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Neurotrophic and Anhidrotic Keratopathy Treated With Substance P and Insulinlike Growth Factor 1

Sandra M. Brown, MD; David W. Lamberts, MD; Ted W. Reid, PhD; Teruo Nishida, MD, DSc; Christopher J. Murphy, DVM, PhD
Arch Ophthalmol. 1997;115(7):926-927. doi:10.1001/archopht.1997.01100160096021.
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We describe the use of topical substance P (SP) and insulinlike growth factor 1 (IGF-1) in the treatment of severe neurotrophic and anhidrotic keratopathy in a young child. These compounds may provide a medical therapy for patients with keratopathy due to corneal anesthesia or dry eyes unresponsive to lubrication.

Report of a Case.  A 16-month-old white girl was referred to 1 of us (D.W.L.) for the evaluation of bilateral nonhealing corneal epithelial defects. She had difficulty swallowing since birth and developmental delay. She never produced tears when crying. An ocular examination revealed bilateral central epithelial defects (~5×5) mm) in both eyes; there was no evidence of infection or uveitis. There were no visible tear lakes. The child had no blink response to a cotton wisp or to instillation of eyedrops. Despite intensive lubrication and bandage contact lens treatment, rapid stromal melting occurred bilaterally (Figure 1), leading to a central descemetocele


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