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Abstract As a neurodegenerative disease, PD involves both central and peripheral nervous systems, especially small nerve fibers damage. PD had progressive degeneration of dopaminergic neurons in the substantia nigra, and patients with secondary parkinsonism (SP) present with similar neurological symptoms, but without primary impairment of the nigrostriatal pathway. The results indicated that patients with SP showed no evidence of corneal nerve abnormality and 18F-DOPA PET, but patients with PD showed the opposite results, and ROC analysis showed combined corneal nerve parameters could increase the AUC to 0.907, indicating that corneal nerve loss may be a surrogate marker for distinguishing SP from PD.
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