Corneal Collagen Cross-Linkage (CXL)

Corneal collagen cross-linkage (CXL) is a therapeutic treatment of Keratoconus (KCS) to stabilise shape. It has been extensively investigated and epi-off CXL is considered the gold standard in treatment.

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Corneal Collagen Cross Linkage (CXL) 1
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Corneal Collagen Cross-Linkage

Corneal collagen cross-linkage (CXL) is the first and most effective treatment shown to stabilize KCS, it was developed in Switzerland in the late 90’s and was approved by NICE in the UK in 2009. It has been extensively investigated and epi-off CXL is considered the gold standard in treatment.

David Anderson has been performing CXL since 2010 and uses the Avedro KXL® system which is considered to be the most advanced platform for treating KCS with more than 400,000 treatments to date. 

Corenal Cross Linking Animation

How Does CXL Work?

Corneal Collagen Cross Linkage (CXL) 3

The cornea is made from collagen proteins layered over each other with bonds in-between to stabilize them called cross links. These cross links increase naturally with age and with ultra-violet light (UV-A) exposure and affect all proteins in the body. Using riboflavin (vitamin B2) eyedrops, combined with a set dose of UV-A these cross links are stimulated to form in large numbers, strengthening the cornea and reducing corneal flexibility preventing progression of the condition. 

Your Epi-off CXL procedure explained

CXL is an outpatient procedure and you will be in the department for around an hour. Local anaesthetic eye drops will numb your eye. The procedure is not painful and will take around 30 minutes to complete. Yellow riboflavin drops (which do not sting) are dropped onto the eye and you will be asked to look at a blue UV-A light. Afterwards we will give you painkillers and a course of eyedrops and vitamin C tablets to take home. For comfort, we will leave a bandage contact lens in the eye which will be removed at your first checkup 4 to 5 days later. 


CXL is more successful the younger you are and the earlier KCS is detected. The thicker the cornea is (> 400 microns) the more likely treatment is to halt progression although thinner corneas can be treated by modified protocols. Overall CXL is effective in more than 90% of cases. CXL can be repeated although in less than 2% of cases overall.

Risks with treatment are low but include infection whilst the epithelium is healing, discomfort during healing and haze following treatment which can increase light scatter or glare. Risks are higher in thinner, steeper corneas i.e. advanced disease. The risk of losing vision is very low, around 2% but has to be balanced against the risk of losing vision with disease progression. Many patients gain vision following the procedure.

CXL can be performed on one or both eyes at the same sitting and can be combined with intra-corneal ring segment insertion (ICR) or topography driven photorefractive keratectomy (PRK) or phototherapeutic keratectomy (PTK). When the cornea is stable further treatment with implantable collamer lens (ICL) surgery can be undertaken to treat any residual refractive or focusing error.

Following treatment your eye will be red, sore, light sensitive and gritty. We recommend that you return home and rest quietly in a darkened room and sleep if possible, we will provide you with pain-killers and anti-inflammatory treatment to take. Your vision will be blurry but recover as the surface epithelium regrows and forms a waterproof seal over the front surface of the eye. Your vision will fluctuate as healing continues and we recommend taking a week off from college or work. 

Yes. If both eyes require treatment you can choose to have each eye treated separately to recover from the first procedure before the second or both eyes can be treated one immediately after the other at the same visit.
No. Rubbing your eyes is associated with progression of KCS so please avoid rubbing or touching your eyes if possible. Treating any allergic eye disease will help to prevent your eyes itching which is often a trigger to rubbing them. We will also advise you on the best lubricant eye drops to use if your eyes feel gritty or uncomfortable to act as an alternative to touching them. Keeping these drops cold will also help alleviate itch.

We can advise you specifically depending on the type of contact lens that you wear and your personal circumstances. In general we recommend no contact lens wear for a minimum of two weeks following CXL up to one month depending on your post-operative course of treatment. 

As soon as you meet the driving vision standard and you feel safe to do so you may drive. You will need to arrange transport home on the day of your procedure as you should not drive then. 

The bandage contact lens is there for comfort so do not worry if it falls out or is washed out by your eyedrops. If this happens just discard the lens, do not try to replace the lens in your eye even if you are an experienced contact lens wearer. Continue using your eyedrops as instructed and contact us if you are concerned or worried. 

