Corneal Collagen Crosslinking

Medically Reviewed by: Brian S. Boxer Wachler, MD

reading classes sitting on a doctors pad with a diagnosis of keratoconus

On this page: Types of CXL | Benefits of Treatment | Candidacy | Cost | Risks

If you have been diagnosed with keratoconus, post-LASIK ectasia or another condition caused by a weakened stroma (middle layer of your cornea), you may benefit from an advanced procedure called corneal collagen crosslinking (CXL). Available in the U.S. as of 2016, corneal collagen crosslinking is an effective treatment that has been performed successfully abroad for years.

This procedure works by strengthening collagen bonds in the stroma.

CXL works by strengthening collagen bonds in the stroma. During the procedure, your surgeon applies eye drops with riboflavin (vitamin B2) and projects ultraviolet light onto your cornea to produce new, stronger bonds in the collagen. Corneal collagen crosslinking is sometimes combined with other procedures for enhanced effect, such as implantation of intrastromal corneal rings (e.g., Intacs) or surface laser ablation procedures (e.g., PRK, epi-LASIK).

Now available in the U.S., corneal collagen cross-linking is an effective treatment that has been performed successfully abroad for years.

Types of Corneal Collagen Crosslinking

There are two basic types of CXL: epithelium off and epithelium on. The difference between the two is pretty self-explanatory. Epithelium-off CXL involves the complete removal of the outer layer of the cornea, whereas the epithelium-on variant leaves the outer layer intact.

Removing the epithelium makes it easier for the riboflavin drops to penetrate the cornea. However it also requires more healing time, results in more postoperative discomfort (which should be minimal regardless) and boasts a greater risk of infection. That said, there are many who believe that epithelium-off CXL yields better visual acuity and contrast sensitivity.

The epithelium-on variant is a good option for patients with thin corneas who may not be good candidates for the alternative.

Speak with an eye doctor specializing in corneal collagen crosslinking to learn more about which type is a better option for you.

Benefits of Corneal Collagen Crosslinking

If you have an eye condition caused by a weakened stroma, you are probably anxious to correct the vision problems the condition is causing you. Corneal collagen crosslinking can at least stop the progression of these problems and usually can give you better vision.

Here are some of the benefits of this amazing procedure:

  • Highly effective
  • Eye drops for anesthetic
  • Takes only one hour
  • Prevents further vision loss in almost all patients
  • Three-fourths of patients experience improved vision

Are you a Candidate?

If you are suffering from any of the following conditions, you may be a candidate for corneal collagen crosslinking:

  • Keratoconus
  • Ectasia
  • Pellucid marginal degeneration
  • Corneal ulcers
  • Corneal infections

Also, some surgeons have performed the procedure to stabilize the corneas of patients who previously underwent radial keratotomy (RK).

Corneal collagen crosslinking appears to work best on patients experiencing ongoing fluctuations in vision. In the future, it may even be used to stabilize the corneas of patients who otherwise might not be candidates for LASIK.

Not everyone is a good candidate for CXL. Schedule an appointment with an eye surgeon in your area to learn if you qualify.

Risks & Complications

Corneal collagen crosslinking is safe and effective. However, it usually does not fully correct for nearsightedness, farsightedness or astigmatism. In other words, you will probably need to wear glasses or contact lenses — or have refractive surgery — to achieve best corrected visual acuity (the best vision possible in your case). In fact, it is possible that you will not have 20/20 vision even after CXL and other surgeries.

Most risks associated with CXL are temporary or rare. That being said, potential complications include:

  • Moderate pain
  • Blurry vision (for a few days)
  • Infection
  • Corneal inflammation
  • Dry eye
  • Corneal haze
  • Mild redness
  • Stinging sensation
  • Temporary damage to cornea, retina or lens from overexposure to UV light, leading to temporary vision loss (1-2 days) or need for surgery

How Much Does Corneal Cross Linking Cost?

Although corneal crosslinking has been performed for years abroad, it is only recently that the procedure has been FDA approved for the U.S. As such, cost information is somewhat limited. However, you can expect the cost of corneal crosslinking to range between $2,500 and $4,000 per eye. This means that the total cost of CXL could range between $5,000 and $8,000 if you require treatment in both eyes.

Keep in mind that the cost of treatment does not include the costs associated with supplemental procedures often performed at the same time as CXL (such as implantation of intrastromal corneal rings or surface laser ablation procedures).

Since the treatment is often for a medical condition, such as keratoconus or corneal ulcers, it is typically covered by insurance. Financing options are available for such procedures, when insurance reimbursement is not available. The only way to get a comprehensive CXL cost estimate is to speak to a qualified eye surgeon.

Read more about corneal collagen cross-linking

About the Reviewer

Dr. Brian S. Boxer Wachler - Boxer Wachler Vision Institute

Brian S. Boxer Wachler, MD, is a Board-certified ophthalmologist and multi-published book author in private practice in Beverly Hills, CA. Often referred to as “America’s TV Eye Doctor,” Dr. Boxer Wachler has a stellar reputation for excellence amongst his peers who have elected him as one of the “World’s Best Refractive Surgeons.”

Dr. Boxer Wachler (or Dr. Brian as his patients affectionately call him) has devoted his career to vision correction, with expertise spanning an array of conditions and treatments, including cataract surgery, FortifiedLASIK™, the treatment of keratoconus and more. To learn more about Dr. Brian, visit his keratoconus specialty website at