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An Edge over the Bulge: KXL and Keratoconus

A 15-year-old girl was referred to our institute after detection of poor vision and squint in her right eye. At the time of examination, her uncorrected visual acuity was 6/300 in the right eye and 6/15 in the left eye, and her best spectacle-corrected visual acuity was 6/300 right eye and 6/7.5 left eye. She had a divergent squint of 300. On slit-lamp examination of the eyes, upper palpebral conjunctiva revealed fine papillae in both the eyes. Right eye had gross clinical findings suggestive of Keratoconus such as Fleischer ring, Vogt striae, thinning and bulging of the central cornea.

The patient was diagnosed with advanced Keratoconus in right eye with outward squint and early Keratoconus in the left eye.  Corneal Topography (corneal mapping) in both the eyes showed an area of increased steepening encompassing the central and the infero-temporal cornea. Rigid Gas Permeable (semi soft contact lenses) trial was advised for the right eye after which best corrected visual acuity of 6/15 was achieved. Collagen Cross Linking was performed in the left eye with the latest advanced 3 min protocol (KXL, Avedro, USA).


  • Keratoconus is a corneal disease which causes weakness and thinning of cornea leading to a conical bulge and irregular shape of cornea resulting in loss of vision, Squint and Lazy eye.

  • Riboflavin 0.1% Ultraviolet A (UVA) collagen crosslinking by a new technique (KXL) now available at Advanced Eye Hospital, has reduced the one hour long procedure to a few minutes and made even thinner corneas suitable for cross linking.

  • Keratoconus is fairly common and awareness needs to be created for early diagnosis.