Corneal Cross-linking (CXL) is a procedure that uses riboflavin (Vitamin B2) and ultraviolet (UV) light to strengthen the cornea, preventing its further thinning and shape change, primarily to halt the progression of keratoconus. The treatment involves applying riboflavin drops and then exposing the cornea to UV light, which creates new bonds (cross-links) between collagen fibres, mimicking the cornea's natural stiffening with age. This process makes the cornea more rigid and halts the weakening that causes blurry, distorted vision in keratoconus.
Corneal crosslinking is the treatment for Keratoconus, it strengthens the collagen within your cornea, the front part of the eye.
How corneal crosslinking works
The procedure uses special eye drops and ultraviolet light to link the collagen fibres in your cornea, creating a stronger, more stable structure. This helps stop, or at least slow down, the changes in cornea shape and vision deterioration.
There are two main types of corneal crosslinking: epi-on and epi-off. This refers to the epithelium, the thin surface layer of the cornea. In the epi-off method, the surface layer is gently lifted to allow the treatment to reach the cornea. The epi-on method leaves this layer intact, but it’s still experimental and often not covered by insurance.
Keratoconus is a progressive condition, which means that without treatment, it can gradually get worse. While it rarely leads to total blindness, the cornea can change from a round shape to a cone shape, causing vision to deteriorate over time. If left unchecked, the only option may eventually be a corneal transplant, which is a major surgical procedure.
How corneal crosslinking helps
Corneal crosslinking is designed to stabilise the cornea and halt the progression of keratoconus, helping to preserve vision and reduce the need for more invasive surgery later. It is the recommended treatment for keratoconus, and early intervention is important — once changes to the cornea have occurred, crosslinking cannot reverse them.
The procedure works by strengthening the cornea to prevent further changes, rather than restoring vision that has already been lost. This is why it is most effective when performed as soon as keratoconus is detected.
Early signs
One early sign that crosslinking may be needed is seeing “ghost” images — multiple, faint copies of objects randomly distributed in your vision. If you notice this, it’s worth discussing corneal crosslinking with your eye specialist.
The cornea is made up of tiny strands of collagen. Corneal crosslinking strengthens these strands by creating “crosslinks” between them, helping the cornea resist changes in shape caused by keratoconus.
The Procedure
Eye drops containing riboflavin (Vitamin B2) are applied to the cornea, allowing it to absorb light.
Ultraviolet (UV) light, delivered by a laser at the correct wavelength, activates the crosslinking.
Anaesthetic drops numb your eye, and if needed, something can be given to help you relax.
Riboflavin soaks in for about 30 minutes, then the UV light is applied. The whole procedure usually takes 1 to 1.5 hours.
Epi-on vs Epi-off
Epi-on (experimental): the surface layer of the cornea (epithelium) stays in place.
Epi-off: the epithelium is gently lifted to allow the drops and UV light to reach the cornea.
Preparation
Do not wear perfume, aftershave, or makeup on the day.
The procedure uses local anaesthetic, so you can usually have a light meal and drink beforehand.
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