Cross-Linking in children and adolescents

Keratoconus is a disease of young people and is most common and most aggressive in children and adolescents (8 to 19 years). It is therefore very important to carry out regular follow-up checks here. Above all, the children of adult patients with keratoconus should also be examined.

Why Early Detection of Keratoconus in Children is Important

Keratoconus and other corneal thinning diseases can develop early in life, sometimes as young as 3 to 4 years old. Detecting the condition early is crucial because progression can be much faster and more severe in children and teens compared to adults.

Warning Signs to Watch For:

Increasing astigmatism (irregular curvature of the eye)
Frequent or strong eye rubbing
Family history, especially if parents have keratoconus

Today, modern devices like the MS-39 allow for early screening and accurate diagnosis in young children.

Why Treat Early?

In 2012, Dr. Farhad Hafezi and colleagues recommended treating keratoconus in children immediately upon diagnosis rather than waiting. This advice is now supported by a new global consensus involving over 90% of leading experts worldwide.

Delaying treatment can lead to rapid worsening of the disease, which may result in severe vision loss. Early cross-linking often leads to stronger improvements and better long-term outcomes.

How is Cross-Linking Procedure Done in Children?

Local anesthesia is used, generally starting from age 9 or 10, to keep the procedure comfortable.
Two main techniques are available:
- Epi-on (transepithelial) CXL – The surface layer of the cornea stays intact. This is ELZA’s preferred method for children because it is less painful and promotes faster healing.
- Epi-off CXL – The epithelium is removed to allow deeper riboflavin penetration and stronger treatment. ELZA also offers a new high-fluence protocol (10 J) that is very effective.
The choice between epi-on and epi-off depends on careful assessment of risks and benefits for each child.

What to Expect After CXL Treatment

Most children tolerate the procedure well with minimal discomfort.
Healing is faster with epi-on CXL, but both methods have proven safety and effectiveness.
Regular follow-up visits are important to monitor progress.

ELZA Institute: Expertise in Pediatric Eye Care

At ELZA Institute, we are leaders in advanced, child-friendly CXL techniques, combining scientific excellence with compassionate care to protect young patients’ vision for life.