Corneal crosslinking (CXL) is the only treatment proven to halt the progression of keratoconus. It works by stiffening the corneal tissue using ultraviolet A light and riboflavin, creating new bonds between collagen fibres that stop the cornea from bulging further. It does not reverse existing changes but prevents further deterioration. Dr Ross MacIntyre performs accelerated epithelium-off corneal crosslinking at Northpark Private Hospital, Bundoora. This page explains who is a candidate, what the procedure involves, what recovery is like, and the risks and benefits. For patients and referrers seeking further context, see keratoconus treatment at Northern Eye Consultants and our keratoconus services at Northern Eye Consultants.
Who is a candidate for corneal crosslinking?
Crosslinking is recommended for patients with documented progressive keratoconus on serial corneal topography, or for younger patients where the risk of future progression is high even without documented change.
The main eligibility criteria are:
- Documented progression of keratoconus on serial topography over three to six months, or high clinical suspicion of future progression in a young patient
- Minimum corneal thickness of 400 microns at the thinnest point
- No significant corneal scarring that would limit the expected benefit
- Age typically 14 years and over, though younger patients can be treated in appropriate circumstances
Rigid contact lens wearers should cease lens wear for at least two weeks before topographic assessment to allow the corneal shape to return to its natural state.
What does the procedure involve?
Corneal crosslinking is performed under topical anaesthetic drops. You are awake throughout. The procedure is performed at Northpark Private Hospital, Bundoora, in a clean clinical setting, not a standard operating theatre.
The corneal epithelium (surface layer) is removed from the central cornea. Riboflavin solution is then applied to the cornea every two to three minutes for approximately ten minutes. Ultraviolet A light is then applied for ten minutes at 9 mW/cm2, with riboflavin continued during this phase. At completion, a bandage contact lens is placed on the eye and remains for approximately five days while the epithelium heals.
The total procedure time is approximately forty minutes per eye.
For a detailed step-by-step explanation of the procedure, the difference between the Dresden protocol and accelerated crosslinking, and a full discussion of CXL Plus procedures, see the complete patient guide to corneal crosslinking at corneaeyedoctor.com.
Benefits of corneal crosslinking
The primary benefit of corneal crosslinking is halting keratoconus progression. Published evidence shows crosslinking stabilises the disease in approximately 95 percent of treated eyes. For a detailed review of the clinical evidence base, see the detailed clinical guide to corneal crosslinking for keratoconus at corneaeyedoctor.com.
- Halting progression and preventing further deterioration of corneal shape
- Preserving existing vision and contact lens tolerance
- Reducing the likelihood of requiring corneal transplantation in the future
- In some patients, modest improvement in corneal shape and best-corrected visual acuity as a secondary benefit of corneal regularisation
- Early treatment when adequate corneal thickness remains provides the best long-term outcomes
Risks and what to expect
Crosslinking is a safe procedure with an established evidence base. The main risks are:
Postoperative pain and discomfort: the first 48 to 72 hours after the procedure are the most uncomfortable as the corneal surface heals. Pain is managed with oral analgesia, ice packs applied gently to the closed eyelid, and cold lubricating drops. Most patients find the discomfort significantly better by day three to four.
Corneal haze: a temporary increase in corneal opacity is normal after crosslinking and typically resolves over six to twelve months. Persistent significant haze is uncommon with modern protocols.
Transient vision reduction: vision is typically reduced and variable for the first four to eight weeks. This is a normal part of the healing response and is not a sign of treatment failure.
Infection: rare with appropriate antibiotic drop use during the healing phase.
Treatment failure: crosslinking halts progression in approximately 95 percent of treated eyes. A small proportion continue to progress and require reassessment.
Preoperative care
Before crosslinking:
- Cease rigid contact lens wear at least two weeks before the procedure
- Attend the preoperative assessment for corneal topography, pachymetry, and a review of your keratoconus status
- Arrange for someone to drive you home on the day of the procedure as you will not be able to drive
- Do not wear eye makeup on the day of the procedure
Postoperative care
After crosslinking:
- A bandage contact lens is worn for approximately five days and is removed at your scheduled review
- Antibiotic drops are used four times daily for at least five days until the epithelium has healed
- Steroid drops are used in a tapering course for three to four weeks
- Preservative-free lubricating drops are used frequently for at least three months
- Ice packs applied gently to the closed eyelid help with pain in the first 48 hours
- Oral paracetamol or ibuprofen taken regularly in the first two to three days
- Avoid swimming, contact sports, and rubbing the eye for at least four weeks
- UV-blocking sunglasses outdoors for at least six months postoperatively
- Most patients require at least one week off work
For a complete guide to the postoperative drop regimen, pain management, and vision recovery timeline, see the complete guide to corneal crosslinking recovery at corneaeyedoctor.com.
How to arrange an assessment
If you have been diagnosed with keratoconus or told your corneal shape is changing, an assessment for corneal crosslinking is appropriate. A referral from your GP or optometrist is required. Referrals can be addressed to Dr Ross MacIntyre, Northern Eye Consultants, Northpark Private Hospital, Bundoora VIC 3083. Contact our rooms on (03) 9466 8822 to arrange an appointment.
Contact Northern Eye Consultants to book an assessment. For referral information for GPs and optometrists, visit our for-referrers page. You can also contact Northern Eye Consultants directly through our website.