Corneal Ectasia: when the cornea loses its strength

The most common form is keratoconus, which often appears in young adults, while other cases may occur after laser eye surgery such as LASIK (1, 2).

As the cornea loses stability, vision becomes increasingly blurred, with often crescent myopia or irregular astigmatism, uncorrectable with glasses. Symptoms include frequent prescription changes, glare, halos, or double vision. Diagnosis is made through corneal tomography, a painless 3-D scan that detects early shape changes. (Figure 1)

Today, treatments focus on stabilising the cornea and improving vision. The gold standard is corneal cross-linking (CXL) — a safe, outpatient procedure that uses riboflavin (vitamin B2) drops and UV light to strengthen corneal fibres and halt progression in most patients. Specialized contact lenses, intracorneal ring segments (ICRS’s) or, rarely, corneal transplant may also be used.

Early detection, in the phase of ectasia susceptibility, is the state-of-the-art approach nowadays, and timely CXL allow most people to preserve clear, natural vision and avoid advanced surgery. A simple non-invasive corneal scan can make all the difference.

Corneal Cross-Linking (CXL): The proven way to protect your vision

What is CXL

Clinically proven, minimally invasive procedure that can stop corneal ectasia from getting worse, helping patients preserve natural vision and avoid major surgery later.

Strengthens the cornea by applying riboflavin (vitamin B2) drops and then shining a gentle UV-A light onto the surface. This creates new cross-links between the collagen fibres, making the cornea stiffer and more stable.

Why it’s a game-changer

It treats the cause, not just the symptoms: Glasses or contact lenses correct vision but do not prevent corneal ectasia from progressing. CXL addresses the root structural weakness of the cornea and has been shown to halt or slow progression in around 90% of cases.

Outpatient and minimally invasive: The procedure usually takes about half-an-hour, is performed under anesthetic eye drops, and patients return home the same day. Most recover within a few days.

Long-term results: Studies confirm lasting corneal stability for 10 years or more after treatment.

FDA-approved and globally recognized: The procedure received U.S. FDA approval in 2016 and is endorsed by the American Academy of Ophthalmology and NICE (UK).

How it works

During treatment, your doctor applies riboflavin drops to soak into the cornea. A controlled UV-A light is then directed onto the eye. The vitamin and light react to create new collagen bonds - similar to adding reinforcing steel to concrete.

The most common method last decade was the “epi-off” protocol, where the outer corneal layer (epithelium) is gently removed to enhance absorption. Mild discomfort, tearing, or light sensitivity are normal for a few days afterward. The cornea gradually becomes more stable and less irregular over the following months.

Who benefits most - You may be a candidate for CXL if:

• You have diagnosed keratoconus or post-LASIK ectasia that is still progressing.

• You want to preserve your vision before changes become advanced.

What’s new in 2026

New-generation “epi-on” and accelerated techniques are reducing healing time and discomfort. New FDA-approved systems, allow transepithelial cross-linking — avoiding epithelium removal — and will launch in 2026. Research confirms that both epi-on and epi-off methods are effective, with ongoing improvements in patient comfort and outcomes.

Why choose CXL now - we live the era of disease prevention

Act early: The earlier CXL is done, the better the long-term visual outcomes.

Avoid a corneal transplant: CXL dramatically reduces the lifetime risk of needing a transplant.

Safety: Proven, science-backed technology used successfully in thousands of patients worldwide.

Ask your ophthalmologist about screening with corneal tomography scan to check for early keratoconus/ectasia susceptibility and learn whether cross-linking is right for you. Protect your cornea today — and preserve the vision you’ll need for tomorrow.

This article was written by Dr. Pedro M. Baptista and Dr. João Heitor Marques, both ophthalmologists at the HPA Institute (Montegro, Faro).