Corneal ulcer

Classification according to ICD-10
H16.0	Corneal ulcer
ICD-10 online (WHO version 2019)

A corneal ulcer is a creeping ulcer of the cornea of the eye , which is often caused by bacteria, but can also be triggered by a fungal infection. Infections of the cornea are possible after trauma or with a special disposition in people with eczema , as well as diabetics , alcoholics and contact lens wearers . A corneal ulcer is extremely painful and accompanied by increased lacrimation and eyelid cramps .

The metabolism of the cornea is highly dependent on an intact nerve supply with the local release of neurotrophins being kept going . In the event of an injury to the sensitive corneal nerve trigeminal , the partial or complete loss of the sensitivity to touch of the cornea due to the reduced blinking and the inability of the corneal epithelium to regenerate due to the reduced production of human nerve growth hormone (hNGF / Human Nerve Growth Factor ) can be serious and nevertheless Almost painless corneal ulcers ( neurotrophic keratitis ) develop, up to and including penetration of the cornea with loss of the eye.

The neurotrophic corneal ulcer is divided into 4 stages:

Stage I: Corneal irregularity, broken tear film (stippling) and reduced visual acuity
Stage II: non-healing persistent epithelial defects (PED / Pesistend Epithelial Defects)
Stage III: Corneal ulcer that has broken through the basement membrane and penetrated into the corneal stroma, up to and including perforation

In 2018, after successfully completing studies , recombinant hNGF obtained from Escherichia coli was ready for the market and can also be prescribed as a drug for patients with statutory health insurance if indicated. The drug used in eye drops with high frequency of use is very expensive and can only be delivered to the patient in fractions while maintaining a cold chain.

literature

Theodor Axenfeld (founder), Hans Pau (ed.): Textbook and atlas of ophthalmology. Gustav Fischer Verlag, Stuttgart 1980, ISBN 3-437-00255-4 , p. 216 (with the collaboration of Rudolf Sachsenweger and others)

Individual evidence

↑ Müller et al .: Corneal nerves: structure, contents and function . In: Exp Eye Res . tape 76 , no. 5 , 2003, p. 521-542 .
↑ F. Hefti: Neurotrophic factor therapy for nervous system degenerative diseases . In: J Neurobiol . tape 25 , no. 11 , 1994, pp. 1418-1435 .
↑ Stephano Bonini, REPARO Study Group: Phase II Randomized, double-Masked, Vehicle-Controlled Trial of Recombinant Human Nerve Growth Factor for Neurotrophic Keratitis . Ed .: American Academy of Ophthalmology. Elsevier, New York 2018.

[1] Müller et al .: Corneal nerves: structure, contents and function . In: Exp Eye Res . tape 76 , no. 5 , 2003, p. 521-542 .

[2] F. Hefti: Neurotrophic factor therapy for nervous system degenerative diseases . In: J Neurobiol . tape 25 , no. 11 , 1994, pp. 1418-1435 .

[3] Stephano Bonini, REPARO Study Group: Phase II Randomized, double-Masked, Vehicle-Controlled Trial of Recombinant Human Nerve Growth Factor for Neurotrophic Keratitis . Ed .: American Academy of Ophthalmology. Elsevier, New York 2018.