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Anaesthetic corneas with intact sub-basal nerve plexus
  1. Virinder K Dhillon,
  2. Mohamed S Elalfy,
  3. Mouhamed Al-Aqaba,
  4. Harminder S Dua
  1. Division of Ophthalmology and Visual Sciences, Nottingham University Hospitals, University of Nottingham, UK
  1. Correspondence to Professor H S Dua, Department of Ophthalmology, Derby Road, Nottingham NG7 2UH, UK; harminder.dua{at}

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In vivo confocal microscopy (IVCM) allows detailed examination of the corneal nerves. Damage to V-1 can result in corneal anaesthesia and neurotrophic keratitis. It is not clear whether corneal anaesthesia is related to loss of nerves in the sub-basal plexus or not. We present evidence from patients with uniocular corneal anaesthesia and a normal sub-basal plexus demonstrating a lack of such correlation.

A 57-year-old woman with history of left trigeminal neuralgia for several years had unsuccessful left alcohol trigeminal root injection followed by a left microvascular decompression. Postoperatively she developed persistent dry eye symptoms. Visual acuity (VA) was 6/9. Her left cornea showed superficial punctuate epithelial erosions (SPEE). Corneal sensation (Cochet–Bonnet) was 60 (normal) in her right eye and 0 (absent) in her left eye. IVCM revealed normal stromal and sub-basal nerves with equal density on both sides (figure 1A,B).

Figure 1

In vivo images taken using a laser scanning confocal microscope (HRT II-Rostock Cornea Module (HRT II-RCM) manufactured by Heidelberg engineering GmbH, …

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  • Contributors VKD, MSE, MA-A and HSD all contributed to literature search and drafting the manuscript. HSD also contributed to the conception and clinical interpretation of confocal microscopic findings, critically revising the article and approving the final version to be published.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval NRES Committee East Midlands.

  • Provenance and peer review Not commissioned; externally peer reviewed.