Book Now

+ 961 1 759637

Corneal cross-linking
What is corneal cross-linking?

Cornea cross-linking is a procedure meant to stop keratoconus disease progression. During the procedure, riboflavin (which is vitamin B2) eye drops are instilled in the eye followed by exposure to a focused ultraviolet light. The combination of the UV light and riboflavin drops produces a reaction inside the cornea, which helps cross-linking the corneal macromolecules, and hence, strengthens the cornea and makes it stiffer. A stiff cornea resists further protrusion and thinning and puts a stop to disease progression. UV cross-linking is performed under anesthetic drops and is a comfortable procedure. 

Mechanism of corneal cross-linking
After cross-linking
What to expect  

Cross-linking is a highly successful procedure which works 95-99% of the times. Even though the aim of cross-linking is to stabilize the disease process and maintain vision, some patients experience an improvement in vision and a decrease in visual refractive error. Full visual recovery after corneal cross-linking might take a few weeks and sometimes a few months. Patients usually experience tearing, burning, and light sensitivity for the first 3 days after the procedure, and vision in the operated eye is usually considerably blurry for the first 7-10 days postoperatively. Afterwards, vision keeps improving over the next 2-3 months, till it reaches the starting vision before the procedure, and in some patients, exceeding it. For this reason, in the event where both eyes are to undergo the procedure, it is usually recommended to perform one eye at a time, so the patient would rely on one eye while the other would recover. Patients would need to get an updated eyeglass prescription at around 3 months postoperatively. After the procedure, patients are instructed to use antibiotic and steroid eye drops as well as tear drops. The last two are tapered slowly over several weeks postoperatively. Patients can return to their daily activities like driving and office and computer work within 4 days, but should avoid direct water contact to their eyes for one week, eye make-up and swimming for one month, and of course, eye rubbing.

Indications & safety



UV cross-linking is usually offered to patients with documented disease progression and often in young individuals below age 19 without documented disease progression as the risk of keratoconus worsening in this age group has been shown to be very high. Pregnant women with keratoconus should be followed carefully as the disease can progress during and right after pregnancy. Patients above age 40 rarely progress and usually do not need corneal cross-linking, although exceptions have been documented.





Cross-Linking is a highly successful and safe procedure which halts keratoconus disease progression. However, a very small percentage of patients might experience a slight worsening of vision after the procedure, and more rarely, an appreciable decrease in vision might develop even when corrected with eyeglasses due to the development of corneal haze and scarring. Infection is another rare side effect which can develop. 

Combined Procedures

Combined customized laser procedures

LASIK and laser surface ablation are generally contra-indicated in keratoconus patients. However, in certain situations, customized minimal laser surface ablation or PRK, combined with UV cross-linking or sometimes following it, can improve vision.



Corneal ring segments and cross-linking


Corneal ring segment insertion can help improve vision before stabilizing it by cross-linking, especially in patients with suboptimal vision who are intolerant to hard lenses (rigid gas permeable) or hybrid lenses. Corneal ring segments can also be inserted in patients who had cross-linking, although some studies suggest that implanting ring segments prior to cross-linking might be more beneficial.

Corneal ring segments