Corneal Cross-Linking (CXL) for Keratoconus at SightMD
Corneal cross-linking can help slow the progression of keratoconus by strengthening a weakened cornea. At SightMD, our eye doctors evaluate your corneal health and determine whether CXL is an appropriate treatment for protecting your vision over time.
What Is Corneal Cross-Linking (CXL)?
Corneal cross-linking (CXL) is a treatment for keratoconus and post-LASIK ectasia, conditions that can cause the cornea to weaken and bulge. This corneal disease treatment uses UV light and vitamin B2 (riboflavin) drops to strengthen the cornea and help slow further progression.
After corneal cross-linking, you will still need eyeglasses or contact lenses. Blurry vision, soreness, and light sensitivity are common during early recovery, and many patients can return to work and resume contact lens wear after about one week. As with any procedure, CXL has potential risks, which our eye doctor will discuss with you before treatment.
CXL works by helping fibers within the cornea cross-link, or bond more tightly. This process mimics the natural stiffening of the cornea that occurs with age.
Who Is a Candidate for Corneal Cross-Linking?
CXL may be recommended for patients with worsening keratoconus or corneal ectasia. Corneal cross-linking may be considered for patients who:
- Have keratoconus that continues to progress
- Have corneal ectasia, including post-LASIK ectasia
- Have very thin corneas
- Have suspected keratoconus
- Have a history of RK surgery
- May be at increased risk of ectasia after laser eye surgery
Because the cornea naturally becomes stiffer with age, keratoconus often stops progressing by the mid-40s. Corneal cross-linking may not be necessary for older patients whose condition is stable. Our eye doctor will evaluate your cornea and determine whether CXL is appropriate for you.
How Does Corneal Cross-Linking Help Keratoconus?
Corneal cross-linking is the only treatment available to stop the worsening of keratoconus and ectasia. Evidence from many studies one year after CXL showed success in halting disease progression in more than 90% of eyes, with more than 45% of eyes also showing an improvement in corneal shape. Long-term studies of 5 years or more suggest a high success rate in preventing keratoconus progression. Vision is better after CXL in about 50% of eyes treated.
If you need corneal cross-linking for both eyes, we can offer treatment for both eyes at the same time. CXL is a same-day procedure, meaning you can return home after treatment. Anesthesia or an IV is usually not needed, although medication may be offered by mouth to help you relax if you are nervous.
What Happens During the Corneal Cross-Linking Procedure?
The corneal cross-linking procedure lasts 1 to 2 hours, depending on the case. Anesthetic eye drops are used to keep you comfortable throughout the CXL procedure. During treatment:
- A small device gently holds your eyelids open.
- The surface layer of the cornea, called the epithelium, is carefully removed.
- Vitamin B2 (riboflavin) eye drops are applied to the cornea for about 30 minutes.
- Our eye doctor checks that the riboflavin has been properly absorbed.
- UV light is directed at the cornea for a predetermined amount of time (15 to 30 minutes).
- A soft bandage contact lens is placed over the eye to protect the surface as it heals.
The combination of riboflavin and UV light strengthens the bonds within the cornea. After the procedure, you can return home with instructions for eye drops, recovery, and follow-up care.
What to Expect During Corneal Cross-Linking Recovery
You will be given eye drops to use after CXL. A soft bandage contact lens will remain in your eye until the surface has healed, usually about 4 to 7 days. If the bandage lens falls out during this time, throw it away and do not attempt to reinsert it.
The First Few Days After CXL
After the anesthetic drops wear off, your eye may feel gritty, red, uncomfortable, and sensitive to light for several days. Your vision will be blurry at first but should clear over the first few weeks. If you experience increasing pain 3 to 4 days after the procedure, contact our office as soon as possible, as this could be a sign of infection. Infection following CXL is rare, affecting less than 1% of patients.
Returning to Work and Daily Activities
Plan to take 4 to 7 days off work or studies while your eye heals and use your prescribed eye drops as directed. Watching TV or using a computer will not damage your eye. You may exercise after 1 week but should avoid swimming, hot tubs, and gardening for 7 to 10 days. Contact lens wear can usually resume during the second week once the eye surface has healed.
Follow-Up Care After Corneal Cross-Linking
Your first follow-up appointment will be scheduled the day after CXL, with a second visit usually 5 to 7 days later. Some patients may be seen daily after CXL to monitor healing. Our eye doctor will check your recovery and vision and confirm when it is safe for you to drive.
Risks of Corneal Cross-Linking
In general, CXL is very safe, but like all procedures, there are risks, and your eye needs time to heal. Approximately 2% of patients may lose some vision in the treated eye because of haze, scarring, or irregularities in the corneal surface. In most cases, this vision loss is reversible with medication or a surgical procedure, such as laser treatment or a corneal transplant.
Without CXL treatment, at least 20% of patients with keratoconus will need a corneal transplant. The risk of transplant is much higher for patients with documented disease progression.
Is Corneal Cross-Linking Right for You?
Corneal cross-linking is a treatment for keratoconus and other corneal ectasias, but not everyone with these corneal conditions will qualify for the procedure. Our eye doctors can evaluate your cornea, review the progression of your condition, and determine whether CXL may be appropriate for you.