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Neurotrophic keratopathy, characterised by poorly healing corneal epithelium, occurs in eyes with decreased corneal sensory innervation. Clinical findings include chronic epithelial defects and corneal ulceration. Numerous conditions predispose to neurotrophic keratopathy including diabetes mellitus, accidental and surgical trauma, herpes simplex and herpes zoster keratitis, leprosy, and topical anaesthetic abuse.
Management of neurotrophic keratopathy includes ocular lubrication, pressure patching, autologous serum eye drops,1 fitting of a bandage contact lens,2 amniotic membrane grafting,3,4 and surgical tarsorrhaphy. Surgical tarsorrhaphy can be very successful in resolving neurotrophic corneal ulceration,5 but many patients find this option cosmetically unacceptable.
We describe a novel method of non-surgical tarsorrhaphy using over the counter adhesive, non-medicated, nasal dilator strips (NDS) (Breathe Right Nasal Strips, Whippany, NJ, USA) applied vertically across the eyelids (fig 1). The adhesive strip consists of parallel bands of plastic imbedded in a pad, and is available in different sizes.
The nasal strips were originally developed to treat patients with snoring problems,6 or to improve nasal congestion.7 In rhinological applications, the strip is typically used horizontally across the nose in order to open the nasal airway. In the current study, we applied the strip vertically over the closed eyelid as shown in figure 1. The adhesive strip creates a firm and effective eyelid closure, and patients can control the application and removal of the strip. The strips have the advantage of being relatively inexpensive, reusable, and reversible, and their use has replaced standard eye patching in our clinical practice. We have noted success with the use of these strips for the management of neurotrophic ulceration and describe two representative cases.
A 60 year old woman developed a neurotrophic corneal ulcer following a complicated retinal detachment repair. After a year of standard medical therapies, including lubrication and frequent conventional patching, she continued to have a 4 mm×4 mm chronic non-healing epithelial defect. Treatment with reversible NDS tarsorrhaphy was initiated with instructions to apply the strips at bedtime and as much as possible during the day. Nine weeks later the corneal epithelial defect had healed completely. Over the next year she gradually decreased the wearing time of the strips and is currently stable without their use.
A 48 year old woman with a 6 mm×2 mm neurotrophic corneal ulcer was referred for management after failing numerous medical and surgical therapies including lubrication, autologous serum eye drops, patching, and an amniotic membrane graft. The patient was instructed to use NDS tarsorrhaphy according to the schedule described in the previous case. Within 2 weeks the corneal epithelial defect healed completely. The patient continues to apply the tarsorrhaphy but with decreasing frequency.
The novel use of nasal dilator strips to perform a temporary tarsorrhaphy has aided us greatly in our management of neurotrophic corneal ulceration. We believe it is an attractive, cost effective, efficient alternative to patching for any ocular condition. In addition, nasal strip tarsorrhaphy allows for immediate reversibility that facilitates patient acceptance.