Corneal Neurotization Surgery(Reinnervating a Numb Cornea)

What the Evidence Shows

Corneal neurotization treats the numb eye at its source. The evidence is observational—case series, one prospective comparison, and reviews—not a randomized trial against drops. The surface benefit is still the most consistent finding in the field.

• Terzis's 2009 series of six eyes established the operation. Sensation rose from essentially none to a mean of about 278 mm on Cochet-Bonnet testing, and every eye stayed free of ulcers across a mean 16-year follow-up.
• Elbaz, Bains, Borschel, and Ali then showed that a sural graft to the supratrochlear nerve can restore feeling through small incisions. Catapano and Fung later reported 19 eyes: sensation rose from 0.8 mm to 49.7 mm, recurrent epithelial defects fell from 89% to 21%, and confocal microscopy plus magnetoencephalography proved the new nerves were real and connected to the brain.
• Woo, Daeschler, Borschel, and Ali later confirmed that the same minimally invasive operation protects against recurrent ulceration and can improve acuity when the surface is still salvageable.
• Fogagnolo's 2020 multicenter series compared direct and indirect transfer in 26 eyes. Neurotrophic keratopathy healed in every patient at a mean of 3.9 months. Sensation improved in both groups, and the two techniques were statistically equivalent at one year.
• Park's 2020 review of 54 published eyes found better sensation and vision after neurotization, with children recovering more feeling and established stromal scarring as the usual limit on acuity.
• Jowett and Pineda described great-auricular transfer through scleral-corneal tunnels and argued that the patient's own nerve, not a processed cadaver graft, is the reliable conduit. Borschel's later 10-year technique update also includes great-auricular donor transfer when the trigeminal system is gone.
• The aim is a stable, feeling surface—not a new blink. If the facial nerve is also out, eyelid weights or slings still have to close the eye. Earlier referral, before irreversible stromal scarring, gives the better sensory result and can make a later corneal transplant possible.
• Donor-nerve choice follows the map of what sensation is left. Trigeminal branches such as the supratrochlear or supraorbital nerve are preferred when they are still working, and the greater auricular nerve is used when facial sensation on that side is absent - so charting the pattern of numbness is a planning step, not a formality.
• Surgery does not replace surface care. Preservative-free lubricants, bandage contact lenses, autologous serum or plasma drops, topical nerve growth factor, punctal plugs, amniotic membrane, and partial eyelid closure may all still be needed before and after neurotization.
• When a corneal transplant is also needed, it is typically deferred about a year and until sensation and the ocular surface have been adequately restored, because a sensate, stable cornea makes the graft safer.
• Reported complications are generally low and mostly self-limiting - numbness or discomfort where a graft is harvested, eyelid swelling or scarring, and infrequent surgical problems. Serious vision-threatening complications are uncommon.