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. Saint Louis Children’s is the only pediatric hospital within 250 miles to offer this therapy for pediatric population.

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. 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.

Cautions: Corneal collagen cross-linking may prevent the progression or worsening of keratoconus without direct or immediate improvement of the vision. The corneal curvatures may not improve or remain only unchanged.

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.

How to Refer a Patient for Consultation

Physician referral is recommended.  For questions or to refer a patient for evaluation for keratoconus or corneal collagen cross-linking therapy, call Children’s Direct at 800.678.HELP (4357).