Sacchetti et al. [36] also suggested grading VKC based on larger clinical signs (presence of ocular symptoms, punctate keratitis, shield ulcer, and photophobia) for selecting the therapy.

neurotrophic keratopathy with punctate staining, vascularization, or scarring but no epithelial defect; stage 2: neurotrophic keratopathy with epithelial defect but no stromal ulceration ...

“Stage 1 is the mild stage, where patients usually have punctate keratitis and minor epithelial irregularities. They might have symptoms of mild discomfort, maybe dryness, but more often they ...