Neurotrophic keratopathy (NK) is a rare degenerative disease caused by impairment of the trigeminal nerve, leading to corneal anesthesia, epithelial breakdown, and progressive vision loss. Conventional treatments primarily focus on symptom management and the prevention of complications, but they do not address the underlying nerve dysfunction. Corneal neurotization (NT) has emerged as a promising surgical intervention aimed at restoring corneal sensation and improving ocular surface homeostasis. This review evaluates the outcomes of corneal neurotization in patients with NK and compares the effectiveness of direct (DNT) and indirect (INT) techniques. Studies have reported significant improvements in corneal sensitivity, with success rates ranging from 60.7% to 100% (mean: 90%). Most patients experienced recovery of corneal sensation, as measured by the Cochet–Bonnet aesthesiometer, with no significant differences in outcomes between DNT and INT. Indirect neurotization using a sural nerve graft was the most commonly employed technique (63% of cases), while the use of acellular allografts demonstrated comparable efficacy and simplified the procedure. Postoperative corneal sensitivity increased significantly, from a preoperative average of 2.717 mm to 36.01 mm, with reinnervation typically occurring within 4–6 months and peaking at 12 months. In vivo confocal microscopy confirmed the presence of nerve regeneration. Neurotization was found to be safe, with minimal donor-site complications, which generally resolved within one year. Although the procedure improves corneal sensation and tear film stability, visual acuity outcomes remain variable due to pre-existing corneal damage. Early intervention is, therefore, recommended to prevent irreversible scarring. However, the number of patients undergoing the procedure remains limited, making it difficult to draw definitive conclusions. Most available studies consist of small case series. Further research with larger sample sizes is needed to refine surgical techniques and optimize patient selection, thereby improving outcomes in the management of NK.

Neurotrophic keratopathy (NK) is a rare degenerative disease caused by trigeminal nerve impairment, leading to corneal anesthesia, epithelial breakdown, and progressive vision loss. NK produces damage through the lack of pain. Conventional treatments focus on symptom management and preventing complications but do not address the underlying nerve dysfunction. Corneal neurotization (NT) has emerged as a promising surgical intervention aimed at restoring corneal sensation and improving ocular surface homeostasis. This review examines the outcomes of corneal neurotization in NK patients, while also comparing the effectiveness of direct (DNT) and indirect (INT) techniques. Studies report significant improvement in corneal sensitivity, with success rates ranging from 60.7% to 100% (average ~90%). Most patients showed corneal sensation recovery, as measured by the Cochet–Bonnet aesthesiometer. No significant differences were found between DNT and INT outcomes. Indirect neurotization with a sural nerve graft was the most performed procedure (63% of cases), with acellular allografts demonstrating comparable efficacy while simplifying the technique. Postoperative corneal sensitivity improved significantly from a preoperative average of 2.717 mm to 36.01 mm, with reinnervation occurring within 4–6 months and peaking at 12 months. In vivo confocal microscopy confirmed nerve regeneration. Neurotization was safe, with minimal donor-site complications, typically resolving within one year. While corneal neurotization enhances corneal sensation and tear film stability, visual acuity outcomes remain variable, influenced by pre-existing corneal damage. Early intervention is recommended to prevent irreversible scarring. Further studies with larger sample sizes are needed to refine surgical techniques and optimize patient selection, ensuring the best possible outcomes for NK patients.