If you have a dry eye patient without typical pain presentation, consider neurotrophic keratitis and this treatment option
At SECO 2026, Katie Rachon, OD, of Virginia Eye Consultants, talks about a patient case that presented as dry eye disease but was actually stage 1 neurotrophic keratitis. She shared how she used CAM360 to treat this patient.
Katie Rachon, OD:
Hi, I’m Katie Rachon. I’m an optometrist, and I am the residency director for our optometric residency program at Virginia Eye Consultants in Norfolk, Virginia. At SECO, I presented a poster using a cryopreserved membrane, a CAM360 from BioTissue, to treat stage 1 neurotrophic keratitis in a patient that had a damaged trigeminal nerve system. The big takeaways from my poster is (1), if you have a recalcitrant dry eye that is not responding properly to treatment, if you have a patient with a history of systemic disease that you know that it can cause a decrease in corneal sensitivity, that you should be adding corneal sensitivity to your testing. In these patients, you’ll see a lot of dry eye signs like superficial punctate keratitis. They’ll be complaining of tearing. They’ll be complaining of blurry vision. You might have a fluctuating refraction for these patients, but they’re not complaining of any pain.
It’s the classic stain without pain. That is actually a sign beyond of what they started. Sometimes they just start with a absent or a decreased nerve sensitivity in their cornea. It’s important to be catching these patients early, but if you have a patient that’s in your chair that has the stage 1 neurotrophic keratitis, meaning that there is no stromal involvement, there is no risk of perforation or thinning of the cornea, then you can very, very easily treat this with a CAM360, very easy to put in. It’s very comfortable for the patient. It fits in very well in most clinical situations. My clinic is very busy, and I find that this is a very quick and painless procedure for a patient. In this particular case, I used a collagen shield, so it was able to dissolve. I used a 72-hour dissolvable one.
I did see her back, but some doctors decide to let patients go without a frequent return follow-up just based on patient transportation or patient limitations. In this case, this patient healed exceptionally well. Essentially, her punctate keratitis healed from the CAM360, and I left that treatment as is. BioTissue has done a good job about researching corneal sensitivity after cryopreserved membrane. Based on patient discussion that we’re going to reassess corneal sensitivity in a few months after this case.
A takeaway: please check corneal sensitivities and please make sure that neurotrophic keratitis is in your differentials if you have a dry eye patient that is not complaining of the typical pain. If you have a stage 1 neurotrophic keratitis, then consider a cryopreserved membrane, a CAM360 to help treat these patients. The patients do tolerate the procedure very well and it’s very fast acting. That is kind of why we’re here is to make sure patient gets better and to not cause any harm. It’s a win-win for patients.
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