Cornea Crosslinking: Before, During and After

Dear Respected Patient

Please read this handout on the day you receive it, bring it to all of your appointments before and after surgery, and on the day of your eye surgery.

Please obtain all your eye drops (with the attached prescription) and artificial tears before the day of surgery. People who are prepared for surgery and who take part in their care enjoy a better experience and can recover in less time with fewer or no problems. The information in this handout will help to get you, your family and your home ready for surgery.

Thank you for allowing us to help with your care. We wish you a pleasant surgical
experience and a quick recovery.

Sincerely,

Team Seema Eye Care

Preoperative Instructions

  1. Please stop all contact lens wear before cornea crosslinking surgery. Rigid Gas Permeable (RGP) and Scleral contact lenses (hard lenses) must be stopped 2 weeks before and Soft Contact lenses 1 week before crosslinking surgery, in the eye undergoing the procedure.
  2. Before the day of surgery, please arrange to have a responsible person to:
    1. Bring you to Seema Eye Care Centre (by car or taxi). You will NOT be allowed to drive yourself home or take a bus.
    2. Stay at Seema Eye Care Centre during your stay if you need a translator or if you require help and stay with you for at least 24 hours after surgery (if possible).
    3. Help you with daily activities as needed and to follow post-op instructions.
  3. Take one tablet of CELEBREX (with food) the night before surgery. Then take one tablet (with breakfast) the morning of the surgery. Continue to take this tablet once daily with food. Celebrex provides inflammation and pain control.
  4. Take one tablet of ATIVAN 1 hours prior to your surgery by dissolving under the tongue. This tablet helps to reduce anxiety and helps keep you calmer during the surgery and hours after the surgery.
  5. Please take all your regular medications, as per usual, on the day of your surgery, unless told otherwise by your eye surgeon or family physician.
    1. A post-operative kit is available for purchase at Seema Eye Care Centre, which includes protective sunglasses, skin tape, eye shields and a bag for your prescriptions and instructions. You may need to purchase additional skin tape

Day of Surgery

What to Bring and Wear to the Surgical Centre Inc.

  • Please wear comfortable clothing (e.g. loose pants and button-front top with short or loose sleeves, and low-heeled, non-slip shoes).
  • Please DO NOT WEAR make-up or false eyelashes.
  • Bring your surgical kit and all of the prescribed medications and eye drops to the day of the surgery to be started immediately after the crosslinking surgery.

What to Expect

  • The surgery takes about 30-40 minutes, but expect to be at Seema Eye Care Centre for 1 to 2 hours. Sometimes the surgery may be a bit later than planned.
  • Please check-in at the front desk. A technician will greet you and ask questions, lie you down on a reclining chair, clean your eye, place a surgical cap on your head and place a gauze on the side of your face, in preparation of your surgery
  • The eyelid (of the operated eye) is kept open with two sticky eyelid drapes and a small, comfortable clip. Please keep both eyes open, blink normally and look towards the microscope lights (during the first few minutes of crosslinking surgery) while the epithelium is being removed. Next, the room lights will be dimmed and Vitamin B drops are placed in the eye for the next 30-50 minutes by a technician. Your eye surgeon will be by regularly to check on your progress. Then an ultraviolet light will be introduced. Please look directly at the light for the next 10 minutes. Again, please do not squeeze your non-operated eye, just keep it open and blink normally.
  • The operated eye will then be rinsed, antibiotic drops will be administered, a bandage contact lens placed and the drape and clip removed. An eye shield will be placed over the operated eye.

Immediately After Crosslinking Surgery

  • You are discharged home with your caretaker.
  • Your vision may be blurry and foggy and may even worsen when you get home. It will begin to improve in about a week after the surgery as you follow the post-operative instructions and eye drop medication schedule correctly.
  • Mild redness of the white part of the eye is also normal after cornea crosslinking.
  • Achiness, soreness, scratchiness, tearing and burning are all normal symptoms immediately after the surgery and for up to 1-2 days after crosslinking surgery.
  • Please take TYLENOL #3 immediately after the procedure and continue to use one tablet every 4-6 hours, as needed, to help with any discomfort.
  • TETRACAINE minims (freezing drops) may be used every hour as needed to help with discomfort. Using it more frequently will not be beneficial.
  • A cold pack, wrapped in a towel, may also be placed over the eye for 5 minutes, then off for 10 minutes. This ice pack rotation can be continued to help with discomfort.

