Corneal Cross Linking

How | Candidates | Cost

What is Corneal Collagen Cross Linking (CXL) ?

Corneal Collagen Cross Linking (CXL) is a technique that was first used in 1998 to treat patients with a disease call keratoconus. In keratoconus, the cornea can become weak, thin, and irregularly shaped. Instead of keeping its normal round shape, corneas with keratoconus can bulge forward into the shape of a cone, causing poor vision.

CXL is now being performed for keratoconus patients in approximately 450 centers throughout the world. CXL is the single most important procedure that can be provided for a keratoconus patient to prevent further progression of the disease. Early detection of keratoconus is imperative because if the cornea becomes too thin or too scarred, then CXL may not be an option.

Every patient is thoroughly tested for keratoconus on each and every examination at Cornea Lens Institute.

How is CXL performed?

The CXL treatment is an outpatient procedure performed in the doctor’s office using only numbing eye drops and a mild sedative like a Valium tablet. You will need to lie flat on your back in a reclining chair and look up at a soft blue light during the treatment. The epithelium, a thin layer of the clear, protective tissue that covers the cornea, is prepared for the procedure. Next, vitamin eye drops (riboflavin) are used in the eye and you will be asked to look at a special blue (ultraviolet) light while reclined.

The procedure takes about an hour and a half to treat both eyes. The procedure is painless, however there will be some discomfort after the procedure that lasts about 8-10 hours and completely resolves by the next day.

Normal corneas have cross-links between their collagen fibers that keep them strong and able to retain a normal shape. In keratoconus, the cornea is weak with too few cross-links or support beams. This weakened structure allows the cornea to bulge outwards. The cross-linking procedure adds cross-links or “cross-beams” to the cornea, making it more stable, holding its shape and focusing power better. These new cross-links help strengthen the cornea which stops the thinning process and further loss of vision.


To qualify for the CXL study, patients must be at least 12 years old and their corneas cannot be too thin or too scarred for the procedure. During your consultation we will determine if CXL might be a good treatment option.

Based on CXL study results over more than a decade, the beneficial effects of CXL appear to last for many years and there is evidence that this strengthening effect may be permanent.

CXL has been performed since 1999. The results and safety profile of CXL have been very positive in numerous studies throughout the world. In fact, by September of 2006, CXL had been approved by all 25 European Union nations. CXL procedures are now routinely performed on patients as young as 10 years old in Europe to prevent the development of keratoconus.


Because of regulatory environment in the US, this procedure is investigational so CXL treatment is not covered by insurance at this time.

Convenient, affordable financing is available to help our patients get the treatment they need before their keratoconus, or other similar conditions, progresses to the point where they can no longer have CXL. Remember, CXL is the only procedure we can offer that halts keratoconus or other similar corneal thinning diseases in its tracks. This is certainly proven to prevent what may be an inevitable future corneal transplant.