Corneal Cross-Linking (CXL)

Corneal cross-linking (CXL) is a procedure designed to stop keratoconus from becoming worse.  Keratoconus is a condition affecting the cornea (window of the eye) causing it to thin and bulge forward affecting vision. Vision can be affected to the point where glasses no longer help. This may lead to, depending on contact lenses, a corneal transplant.

Corneal cross-linking uses a combination of special drops (riboflavin or vitamin B2) and light (UVA light) to strengthen the cornea and reduce the bulging of the cornea. It is a process where bonds form between collagen molecules within the structure of the cornea to stiffen its structure.

This has now been used as a treatment for keratoconus for 10 years. It appears to prevent progression and may occasionally reverse the corneal bowing to a certain extent. It can also be combined with other treatments to improve vision rather than just stabilise it.

Midland Eye offers the best available combination of corneal consultant led assessment, management and treatment. Corneal cross-linking is not just a treatment but works in combination with discussion, measurements with the highest quality imaging equipment and treatment with advanced techniques. Accelerated epithelium-off corneal cross-linking is our treatment of choice which ensures the cross-links achieve their full effect.

Anaesthetic drops are firstly applied to numb the eye and the epithelium is loosened and removed painlessly with a special solution.  The riboflavin is a yellowish drop applied for a fixed period of time (can be as little as 10-20 minutes) and then the ultraviolet light shines to create the cross links for around 10 minutes.

At the end of the treatment, more drops are applied to help with the healing. Contact lenses are also sometimes used to help with healing.

Following the cross-linking you will be sent home with drops. If a bandage contact lens was placed, this will be removed in a week. It is possible to experience some eye discomfort for around 24-72 hours afterwards whilst the skin over the cornea heals. Vision may be blurred for several weeks (can very occasionally take longer to recover) but will clear in time.

Your eyes may also be sensitive to light so sunglasses are advised. It is usual to allow around a week of work to recover. Avoid disturbing or touching the front of the eye in any way.

Activities such as watching TV or using a computer will not do any damage to your eye, however, you might find it more comfortable to rest with your eyes closed early on.

Corneal cross-linking is not a treatment in itself to improve the vision. It aims to stabilise the changes on the cornea to prevent keratoconus from becoming worse. It can, however, be used in combination with other treatments to first stabilise then improve vision.

This is why having a tailored approach to care will allow you to decide whether you are happy with your current vision but do not want your keratoconus to become worse. You may decide if you would like to combine CXL with another treatment to improve your vision.

There are options to potentially free yourself from reliance on contact lenses or reduce dependence on spectacles. Please discuss this during your consultation.

Unlike other treatments to improve vision, corneal cross-linking aims to stabilise vision. So it may take a year for a person undergoing CXL to realise that their vision has not become worse. This will be confirmed in follow-up tests. During the recovery period, your vision may fluctuate and measurements may change.

There may be some haze in the area where the cross linking was working which fades over time. However, corneal cross-linking is a very safe procedure when used for the correct reasons. It may reduce the long term need for more invasive procedures such as corneal transplants.

When used in combination with a treatment to improve your vision, it will reduce the chance of your vision changing again from keratoconus in the future.

Thank you to Mr Ankur Barua for providing the answers above.