The First Day After Epi-off Corneal Cross-Linking
At the end of your procedure, antibiotic drops are placed in your eye and a clear bandage contact lens is usually left in place to protect the healing surface. It is normal to have:
Normal symptoms after CXL
- Watering of the eyes and nose.
- Light sensitivity and glare.
- Halos at night.
- Redness and mild swelling of the eye.
- Foreign body sensation, burning, or the feeling that something is in the eye.
- Vision that is foggy or like seeing under water.
Try to go home, keep your eyes closed as much as possible, and rest for the remainder of the day. You may shower or bathe, but avoid getting water or soap directly into the treated eye.
Pain Control After CXL
Epi-off CXL can be uncomfortable for the first few days while the epithelium (surface layer) of the cornea regrows. You will be given a plan for pain control.
Over-the-counter options
- Acetaminophen (Tylenol).
- Ibuprofen (Advil) or another non-aspirin analgesic, if not restricted by your other doctors.
Prescription medications
- Medications such as Percocet, Norco, or Neurontin may be prescribed to take up to 3 times per day, as directed.
Take pain medication exactly as prescribed. If you have severe pain that is not relieved by the plan you were given, contact the office promptly.
Eye Drops and Bandage Contact Lens
You will follow a specific drop schedule after CXL. Always wash your hands before instilling drops and avoid touching the bottle tip to your eye or lashes.
| Medication | Purpose | Typical Schedule* |
|---|---|---|
| Antibiotic (e.g., Moxifloxacin) | Reduces risk of infection | You started this 1 day before surgery. After CXL, continue 1 drop 4×/day for 5 days, then stop unless instructed otherwise. |
| Steroid (e.g., Prednisolone) | Controls inflammation | Start after the bandage contact lens is removed. Then use 1 drop 4×/day for 7 days, then 3×/day for 7 days, then 2×/day for 7 days, then 1×/day until the bottle is finished. |
| NSAID (e.g., Ketorolac) | Additional anti-inflammatory effect | Start after surgery (or as directed): 1 drop 4×/day for 7 days, then 3×/day for 7 days, then 2×/day for 7 days, then 1×/day until finished. |
| Ointment (e.g., Erythromycin) | Surface protection and infection control | Apply a small amount in the eye 3×/day for 7 days, starting the evening after surgery unless told otherwise. |
| Preservative-free artificial tears | Comfort and lubrication | Use as needed for dryness and irritation. Many patients use them every 1–2 hours in the early weeks, then taper based on comfort. |
| Comfort drops (e.g., PF artificial tears + Proparacaine) | Comfort and pain relief | Use as needed for pain or irritation. Can use up to 6x/day for 5 days. |
*Your exact regimen may differ. Always follow the written instructions you receive on surgery day.
Bandage contact lens
- A clear bandage contact lens is usually left in place for around 3–5 days to protect the healing cornea.
- Do not rub your eye or attempt to remove or replace the lens if it falls out; call the office instead.
- You will be told when the bandage lens will be removed at a follow-up visit.
Activity Timeline After Epi-off CXL
Epi-off cross-linking is a surface procedure. The first several days are focused on healing and comfort. The table below gives a typical, conservative timeline; your surgeon may adjust this based on your exam.
| Activity | When it is usually safe* | Notes |
|---|---|---|
| Light screen time (phone, TV) | Day 2–3 as comfort allows | Keep sessions short; brightness low; stop if pain or light sensitivity worsens. |
| Showering / washing face | Day 1 | Keep eyes gently closed; avoid water and soap directly in the treated eye for about 1 week. |
| Reading, light housework | Day 3–5 | Vision may still be blurry; build up time gradually. |
| Return to desk work / school | Around Day 4–7 | Depends on comfort, vision, and commuting needs. |
| Driving | After your doctor confirms it is safe | Usually after an early follow-up, once vision meets legal driving standards. |
| Light exercise (walking, gentle indoor bike) | After Day 3–5 | Avoid sweat running into the eye; do not rub the eye. |
| Strenuous exercise (running, gym workouts, aerobics) | About 1–2 weeks | Wait until the surface has healed and pain is gone; avoid eye trauma and sweat in the eye. |
| Contact sports (basketball, soccer, martial arts) | Around 4 weeks | Use eye protection as advised; avoid any risk of getting hit in the eye until your surgeon approves. |
| Swimming, hot tubs, ocean, jacuzzi, sauna | Minimum 3 weeks | Avoid all water directly in or around the eye to reduce infection risk; many surgeons prefer 3–4 weeks. |
| Eye makeup (mascara, eyeliner, shadow) | About 2 weeks | Use new products and remove gently; avoid rubbing or pressing on the eyelids. |
| Hair coloring, facials, lash extensions, tints | About 2–4 weeks | Avoid chemicals, vapors, and manipulation close to the eye until your doctor says it is safe. |
| Sleeping without a shield | After 3–7 nights (per your surgeon) | Wear an eye shield at bedtime early on to prevent accidental rubbing while asleep. |
*Always follow the specific instructions you receive from your surgeon, which may be more or less restrictive depending on your cornea and healing.
General “do’s”
- Wear sunglasses outdoors for at least the first 6 months after CXL.
- Use your preservative-free artificial tears generously.
- Keep away from dusty, smoky, or dirty environments in the first couple of weeks.
- Drink plenty of water; some patients are advised to drink aloe vera juice with orange juice as part of their healing routine.
General “don’ts”
- Do not rub, poke, or press on your eye.
- Do not let shower water, pool water, or hot tub water into the eye until cleared by your doctor.
- Do not sleep face-down into the pillow on the treated eye early on.
- Do not skip or stop drops early, even if the eye feels better.
When to Call the Doctor After CXL
Call immediately if you notice:
- Severe or increasing pain not relieved by prescribed medication.
- Sudden worsening of vision or a “dark curtain” in your vision.
- Thick yellow or green discharge from the eye.
- Marked increase in redness or swelling.
- New flashes of light or a sudden shower of floaters.
- Loss or displacement of the bandage contact lens.
For questions or concerns about your recovery, you can reach:
- Khanna Vision Institute: (805) 230-2126
- Counselor: (818) 857-1735
Frequently Asked Questions About Recovery After CXL
How long until my vision stabilizes after CXL?
Vision often fluctuates for several weeks to months after epi-off CXL. The goal is to stop progression of keratoconus or ectasia; some patients notice gradual improvement, while others mainly notice stability. A new glasses or contact lens prescription is usually considered after the cornea has stabilized.
Will I still need glasses or contact lenses?
CXL is designed to strengthen the cornea, not to eliminate glasses. Many patients still need glasses or specialty contact lenses (such as scleral lenses), but with a more stable corneal shape over time.
Can both eyes be treated on the same day?
This depends on your individual case and surgeon preference. Some patients have both eyes treated the same day; others are staged so one eye heals before the second is treated. Your surgeon will explain the plan in advance.
What if my job is very physical or in a dusty environment?
You may need extra time off, stronger eye protection, or a temporary job modification. Discuss the specifics of your work with your surgeon so they can give you a safe, individualized plan.