Which finding is most associated with decreased corneal sensation?

• A. Filamentary keratopathy
• B. Acanthamoeba keratitis
• C. Neurotrophic keratopathy
• D. Thygeson's SPK

Answer: (C)

Corneal sensation is essential for maintaining a healthy surface because the sensory nerves provide trophic support to the epithelium and trigger reflex tearing and blinking. When these nerves are damaged or diminished, the corneal epithelium loses that trophic signaling and heals poorly, leading to neurotrophic keratopathy. The key feature is decreased corneal sensation, often with persistent epithelial defects or ulcers and potential stromal thinning due to inadequate epithelial maintenance. Filamentary keratopathy comes from tear film instability and mucus filaments on an otherwise intact surface, so sensation isn’t the defining issue. Acanthamoeba keratitis presents with severe pain out of proportion to exam and characteristic infiltrates; decreased sensation isn’t the central association. Thygeson’s superficial punctate keratitis shows recurrent epithelial erosions with relatively normal sensation. Thus, the finding most associated with decreased corneal sensation is neurotrophic keratopathy.