Use of Topical Insulin to Treat Refractory Neurotrophic Corneal Ulcers

Abstract

Purpose: To report the clinical course of 6 patients with refractory neurotrophic corneal ulcers that were treated with topical insulin drops.

Methods: Retrospective chart review of patients who had neurotrophic corneal ulcers or epithelial defects refractory to standard medical and surgical treatment. Insulin drops, prepared by mixing regular insulin in artificial tears with a polyethylene glycol and propylene glycol base at a concentration of 1 unit per milliliter, were prescribed 2 to 3 times daily.

Results: Six patients, aged 2 to 73 years, developed neurotrophic corneal ulcers refractory to a range of medical and surgical treatments, including bandage contact lens, amniotic membrane grafting, and permanent tarsorrhaphy. Each patient was administered topical insulin drops with complete corneal reepithelialization within 7 to 25 days.

Conclusions: Topical insulin may be a simple and effective treatment for refractory neurotrophic corneal ulcers. Further study is required to determine the clinical efficacy and side effect profile of insulin drops.

Figure 1

Three Patients Treated With Topical Insulin. A 2-year-old girl with proptosis and lagophthalmos from an orbital teratoma presented with a neurotrophic corneal ulcer refractory to lubrication and permanent lateral tarsorrhaphy (A). Insulin eye drops were initiated with resolution of the ulcer after 14 days (B). A 24-year-old woman with neurotrophic keratopathy secondary to herpes zoster keratitis presents with a corneal ulcer refractory to lubrication and use of scleral contact lens (C). Insulin drops were initiated with resolution of the ulcer after 25 days (D). A 47-year-old woman with neurotrophic keratopathy secondary to cranial nerve injury presents with near descemetocele in the central cornea of the left eye (E). Insulin drops were initiated with resolution of the ulcer after 7 days (F).