Epioxa Cross-Linking (CXL) Keratoconus Treatment

At Southwest Eye Institute in El Paso, Texas, we’re proud to now offer Epioxa cross-linking, the latest FDA-approved treatment to stop keratoconus from worsening and stabilize your vision.

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What is Epioxa Cross-linking (CXL)?

Is your eyesight changing rapidly or getting blurrier even with new glasses? You might be facing keratoconus, a progressive condition that can worsen vision over time. At Southwest Eye Institute in El Paso, Texas, we understand how frightening it is to watch your vision deteriorate. 

Epioxa is the first and only incision-free, epithelium-on corneal cross-linking therapy for keratoconus, meaning no surgery or corneal scraping is required. This advanced procedure strengthens your cornea using special vitamin B2 eye drops, oxygen delivery, and UV light – all without cutting the eye, resulting in significantly less pain and a faster recovery

Image of Epioxa the newest crosslinking treatment.

Benefits of Epioxa vs. Traditional Cross-Linking

Epioxa is the first and only epithelium-on corneal cross-linking therapy for keratoconus, meaning no corneal scraping is required. This advanced procedure strengthens your cornea using special vitamin B2 eye drops, oxygen delivery, and UV light – all without scraping the eye, resulting in significantly less pain and a faster recovery.

Epioxa is an incision-free option. Unlike older cross-linking that required scraping off the corneal epithelium, Epioxa leaves the protective surface layer intact. This means significantly less trauma to your eye. Keeping the epithelium on greatly reduces pain and speeds up healing – there’s no raw wound on your cornea to recover from.

Because the corneal surface isn’t removed, Epioxa patients experience less discomfort during and after the procedure. The pain that was typically associated with epi-off cross-linking is significantly reduced in intensity and duration. Most patients only report mild irritation or dryness for a day or so, if any. You can often get back to your routine quickly, without the agony that earlier cross-linking patients endured during recovery.

Epi-On corneal cross-linking with Epioxa offers a smoother recovery and significantly less downtime than traditional methods. Because the corneal surface remains intact, patients avoid the extended healing period required with older Epi-Off procedures. Many people return to normal daily activities within a day or two. Vision may appear slightly hazy immediately after treatment as the cornea stabilizes, but it typically clears more quickly than with traditional cross-linking. The procedure itself is also much faster, taking about 22 minutes, compared to 60–70 minutes for the traditional Epi-Off approach.

In traditional “epi-off” cross-linking, removing the epithelium creates an open wound, which can lead to infection, scarring, and other complications during healing. Epioxa avoids this entirely. By keeping the cornea’s surface intact, the risk of infection or scarring is much lower. The procedure has an excellent safety profile; clinical trials found it to be very well-tolerated with minimal adverse effects.

Epioxa’s use of the O₂n system and Boost Goggles ensures that your cornea has plenty of oxygen during the UV light treatment. Why is this important? Oxygen is a crucial ingredient for the cross-linking reaction that strengthens the cornea. By delivering additional oxygen, Epioxa can achieve robust cross-linking without removing the epithelium. This innovative approach helps Epioxa match the effectiveness of traditional cross-linking while being gentler on the eye. It’s cutting-edge science working for you, the patient.

Epioxa has undergone rigorous testing. It was FDA-approved in late 2025 after two large clinical trials proved its effectiveness in halting keratoconus progression. In those studies with over 400 patients, Epioxa significantly improved corneal stability (measured by a reduction in corneal curvature steepness) at 12 months post-treatment. The outcomes showed that Epioxa works to strengthen the cornea and slow or stop keratoconus, just as well as the older method – but with far better comfort and safety for patients. It is now the first and only FDA-approved epithelium-on cross-linking therapy for keratoconus, representing a new standard of care.

Because keratoconus often starts early in life, it’s crucial to treat it early. Epioxa is approved for both adults and children (age 13 and up), whereas many past treatments were primarily for adults. This means teenagers with progressive keratoconus can get help before the disease causes serious damage. Our doctors can safely perform cross-linking on teens to stabilize their vision at a young age, giving them a better chance at a normal life without severe visual impairment.

Photo of a family that could be affected by keratoconus genetically.

Are you wondering if CXL can help you? 

Schedule an evaluation at Southwest Eye Institute in El Paso to find out if you’re a good candidate for corneal cross-linking. Early treatment can make all the difference in protecting your sight.

