Keratoconus: Diagnosis, Cross-Linking and Corneal Rings

Keratoconus is a condition in which the cornea gradually thins and bulges forward into a cone shape. This causes blurred and distorted vision and an increasing, irregular astigmatism. It usually starts in the teens or twenties. Eye rubbing and eye allergy are linked to its progression.

Early diagnosis matters, because treatment can slow or stop the condition from getting worse. Our approach combines corneal scans, monitoring, and treatment matched to the stage of the disease.

Who it's for

• Teenagers and young adults with rapidly changing glasses, especially increasing astigmatism.
• People who were told they are not suitable for LASIK because of their corneal shape.
• Patients with confirmed keratoconus that is progressing, for whom cross-linking may be recommended.
• Patients whose vision is poor with glasses or who do not tolerate contact lenses, for whom intracorneal rings may help.
• Family members of people with keratoconus, who may benefit from a screening scan.

Treatment options

• Specialty contact lenses: rigid gas permeable (RGP) and scleral lenses can improve vision for many people with keratoconus. RGP and scleral lens fitting is available at the clinic. The choice of lens and the fitting depend on your assessment. Glasses may be enough in early stages.
• Corneal cross-linking (CXL): riboflavin (vitamin B2) drops and ultraviolet light strengthen the bonds in the corneal tissue. The aim is to slow or stop progression, not to restore normal vision.
• Intracorneal ring segments: small, thin arcs placed inside the cornea to flatten and regularise its shape, which may improve vision and contact lens tolerance.
• Corneal transplantation: for advanced cases or corneal scarring (see Corneal Transplantation).

How it works

1. Diagnosis: corneal topography or tomography scans measure the shape and thickness of the cornea. Repeated scans over time show whether the condition is progressing.
2. Contact lens fitting: if RGP or scleral lenses suit your eyes, the lens is chosen and fitted based on your corneal measurements, with follow-up visits to check comfort, fit and vision.
3. Cross-linking: the eye is numbed, the surface layer is usually removed, riboflavin drops are applied, and the cornea is exposed to controlled ultraviolet light. The procedure usually takes under an hour.
4. Rings: the eye is numbed, a channel is made inside the cornea, and the segments are inserted.
5. Your doctor may combine or stage treatments depending on your scans.

Recovery

• After cross-linking, expect discomfort, watering and light sensitivity for a few days. A bandage contact lens is used until the surface heals. Vision may be blurred for several weeks.
• After ring implantation, the eye is usually irritated for a few days, and vision improves gradually over weeks.
• Stop rubbing your eyes. Treating eye allergy is an important part of long-term care.
• Regular scans are needed for years afterwards to confirm the cornea remains stable.

Frequently asked questions

Your care team

• Diagnosis and treatment, including cross-linking and ring implantation: Dr. Omar Khaled Al-Duwailah
• Assessment, contact lens fitting and follow-up: Dr. Omar Khaled Al-Duwailah, with our specialist medical team

This page provides general information and does not replace a medical consultation. Suitability, risks and results differ from person to person and will be discussed with you by your doctor.