Corneal cross-linking (CXL) is a treatment which 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 one week after the procedure. Although vision is often hazy at first, most patients can resume contact lens wear and return to work after one month. As with all operations, there are risks: CXL is safe, but there is a small chance of worse vision afterwards.
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 mimics and accentuates the normal age-related stiffening of the cornea, which is known as natural cross-linking.
Which patients benefit from CXL?
The treatment is recommended only for patients whose corneal shape scans show that their keratoconus is getting worse, or for those who are at particularly high risk of worsening keratoconus. Because natural cross-linking occurs with age, keratoconus usually stops getting worse by the mid-30s, so CXL is not normally required for older patients.
Will I have both eyes treated at the same time?
We usually carry out CXL on one eye in the first instance with a second date being made for the other eye if treatment is indicated for both eyes.
What happens during CXL?
CXL is performed as a day-case procedure by a member of the consultant team. Although the procedure takes less than 45 minutes, there is usually some waiting time before treatment and you will also need to stay for a short while afterwards 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 before a small clip is placed to keep your eyelids open. The surface skin of your eye (epithelium) is gently brushed clear and riboflavin drops are applied every few minutes for at least 30 minutes. Following 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 of the procedure.
What happens after CXL?
You will be given eye drops to use after the procedure. The soft ‘bandage’ contact lens will remain in your eye until the surface has healed (about seven days). If the bandage lens falls out during this time, please throw it away – do not attempt to reinsert it.
The anaesthetic drops will wear off later on the day of your procedure, and your eye will be gritty and red for several days. Everyone’s experience of pain is different, with some patients reporting very little discomfort and others describing the first few days as very painful. Your eyes could be light sensitive and many patients find sunglasses helpful.
Your vision will be quite blurred at first, but should clear gradually over the first few weeks. It is normal to experience fluctuating pain within the first two days after surgery. However, if you experience increasing pain three or four days after the procedure this could be indicative of infection and you should contact the hospital ophthalmology department. Please note that infection is rare, affecting fewer than 1% of patients.
Do I need to take time off work or studies?
Yes. You should allow at least one week off while most of the surface healing occurs, or two 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, but 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, but 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 and can 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, but like all operations your eye needs time to heal and problems do occasionally occur. Your consultant will discuss any risks with you in more detail.
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Feedback
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