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Key Benefits of Cross-Linking for Keratoconus

Cross-linking offers several important benefits for patients with keratoconus or corneal weakening:

CXL is the first treatment clinically proven to slow or stop keratoconus from worsening. By addressing the root cause (a weak cornea) rather than just the symptoms, it helps keep your natural cornea stable. This means your condition won’t advance to more severe stages.

By stabilizing the cornea early, cross-linking preserves your current vision and prevents serious corneal damage. Many patients who undergo CXL avoid needing a corneal transplant in the future, which is a much more invasive surgery. In short, CXL keeps you out of the operating room for as long as possible by safeguarding your cornea’s integrity.

CXL is performed right in our El Paso clinic. No incisions or stitches are required – we use only numbing drops on your eye. You’ll be able to go home the same day. The most common side effect is some mild discomfort or light sensitivity for a few days while the cornea’s surface heals. There is a low risk of complications, and our team will provide you with eye drops and guidance to ensure a smooth recovery.

Cross-linking creates lasting added strength in your cornea. Just one treatment can often stabilize the cornea for years, effectively freezing the disease’s progression long-term. This means you get a durable benefit that protects your vision for the foreseeable future. Many patients also find their contact lenses fit more comfortably after CXL, since a stronger cornea can hold a better shape for clearer vision.

Keratoconus cross-linking is generally covered by insurance as a medical treatment (not just a vision correction procedure). Since it’s an FDA-approved therapy to stop a disease, most insurance plans do cover CXL for keratoconus. We will help you understand your coverage and costs so you can plan accordingly.

Who Is a Candidate for Epioxa Cross-Linking?

Epioxa cross-linking is an excellent option for most keratoconus patients, but we’ll make sure it’s right for you through a thorough examination. General guidelines for candidates include:

1

Diagnosed Keratoconus:

You should have keratoconus (any stage from early to early-advanced). Whether you’re newly diagnosed or have known keratoconus that’s getting worse, cross-linking is the only treatment that can slow or stop it. We also treat patients who have had a rapid change in their prescription or corneal shape and are suspected to have keratoconus even if not formally diagnosed yet.

2

Ages 13 and Up:

Epioxa is FDA-approved for pediatric and adult patients 13 years of age or older. Teens, young adults, and older adults with keratoconus can all be candidates. (For patients under 13, cross-linking is typically not performed, but we can monitor closely until they are eligible or consider investigational options.)

3

Progressive or Significant Keratoconus:

Generally, if there is evidence your keratoconus is worsening (for example, your cornea is getting more curved or your vision is declining), you should strongly consider cross-linking. That said, even stable keratoconus can be treated in some cases to prevent future progression – our doctors will evaluate the stability of your condition. We prioritize treatment for corneas that show progression or are at high risk of progression (common in younger patients).

4

Corneal Thickness:

Part of our evaluation is measuring corneal thickness. For any cross-linking (epi-on or epi-off), the cornea needs to have a minimum thickness to do the procedure safely. Because Epioxa doesn’t remove the epithelium, it can often be performed on slightly thinner corneas than older methods could handle (since we’re not scraping the surface, we preserve thickness). However, if the cornea is extremely thin (typically under ~375 microns in the area to be treated), cross-linking might be too risky. We will measure your cornea and let you know if Epioxa is safe to proceed.

5

Other Eye Health Factors:

We’ll also check for other eye conditions. For example, if you have significant corneal scarring or opacities, those won’t go away with cross-linking – in such cases a transplant might still be needed. If you have active eye infections or severe dry eye, we’d address those before doing cross-linking. Patients who have had prior herpes simplex virus infections in the eye must be managed carefully (cross-linking can sometimes reactivate herpes, so prophylactic medication may be given). Additionally, if you’ve had cataract surgery and lack a UV-blocking lens implant, or if you have certain sensitivities, these are considerations (our doctors will review your history thoroughly). The vast majority of keratoconus patients, however, do qualify for Epioxa treatment.

6

Not Pregnant:

As a precaution, we typically do not perform cross-linking on pregnant women. Hormonal changes can sometimes accelerate keratoconus, but we’d likely monitor and wait until after pregnancy to treat, to ensure the safest environment and most stable measurements for your eyes.

