Corneal Cross-linking for Children

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Washington University pediatric ophthalmologists at St. Louis Children’s Hospital now offer outpatient corneal collagen cross-linking therapy. The therapy may improve the quality of eyesight or life in children at risk for a sight-threatening cornea thinning condition: keratoconus. St. Louis Children’s is the only pediatric hospital within 250 miles to offer this therapy for pediatric population.

What is Keratoconus?

Progressive or unstable keratoconus causes the cornea (the clear layer in font of the pupil) to thin and bulge like a cone, leading to extremely blurred vision or severe near-sightedness. This abnormal shape prevents the light entering the eye from being focused correctly on the retina and causes distortion of vision. Some eventually may need corneal transplantation to restore the corneal integrity and eyesight.

Children at risk for keratoconus are those with:

• High near-sighted astigmatism
• Down syndrome and other neurodevelopmental disorders
• Severe eye or skin allergies with excessive eye rubbing, causing the cornea to thin

How Can Corneal Collagen Cross-Linking Help?

Keratoconus usually starts in childhood. One in 500 children in the U.S. have thin and misshapen corneas that can progress to keratoconus. Cross-linking of the corneal collagens can strengthen and stabilize the cornea. Cross-linking usually works better in younger corneas and may prevent the corneal thinning or warpage from progressing, thus may reduce the need for future corneal transplant.

To determine if cross-linking therapy is needed, our pediatric ophthalmologists perform complete eye examination including measurements of corneal thickness and curvature to ensure the safety and efficacy of the procedure.

What to Expect During and After the Procedure

If cross-linking therapy is recommended, the child will receive brief sedation with general anesthesia. After numbing drops are applied, the epithelium (the thin layer of the corneal surface) is gently removed to allow the diffusion of the cross-linking medication. A special eye medication (Photrexa) is applied to the cornea for a pre-planned duration. The medication is activated by UV light to induce a photochemical reactions to strengthen and stiffen the cornea, keeping it from further bulging. A clear soft contact lens is then placed on the eye to provide the comfort and proper healing.

After surgery, the eye may feel scratchy or light sensitive for a few days, but there are no major restrictions on daily activities. Eye rubbing or water sports should be avoided until the cornea completely heals to prevent delayed healing or infection. The child can return to school and normal play. Eye drops are used for about one week and the contact lens is removed.

Post-Op Checks in the Eye Center

Your child’s nurse will tell you the time to return to the Eye Center for a post-operative office visit the day after surgery. Your child will need to be seen several times in the first months to track their progress.

Post-operative appointments will be made for the following:

• Next day, 1-2 weeks, 6-8 weeks, 6 months
• For families who travel long distances it may be possible to arrange follow-up exams with their local eye care provider.