

According to the report, pediatric NK has added visual significance because stromal opacification may place children at risk for amblyopia. In contrast to adult-onset NK, which is typically acquired, childhood disease is more commonly linked to genetic pain insensitivity syndromes, cranial dysinnervation disorders, or broader developmental anomalies.

The authors also note that visual function can remain well preserved in many affected children when supportive management or targeted medical and surgical interventions directed at sensory nerve function are used.

Based on these findings, the report proposes a modification to the current NK classification, adding a category for eyes with no detectable corneal sensation but otherwise normal clinical findings—a phenotype the authors state is commonly encountered in early-stage pediatric NK.

Reference

Jiang J, Ashton CBJ, Larkin DFP. Neurotrophic keratopathy in childhood: advances in understanding of pathogenesis and management. Eye (Lond). 2026;doi: 10.1038/s41433-026-04278-7. Epub ahead of print. PMID: 41644711.