Corneal cross linked: ✅. So what now? Like most eye surgeries, corneal cross linking is a very easy painless procedure to have. But after the procedure, there will be a small amount of time to recover from the operation.
Most of the recovery after corneal cross linking happens within the first week after the procedure. When the surface of the cornea (or epithelium) is removed to perform the treatment, this surface must regrow over the course of a week. This can cause blurry vision and scratchiness or discomfort to the eye until everything is healed over.
Beyond that first week, there still will be a few minor things which can affect your vision until everything is fully healed up.
Note: The recovery after corneal cross linking will depend on the type of corneal cross linking being performed. Corneal cross linking is an evolving procedure. As surgeons investigate how to perform the procedure more efficiently and effectively, different types emerge. When talking about recovery time, there are two main types involved: called epi-on and epi-off. Within the United States, the epi-off type is the FDA approved corneal cross linking procedure and the type focused on in this article.
Initial Recovery
Corneal cross linking is a painless and relatively quick procedure. But the recovery afterwards does have some discomfort, blurred vision and can last up to a week. This recovery all boils down to the epithelium on the surface of the cornea.
The cornea is a very sensitive structure. Unprotected, the cornea will be so sensitive that it will cause you to have pain. Fortunately, the cornea is normally protected with a thin layer of cells on the surface called epithelium.
But during corneal cross linking, this thin layer of cells is removed. This allows for the special eye drops and UV light to really absorb into the cornea and cross link the cornea. (see also The Complete Walk-through of the Corneal Cross Linking Procedure).
Following corneal cross linking, this layer regrows. But it takes some time for everything to return back to normal; because of that, there is a recovery time after corneal cross linking.
Pain or discomfort
For the first 4-5 days after corneal cross linking, there can be discomfort or scratchiness to the eyes. After-all, the epithelium can’t protect the cornea if it isn’t there. This discomfort can be variable; some people will notice it more than others.
To help prevent as much discomfort as possible, a soft contact lens is added to the eye at the end of the procedure. This contact lens doesn’t have any prescription, it is purely designed to provide a protective barrier to the sensitive cornea. It prevents simple things such as the eyelids blinking from causing you to have pain.
This contact is designed to stay within the eye full time for approximately one week until it is removed by your eye surgeon. Even if you have experience putting in and taking out contact lenses, you want to leave this one alone until that epithelium is healed up.
What can you do for the pain?
- Use artificial tears. These will prevent the eye from drying out and provide additional lubrication on the surface of the eye. A dry eye and especially a dry contact lens can become more uncomfortable after corneal cross linking.
- Take ibuprofen or Tylenol. This can help reduce the amount of pain you feel. While it probably won’t take care of everything, it can still make your recovery just a little bit easier.
- Keep your eyes closed. While this can be difficult to do for 4 to 5 days straight, keeping your eyes closed or taking naps from time to time will prevent your eyelids from rubbing against your cornea. Good time to get into a new audiobook!
Blurry vision
Again related to the epithelium on the eye, your vision will be blurry for the first week after corneal cross linking.
Before the procedure, your cornea was nice and smooth. The epithelium that covers the cornea has a smooth surface. When this epithelium is removed during corneal cross linking, the layers underneath are rough instead.
A smooth surface is better for light to pass through than a rough surface. If you are out fishing on a smooth pond in nice clear water, you’ll be able to see exactly where the fish are. But if a storm starts to blow in and the water becomes choppy, your view becomes blurred and finding out where to cast your line becomes more challenging.
And even though you may have already had blurred vision before surgery, it can get even more blurry afterwards. That is, until the smooth epithelium regenerates.
Beyond The First Week
Ok, once you get past that first week, you’re good right? Well, sorta. A lot has healed up already but there still can be some additional recovery after corneal cross linking that can affect your vision.
Haze
The meat of the cornea contains smooth transparent stacked layers of cells called the stroma. This is the layer which is actually targeted by the UV light. The light causes this layer to cross link together to improve the strength of the cornea.
But the UV light does have some side effects and the cornea must recover after the blast of UV light. As the cornea recovers, it can develop some haze. This haze peaks around months 1 to 3 before gradually resolving over the rest of the year.
Typically, this haze has little effect on the vision but its possible it can cause things to be slightly more blurry, especially within the first few months after corneal cross linking.
Change in the prescription of the eye
One byproduct of making the cornea stronger is that it changes the curvature of the cornea.
A weak cornea will bend more. This is what happens in keratoconus. That bend in the cornea causes an irregular cone to form. More bending means a steeper curvature. A stronger cornea will bend less and be less steep.
Steeper cornea with keratoconus; image by Madhero88, CC BY-SA 3.0, via Wikimedia Commons
After corneal cross linking, the cornea becomes stronger. This stronger cornea will actually become flatter. Because the curvature of the cornea affects the glasses or contact lens prescription of the eye, this means the prescription of the eye will change after corneal cross linking.
In the short term, this may mean your glasses or contact lenses don’t correct your vision as optimally as before, but this prescription change can actually improve vision somewhat in the long term. Having a flatter cornea can cause you to have less prescription and less astigmatism.
Of all the recovery steps after corneal cross linking, this change in prescription can take the longest to stabilize. In fact, while the biggest change is within the first year, the prescription of the eye can still continue to change years out from the procedure!
Thus, while you are recovering from corneal cross linking, you may end up needing to get updated pairs of glasses and / or contact lenses.
Summary
Following “epi-off" corneal cross linking, expect to have some pain and discomfort for the first week following the procedure. After that first week, most of the recovery is done, however you still can have some changes in vision and prescription months and years later.
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