Postoperative Instructions

 

  1. You will receive a prescription for three (2) medicated eye drops and will use non preservative artificial tears as outlined in the drop schedule below.
    1. Hylo and i-drop non-preservative artificial tears are available at Seema Eye Care Centre
  2. When using two or more eye medications, always wait 5 minutes after instilling the first eye medication before instilling the next one.
    1. Only one drop from each bottle is required each time
  3. Please start the drops 2-3 hours after surgery and follow this eye drop medication schedule: :

  4. Use the chart below to track drops for the first month by filling in a circle every time you use a medication drop. Always wait 5 minutes after instilling the first medication before instilling the next one.
  5. For at Least 2 Weeks After your Operation:
    1. Avoid rubbing the eye and protect the eye from dust particles.
    2. If the bandage contact lens falls out, please call Seema Eye Care Centre. Depending on the post-operative day, your eye surgeon will decide whether it needs to be replaced or not
    3. Wear dark glasses to protect from bright light, as the eye may be sensitive.
    4. Do not squeeze or poke the eye with fingers or glasses (place your thumbs over the ends of your glasses, by your ears, when removing).
    5. Always wear a protective eye shield while sleeping. This will protect the eye from being rubbed or scratched in your sleep.
  6. Activity After Surgery:
    1. It is recommended to take 1-3 weeks off work/school (pending your recovery).
    2. No driving for 1 week.
    3. Hold all regular activities until 1 week after your surgery. If you have any questions regarding specific activities be sure to ask your doctor.
    4. Reading, writing, working on a computer and TV watching are permitted but only for very short periods (minutes). If you feel fatigue, pressure or strain in your eye, STOP the activity immediately and rest your eye.
    5. When taking a shower, avoid getting water directly into the operated eye.
    6. Air travel is allowed after 4 weeks; please consult with your surgeon before flying.
    7. Over the first 2-3 weeks you may feel as though something is in your eye or experience a scratchy sensation; this is a normal part of the healing process.
    8. You may have different visual sensations after surgery while the eye is healing. Vision may be blurry, variable and mildly sensitive to light. These changes are normal and usually decline over the 6-8 weeks after surgery.
  7. Warning Signs to be Aware of:
    If at any time after the surgery you develop any of the following symptoms in the operated eye, contact Seema Eye Care Centre immediately at (403) 253-5300. DO NOT WAIT UNTIL YOUR NEXT APPOINTMENT.

    • R = Significant, increasing redness with discomfort of the eye
    • S = Increased sensitivity to light or tremendous photophobia or flashing lights
    • V = Visual blurring that worsens significantly and becomes less clear
    • P = Constant aching or pain in the eye (not just a moment of fleeting pain)

 If this is an after-hours emergency (after 5:00 pm on weekdays or weekends), you may contact Health Link at 811 or seek immediate care at the nearest emergency department or dial 911. In the event that you are admitted to the hospital because of complications from the surgery, please contact Seema Eye Care Centre.

 

Patient’s Name:

First Eye to be Operated on: ☐ RIGHT        ☐ LEFT

Crosslinking Date:

Crosslinking

Time: One Day Post-Op Follow-up:

One-Week post-op follow-up:


Second Eye to be Operated on: ☐ RIGHT           ☐ LEFT

Crosslinking Date:

Crosslinking Time:

One Day Post-Op Follow-up:

One-Week Post-Op Follow-up:

 

Please be aware that there is a possibility that your surgical date may be moved or postponed in the event of an emergency surgery that requires your surgeons operating time. Please note that this is an infrequent occurrence and in the event that your surgery needs to be moved you will be contacted by Seema Eye Care Centre as soon as possible.

Note: Please be aware that there will be a charge of $50 for the Pentacam Topography at the 1 month, 3 months, 6months, and 1 year follow-up Visits. This test is used to follow your cornea’s shape and ensure it has stabilized completely.