Diabetes Mellitus (DM) is widely recognized as a major cause of blindness, with Diabetic Retinopathy (DR) being the most frequently cited underlying pathophysiologic mechanism. This makes DR, among all ocular manifestations of diabetes, the focus of most diagnostic as well as therapeutic interventions. However, diabetic neurotrophic keratopathy, a common ocular complication of diabetes that is caused by corneal nerve fiber damage, is a diagnostic entity that generated a lot of attention recently in the ophthalmology community for being largely unrecognized, underdiagnosed and generally not treated, rendering a large number of the growing population susceptible to this serious ocular complication. This is largely because of the challenge in diagnosis and management of diabetic neurotrophic keratopathy. In this manuscript, we discuss the epidemiology, pathophysiologic mechanisms, diagnostic challenges and the innovative therapeutic interventions of diabetic neurotrophic keratopathy, an entity with potentially serious implications for diabetic patients, both type 1 as well as type 2 alike.