What is Corneal Cross-Linking?

Corneal cross-linking (CXL) is an advanced treatment for keratoconus, a progressive eye condition in which the cornea thins and bulges into a cone shape, leading to distorted vision. If left untreated, keratoconus can worsen over time, making everyday tasks like reading and driving difficult.

CXL strengthens the corneal structure by using riboflavin (Vitamin B2) eyedrops and ultraviolet (UV) light to create additional cross-links between collagen fibers. These cross-links act like reinforcement beams, helping to stabilize the cornea and prevent further bulging.

This is currently the only treatment that can halt the progression of keratoconus, potentially delaying or preventing the need for a corneal transplant.

Types of Corneal Cross-Linking

There are two main types of corneal cross-linking procedures:

1. Epithelium-Off (Epi-Off) Cross-Linking

• The outer layer of the cornea (epithelium) is removed to allow the riboflavin drops to penetrate deeply.
• This technique is clinically proven to be highly effective but has a longer recovery time and a higher risk of infection or corneal haze.

2. Epithelium-On (Epi-On) Cross-Linking

• The epithelium remains intact, with special eyedrops or a sponge used to enhance riboflavin absorption.
• This minimizes pain and recovery time while reducing the risk of complications.
• However, research is ongoing to determine if it is as effective as epi-off cross-linking.

Your doctor will recommend the most suitable technique based on your condition and eye health.

Who Should Consider Corneal Cross-Linking?

Corneal cross-linking is most effective for individuals with early-stage or progressive keratoconus. It is recommended if:

✅ You have been recently diagnosed with keratoconus.
✅ Your vision is worsening over time.
✅ You want to prevent the need for a corneal transplant in the future.
✅ Your cornea still has sufficient thickness to undergo treatment.

Since CXL does not reverse existing corneal changes, early diagnosis and treatment are key to preserving vision.

What Happens During the Procedure?

🕒 Total Duration: 60–90 minutes

Step-by-Step Process

1️⃣ Preparation

• Numbing eyedrops are applied.
• A mild sedative may be given to help you relax.

2️⃣ Riboflavin Application

• Vitamin B2 (riboflavin) eyedrops are applied to the cornea for about 30 minutes to enhance light absorption.

3️⃣ UV Light Exposure

• You will lie back and look at a specialized UV light for around 30 minutes.
• The UV light activates the riboflavin, triggering the strengthening process.
• The procedure is painless due to numbing drops.

Recovery & Aftercare

Your recovery depends on the type of cross-linking procedure you undergo.

Epi-On Cross-Linking Recovery

✔️ Painless recovery
✔️ Resume daily activities within 24 hours
✔️ Can wear contact lenses sooner

Epi-Off Cross-Linking Recovery

Pain and discomfort for several days
Avoid rubbing your eyes
You may need pain medication and antibiotic/steroid eyedrops
Recovery takes 4–10 days (but vision stabilizes over 3–6 months)

👓 Post-Surgery Care:

• A soft contact lens may be placed on your eye for about a week to protect the cornea.
• Avoid bright lights and screen exposure for a few days.
• Follow your doctor’s instructions for eyedrops and medications.