We’d like you to avoid eye make-up for 7 days following CXL treatment as removing it can risk damaging the healing surface setting back recovery, any other face make-up can be worn after 48 hours. 

Don't Just Take Our Word For It

All Round Excellent Experience
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I underwent insertion of an intracorneal ring combined with corneal crosslinking in my left eye with Anderson Eye Care in September 2019. The procedure is entirely painless and does not take long, all you feel is pressure on your eye. There was moderate discomfort from around 2 hours post procedure until around 12 hours post procedure, however you are provided with painkillers and numbing eye drops which keeps everything under control. I woke up the morning after with no discomfort whatsoever, which was surprising to say the least. From my initial consultation with David through to my procedure and followup appointments, I found David and the other staff at the Nuffield facility to be professional and polite. I would rate my experience with Anderson Eye Care as exceptional and would not hesitate to consult with David again should I need treatment in my other eye. --Daniel Rogers
Corneal Cross-linking
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I was referred to Mr Anderson last year for treatment for keratoconus and underwent corneal cross-linking on both eyes. I am 24 years old and have been seeing various opticians and eye doctors since 2015. Mr Anderson was knowledgeable and very helpful in explaining the process to me and I felt confident in him going into the procedure. There were no problems with the surgery and I was well-prepared for the discomfort I experienced in both eyes while recovering over the following couple of days, with advice, eye drops and pain relief. Having both eyes done at the same time meant that I couldn't see properly for most of that recovery period, but it also meant both eyes recovered in the same time frame and I only had to go in for surgery once. I have no regrets about choosing to have the treatment this way. Mr Anderson and his staff were very professional, helpful and kind both when I went in for the procedure and when I returned for follow up appointments. I would have no hesitation in recommending him to others.
Removal of Scar tissue- Superficial Keratectomy
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I have been under the care of Mr David Anderson for my Keratoconus for many years so when he recommend that i needed a procedure to remove scar tissue- superficial keratectomy, i did not hesitate. HIs calm, relaxed, professional manner reassured me every step of the way from the initial consultation to the post op follow up appointment. i felt fully informed and the information was on a comprehensible level so i never felt overwhelmed by the specialist medical terminology. His efficient and professional team were caring and considerate and their approachable manner put my mind at ease. i was confident i was in good hands throughout. I highly recommend Mr David Anderson without hesitation. In fact i have to have the same procedure on my other eye in the near future and am completely at ease in the knowledge that Mr Anderson will be my surgeon. Thank you to all the team.
Corneal Cross Linking
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I live in Guernsey and was referred to Mr Anderson for help with my condition known as Keracatonus. I met David who from the offset knew what he was able to offer me. His knowledge of eyecare was incredible something I had not experienced before, I'm 31 years old. I agreed to have Corneal Cross Linking done. At first it was very daunting as I did my research but when it came to the procedure I was looked after very well. The procedure was over and done with in over 30 minutes. There is discomfort for a few days after but rest is the key. Eye drops and pain killers benefit as well as sunglasses and goggles for the shower. Overall the experience was worthwhile as my corneas are now fantastic and I'm working at improving my vision with the help of my optician and continued support from David and his team. I would highly recommend Anderson Eyecare to anyone considering procedures especially Corneal Cross Linking.
Corneal Cross Linking
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Diagnosed with advanced Keratoconus at the age of 19, I was referred to Dr Anderson at the Nuffield Hospital in Chandlers Ford, Eastleigh. My initial meeting with Dr Anderson left me feeling encouraged and in safe hands. I had the condition explained to me in depth and was guided through the Corneal Cross Linking procedure which would halt the thinning of my corneas. The operation itself was not painful. Dr Anderson's consideration towards my comfort was excellent. The after care and follow-up appointments are a constant reminder of the exceptional quality of his practice as my vision is stable and healthy. I understand having corneal treatment at a young age is daunting, but Dr Anderson's professionalism, expertise and care towards his patients left me feeling calm and confident. I would highly recommend Dr Anderson's practice to anyone.
Cross linking
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My son (19) was diagnosed with keratoconus following a trip to emergency department with hydrops. We were referred to Mr Anderson regarding care and plan for future treatment Mr Anderson and his team have been exellent from start to finish. Cross linking was advised (on his good eye ) and this was completed very quick within 5 days of seeing Mr Anderson his PA Lisa Kept us informed and was very professional. my son recovered within a week and I can not thank the team enough. Once again thank you.

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