Why Early Stabilization Matters

If you or a loved one has been diagnosed with keratoconus, acting early can make all the difference. Keratoconus is a progressive disease – it tends to worsen over time, and younger patients often see faster progression. The goal of any keratoconus treatment is to halt the disease before it causes irreversible damage. Here’s why timing is so important:

  • Prevent Severe Vision Loss: Early in keratoconus, vision might be correctable with glasses or special contact lenses. But as the cornea continues to weaken and bulge, vision can deteriorate beyond what lenses can fix. Eventually scarring or extreme thinning can lead to legal blindness in the affected eye. By stabilizing the cornea early with cross-linking, we can maintain your best possible vision and prevent those severe outcomes.

  • Avoid the Need for Corneal Transplant: As mentioned, a significant fraction of untreated keratoconus patients end up needing cornea transplant surgery down the road. While transplants can restore vision, they come with higher risks, longer recovery, and potential complications (rejection, lifelong medication). Cross-linking early on can save your natural cornea. Stopping keratoconus progression means you’re far less likely to ever face a transplant. It’s a preventative approach that preserves your own eye tissue.

  • Better Long-Term Vision Quality: The sooner we strengthen the cornea, the less distortion will occur. If we intervene when your keratoconus is mild or moderate, your cornea will maintain a more regular shape after treatment. That can make it easier to fit contact lenses and achieve clear vision. If one waits until the condition is advanced, even if cross-linking stops further progression, the vision might already be very impaired from scarring or irregular astigmatism. Early treatment gives you the best chance to retain good vision with minimal corrective lenses afterwards.

  • Fast Progression in Youth: Keratoconus often progresses most rapidly in patients under 30. Teenagers and people in their twenties can see significant changes in their vision in just months. This is why Epioxa being approved for ages 13+ is so important – we can treat young patients before too much damage occurs. If you’re a parent of a child or teen with keratoconus, consider cross-linking sooner rather than later to safeguard their sight during those critical formative years.

  • Cross-Linking Only Halts (Doesn’t Reverse) the Disease: It’s worth emphasizing that treatments like Epioxa stop keratoconus from getting worse – they don’t cure it or undo the thinning that’s already happened. That means timing matters; we want to freeze the disease before it causes serious vision loss. Early cross-linking can essentially “lock in” your current level of vision so it doesn’t decline further. The later you wait, the more vision quality you might lose that cannot be restored. Thus, acting early maximizes the vision you get to keep.

Frequently Asked Questions about Keratoconus & Cross-Linking

 A: Corneal cross-linking is a treatment designed to strengthen the cornea. In keratoconus, the cornea weakens and bulges; cross-linking uses vitamin B2 eye drops (riboflavin) and UV light to reinforce the collagen fibers in the cornea, making it stiffer. It’s like adding extra cross-ties to a weak framework. This prevents further thinning and bulging. The result is that progression of keratoconus is slowed or stopped. Cross-linking does not typically improve your vision immediately (since it doesn’t reverse the existing cone shape), but by halting the disease it preserves your vision from getting worse.

 A: Epioxa is a newer, incision-free version of cross-linking. The older method required manually removing the cornea’s surface layer, which caused pain and longer healing. Epioxa does not require removing the surface. Instead, it uses specially formulated riboflavin drops that penetrate the intact surface and a device that delivers extra oxygen during the UV treatment. This allows effective cross-linking without the pain, infection risk, or slow recovery of the traditional technique. In short: both methods strengthen the cornea, but Epioxa is gentler and quicker to heal, with equal efficacy. It’s also the only FDA-approved epi-on treatment available.

A: Yes. Epioxa has been shown to be safe and well-tolerated in clinical trials. Because it’s less invasive (no surgery), the safety profile is arguably better than the older method. There’s a much lower risk of infection or scarring since the corneal surface isn’t cut open. The most common side effects observed were mild and temporary, such as slight corneal haze, light sensitivity, or irritation in the days after treatment. These usually resolve on their own. Serious complications are very rare. Our doctors will discuss all the potential risks with you, but overall Epioxa is considered a very safe procedure for keratoconus – and far safer than letting keratoconus progress untreated.

A: The procedure itself is painless. We use numbing drops so you won’t feel the drops or the light. You’ll be awake but comfortable. After the numbing wears off, most patients have minimal pain. You might feel a bit of grittiness or burning in the eye for a day, but this is usually mild. Because Epioxa keeps the epithelium intact, patients avoid the severe pain that used to come with the old epithelium-off cross-linking. You also won’t have to deal with a big contact lens bandage or a raw wound on your eye, which is what caused most of the pain before. If needed, over-the-counter pain relievers or artificial tear drops are enough to keep you comfortable during the short recovery.

