Keratoconus is a progressive eye condition that occurs due to an abnormality in the shape of the cornea and results in a number of vision problems. Corneal ectasia is a rare but serious complication resulting from vision correction procedures such as LASIK and PRK.

Corneal cross-linking, or CXL, is an innovative procedure used to treat keratoconus and corneal ectasia by strengthening and stabilizing the cornea.

Technology marches ahead every day with the singular purpose of making lives better. If you ask most Cornea surgeons about the one technology that they’ve been waiting for over the past couple of years, they’re likely to tell you about Corneal Collagen Cross-linking, also referred to as corneal cross-linking or CXL. Milan Eye Center is proud to adopt and implement this life-changing procedure. Patients suffering from progressive keratoconus and corneal ectasia following refractive surgery can now receive a therapeutic treatment that has been rigorously tested and FDA approved.

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What is Corneal Cross-Linking (CXL)?

Corneal cross-linking is a simple procedure that uses Vitamin B2 (Riboflavin) and UV light to strengthen corneas. Corneas can become weak, progressively thin, and bow forward causing irregular astigmatism and loss of vision in some patients. This process is called ‘ectasia’. The most common cause of ectasia is keratoconus. Rarely, patients with a history of LASIK or photorefractive keratectomy (PRK) can also develop ectasia.

Traditionally, these patients had to wear hard contact lenses and bear with deteriorating vision. Surgeons were forced to watch as the disease progressed in many of their patients until they required a corneal transplant. The goal of CXL is to stabilize and even reverse ectatic corneas and prevent progression of the disease.

About the Outpatient Procedure

Corneal cross-linking is performed in an office setting and takes approximately 2 hours total for prep time, treatment time, and proper recovery time. The most wonderful thing about this procedure is that it is a minimally invasive procedure and involves only eye drops, UV light, and a painless brushing off of the surface cells of the cornea. This technology is a game-changer and we are proud to offer it to our patients!

Does it Hurt?

There can be some discomfort during immediate recovery but usually not during the treatment. Immediately following treatment, a bandage contact lens is placed on the surface of the eye to protect it. After the numbing drops wear off, there could be some discomfort, managed with Tylenol and artificial tears. If the pain is severe, pain medication may be used.


Recovery generally takes a few days, after which, vision recovers slowly over the next few weeks. You may notice a sensitivity to light and have a foreign body sensation post-procedure. Sunglasses may help with the light sensitivity. You may also experience discomfort in the treated eye. You should not rub your eyes for the first five days after the procedure.

If you experience severe pain in the eye or any sudden decrease in vision, you should contact your physician immediately. If your bandage contact lens from the day of treatment falls out or becomes dislodged, you should not replace it and also contact your physician immediately.

Is Corneal Cross-Linking Right for Me?

Patients over the age of 14 who have been diagnosed with progressive keratoconus or corneal ectasia following refractive surgery should ask their doctor about corneal cross-linking. We’re happy to be able to offer an effective treatment for patients who, until recently, had no therapeutic options to limit the progression of this sight-threatening disease.

Frequently Asked Questions about Corneal Cross-Linking

Does corneal cross-linking require removal of the epithelium?

Yes, currently the only approved method for crosslinking requires removal of the epithelium or “epi-off” – during the procedure your doctor will apply topical anesthesia to numb the eye prior to the removal of the epithelium. This process helps to prepare your eye so that the drug can penetrate the tissue of the cornea to have an effective cross-linking procedure. “Epi-on” is where the epithelium is still intact, is still undergoing trials and has not been approved by the FDA.

Am I awake during the CXL procedure?

Yes, typically you will be awake during the CXL treatment. You’ll be given medication and numbing anesthetic drops.

What are the side effects of corneal cross-linking?

The most common ocular adverse reactions are:

  • Haze (corneal opacity)
  • Inflammation (punctate keratitis)
  • Fine white lines (corneal striae)
  • Disruption of surface cells (corneal epithelium defect)
  • Eye pain
  • Reduced sharpness of vision (visual acuity)
  • Blurred vision

Note: The side effects noted above are not a comprehensive list. Please contact your physician to discuss these in further detail.

It’s the right time for clearer vision

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