Corneal nerve regeneration: treatments and monitoring approaches

BACKGROUND: Diagnostics and therapeutics for corneal nerve pathologies are rapidly evolving, with continual advancements in imaging, laser, machine learning, biologic, and surgical technologies. Recent changes in our understanding of corneal nerve structure and function underscore the need to evaluate diagnostic approaches, including advancements in esthesiometry, in vivo confocal microscopy, and anterior segment optical coherence tomography. METHODS: A literature review was conducted on diagnostic and therapeutic methods used for corneal nerve regeneration. We searched Google Scholar and PubMed for relevant articles using key terms such as: 'corneal nerve regeneration', 'corneal nerves', 'corneal nerve diagnostics', 'neurotrophic keratitis treatment', 'corneal nerve imaging', 'in vivo confocal microscopy', and 'corneal neurotization'. A total of 112 articles were included. DISCUSSION: Corneal nerve treatments require an in-depth understanding of neurotrophic mediators and nerve function, with current key treatments, such as cenegermin, targeting one of the most well-studied pathways. Other emerging treatment areas, including insulin drops, autologous serum, and surgical approaches, are discussed as avenues for further exploration to aid the regeneration of corneal nerves and address the many related diseases resulting from corneal nerve injury or dysfunction. CONCLUSION: This paper provides an overview of traditional and emerging approaches to the diagnosis and management of corneal nerve pathologies and highlights clinically relevant pathophysiological mechanisms. By leveraging advanced imaging modalities such as in vivo confocal microscopy, clinicians can detect nerve injury before symptom onset, enabling critical early intervention. Furthermore, integrating emerging regenerative therapies shifts the clinical paradigm from palliative symptom management to active restoration of corneal nerve integrity.