 A: Recovery with Epioxa is relatively quick and easy. There is no surgical incision to heal, so your epithelium stays intact and begins functioning normally right away. You will likely have blurry vision for a few days as the cornea settles and the riboflavin clears – this is normal. You may also have some light sensitivity or a sandy feeling in the eye for 24-48 hours. Most patients return to work or school within a day or two, compared to about a week or more with the older procedure. We usually have you back for a follow-up the next day to check the eye, and additional follow-ups over the next weeks to monitor healing.

In terms of results: the goal (stopping progression) is something we confirm over time. You likely won’t feel anything different immediately, but that’s good – it means your cornea is stable. In some cases, after 3-6 months the cornea’s shape actually improves slightly (flattening of the cone), which can lead to better vision or easier contact lens fitting. However, the main “result” is that your keratoconus is no longer worsening. We will perform corneal scans at follow-ups (6–12 months later) to ensure the disease has stabilized. Clinical studies showed a significant improvement in corneal curvature at 1 year post-Epioxa, indicating the treatment works to strengthen the cornea. So, patience is key – the benefit is long-term preservation of vision rather than an immediate change you notice the next day.

 A: Probably yes. Cross-linking (including Epioxa) is not a refractive procedure – it doesn’t reshape your cornea like LASIK would. Its purpose is to prevent further shape change, not to give you perfect vision. Most keratoconus patients will continue to wear glasses or (more commonly) hard or scleral contact lenses to correct any remaining irregular astigmatism. The good news is that by stabilizing the cornea, it often becomes easier to fit with contacts (because the shape stops changing and sometimes even becomes slightly more regular). Some patients do notice they can wear their contacts longer or more comfortably after cross-linking. And if your prescription was rapidly changing before, cross-linking will make it stable – so you won’t have to keep getting new, stronger glasses every few months. In summary, Epioxa preserves your best corrected vision; you may still need lenses to see 20/20, but it keeps that level of vision achievable for the future.

 A: The procedure itself usually takes around 60 minutes or less. Plan to be at our office for about 1.5 to 2 hours on the day of treatment, which includes prep time and a short post-op observation. You’ll be awake the whole time and can go home soon after we finish (you’ll need a driver since we dilate or at least because your vision will be blurry).

As for cost and insurance: Corneal cross-linking is generally covered by insurance when medically necessary for keratoconus. Epioxa, being the new FDA-approved method, is expected to be covered similarly to the previous FDA-approved cross-linking. Our staff will help obtain pre-authorization from your insurance before the procedure. Every plan is different, but many do cover the bulk of the cost (since keratoconus is a medical condition, not just vision correction). We also offer financing options or payment plans if needed. We’ll make sure you have a clear understanding of any out-of-pocket costs before scheduling the treatment. Don’t let cost concerns keep you from inquiring – preserving your vision is an investment, and we’ll work with you to make it attainable.

 A: It depends on the situation. If both of your eyes have progressive keratoconus, we can treat them in a staged approach. Often we treat one eye at a time (separated by a week or two) so that you always have one “good” eye for daily tasks during the immediate recovery. However, because Epioxa’s recovery is quick and relatively mild, some patients do opt to treat both eyes on the same day or within the same week. Our surgeon will discuss the pros and cons of simultaneous vs. sequential treatment. In many cases, we still prefer one eye at a time to ensure you’re comfortable and to observe healing, but we’ll create a plan tailored to your needs and schedule.

 A: Untreated keratoconus typically keeps getting worse. Vision that is mildly blurry can turn into serious visual distortion. You might go from needing glasses to hard contacts, and eventually even contacts might not provide clear vision if the cornea becomes too irregular or scarred. As noted earlier, advanced keratoconus can lead to permanent scarring and the need for a corneal transplant. Essentially, by not treating, you’re risking significant vision loss. Cross-linking is the only proven method to halt keratoconus progression, so without it (or a future equivalent therapy), the disease will usually continue to progress until a major intervention (like transplant) is the only option. We strongly encourage treating progressive keratoconus early – it can save you from a lot of vision loss and bigger surgeries later on.

We’re here to help. Please call our office or schedule a visit and we’ll gladly answer any other questions about keratoconus, Epioxa, and what you can expect. Educating and reassuring our patients is an important part of our care philosophy.

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Keratoconus doesn’t have to progress to the point of severe vision loss. With corneal cross-linking, you can take control of your eye health and stabilize your vision before the condition worsens.

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