What is the hallmark sign associated with Neurotrophic keratopathy?

• A. MGD
• B. Floppy eyelid syndrome
• C. Inferior SPK
• D. Decreased corneal sensitivity

Answer: (D)

Neurotrophic keratopathy centers on loss of corneal innervation. The cornea normally relies on sensory nerves, mainly from the trigeminal nerve, to provide trophic support and to trigger protective reflexes like blinking and tear production. When corneal sensation is reduced, the epithelium receives less nourishing input and the reflexes that help protect and heal the surface are diminished. This makes the corneal surface susceptible to poor healing, persistent epithelial defects, and, in more advanced cases, neurotrophic ulcers. Because of this, decreased corneal sensitivity is the defining feature. Other findings such as meibomian gland dysfunction or floppy eyelid syndrome involve different mechanisms and aren’t specific hallmarks of NK, and superficial punctate keratopathy can occur but doesn’t define NK as clearly as loss of sensation.