Corneal cross-linking (CXL) aims to slow down or halt the progression of keratoconus. It is successful in more than 90% of cases. After treatment you will still need to wear spectacles or contact lenses. Your eye will be sore for about 1 week after. Vision is often hazy at first. Most patients can resume contact lens wear and return to work after 1 month. As with all operations, there are risks. CXL is safe but there is a small chance of worse vision after.
What is CXL?
Keratoconus gets worse because the cornea weakens. CXL uses ultraviolet light and vitamin B2 (riboflavin) drops to stiffen the cornea. Used together they cause fibres within the cornea to cross-link or bond more tightly. This treatment copies and accentuates the normal age-related stiffening of the cornea. This is known as natural cross-linking.
Which patients benefit from CXL?
The treatment is recommended for patients whose corneal shape scans show that their keratoconus is getting worse. It is also for those who are at particularly high risk of keratoconus getting worse. This is because natural cross-linking happens with age. Keratoconus usually stops getting worse by the mid-30s, so CXL is not normally needed for older patients.
Will I have both eyes treated at the same time?
We usually do CXL on 1 eye in the first instance. A second date will be made for the other eye if treatment is for both eyes.
What happens during CXL?
CXL is done as a day-case by a member of the consultant team. Although the procedure takes less than 45 minutes, there is usually some waiting time before treatment. You will also need to stay for a short while after so we can check that you have everything you need to go home. Please be prepared to spend up to half a day in hospital.
You will be asked to lie flat on the treatment table. Anaesthetic drops are used to numb the surface of your eye. Then a small clip is used to keep your eyelids open. The surface skin of your eye (epithelium) is gently brushed clear. Riboflavin drops are applied every few minutes for at least 30 minutes. After this the ultraviolet light is shone at your eye for 10 minutes. A soft ‘bandage’ contact lens is placed on your eye at the end.
What happens after CXL?
You will be given eye drops to use after. The soft ‘bandage’ contact lens will stay in your eye until the surface has healed. This is usually about 7 days. If the bandage lens falls out during this time, please throw it away. Do not try to put it back.
The anaesthetic drops will wear off later on the day of your procedure. Your eye will be gritty and red for several days. Everyone’s experience of pain is different. Some patients report very little discomfort. Others describe the first few days as very painful. Your eyes could be light sensitive. Many patients find sunglasses helpful.
Your vision will be quite blurred at first. It should clear gradually over the first few weeks. It is normal to have fluctuating pain within the first 2 days after surgery. If you have increasing pain 3 or 4 days after this could be an infection. You should contact the hospital ophthalmology department. Please note that infection is rare, affecting less than 1% of patients.
Do I need to take time off work or studies?
Yes. You should allow at least 1 week off while most of the surface healing occurs. 2 weeks if your job involves a lot of computer work and the treatment is being done on your best eye.
Day to day activities such as watching TV or using a computer will not do any damage to your eye. You might find it more comfortable to rest with your eyes closed early on.
What should I do, or not do, before and after CXL?
Please do not wear your contact lenses on the day of your treatment. After the treatment keep your contact lenses out. It is ok to wear glasses. Use any eye drops as prescribed. Wash and shower normally. Try to avoid getting water in your eyes. You may exercise but should not swim before the surface of your eye has healed.
We will check your vision in the clinic at your follow up appointment. We will then confirm if your vision is good enough to drive. It is normally safe to resume contact lens wear once the eye surface skin layer has healed. This typically happens around the end of the second week after your procedure.
What are the risks of CXL?
In general, CXL is very safe. Like all operations your eye needs time to heal and problems do happen sometimes. Your consultant will discuss any risks with you in more detail.
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Feedback
We appreciate and encourage feedback, which helps us to improve our services. If you have any comments, compliments or concerns to make about your care, please contact the Patient, Advice & Liaison Service:
pals@ncic.nhs.uk | 01228 814008 or 01946 523818
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complaints@ncic.nhs.uk | 01228 936302