Neurotrophic keratopathy is a rare degenerative corneal disease caused by impaired corneal innervation and characterized by reduced corneal sensitivity and trophic changes that may lead to the development and persistence of corneal defects. The diversity of etiological factors, the absence of pronounced corneal syndrome, and the similarity of early manifestations to other ocular surface disorders frequently result in delayed diagnosis and complicate treatment selection. Therefore, a comprehensive approach to the examination of patients with neurotrophic keratopathy remains highly relevant, as it allows objective assessment of disease severity and monitoring of pathological changes during treatment. Report the case of a 69-year-old woman with a persistent postherpetic corneal erosion of the right eye lasting for four months and refractory to conservative treatment. The patient complained of decreased vision and a foreign body sensation. Best-corrected visual acuity was 0.08. Slit-lamp examination revealed an epithelial defect involving 7.6% of the corneal surface, accompanied by perifocal and stromal edema. Corneal sensitivity was absent at all nine examined points. Anterior segment optical coherence tomography demonstrated a minimum corneal thickness of 609 μm. In vivo confocal microscopy revealed marked depletion of the subbasal nerve plexus, with a corneal nerve fiber density of 4 fibers/mm2, a corneal nerve branch density of 3 branches/mm2, and a corneal nerve fiber length of 662 mm/mm2. An extended diagnostic algorithm incorporating clinical, functional, and instrumental examinations was used for comprehensive assessment of the ocular surface and subsequent follow-up. Following sublimbal orbital fat transposition (S-LOFT), involving transposition of the inferomedial orbital fat pad beneath a scleral flap to the limbal area, complete corneal epithelialization was achieved, with no recurrence of epithelial defects during the 12-month follow-up post-S-LOFT period. This clinical case demonstrates the practical value of an extended diagnostic algorithm for patients with neurotrophic keratopathy. Comprehensive evaluation of the ocular surface enables timely diagnosis, objective assessment of pathological changes, rational selection of treatment strategy, and monitoring of therapeutic outcomes.