Epioxa is a next-generation epithelium-on (epi-on) corneal cross-linking treatment for progressive keratoconus, developed as the successor to traditional epi-off cross-linking. It combines a specially formulated riboflavin (vitamin B2) solution, supplemental oxygen and ultraviolet (UV-A) light to stiffen the cornea — but, crucially, it does this without scraping away the corneal surface (epithelium). That means less pain, a lower risk of infection and a faster return of vision than the older epi-off technique. Private Epioxa cross-linking costs from £4,500 per eye in the UK, all-inclusive of assessment, scans, the procedure and aftercare. Like all cross-linking, the goal is to halt progression of keratoconus rather than reverse it.
What is Epioxa cross-linking?
Keratoconus is a condition in which the cornea — the clear front window of the eye — progressively thins and bulges into an irregular cone shape, distorting vision. Corneal cross-linking is the only treatment proven to stop keratoconus getting worse. It works by creating new chemical bonds (cross-links) between the collagen fibres in the cornea, making it stronger and more stable.
Traditional cross-linking is performed “epi-off”: the surface epithelium is removed so that riboflavin can soak into the cornea. Epioxa is an “epi-on” procedure — the epithelium is left intact. A reformulated riboflavin is used to penetrate the surface, and supplemental oxygen is supplied during UV light exposure to drive the cross-linking reaction. Keeping the epithelium in place avoids the raw, painful surface that follows epi-off treatment.
Who might benefit
- Documented progressive keratoconus — worsening on corneal topography over time.
- Younger patients, in whom keratoconus tends to progress faster.
- Other corneal ectasias, such as post-LASIK ectasia, on a case-by-case basis.
- Patients who want to avoid the pain and slower recovery of epi-off cross-linking.
- Those with a corneal thickness suitable for cross-linking, confirmed on scanning.
Has your keratoconus been getting worse? A corneal assessment with topography confirms progression and whether epi-on cross-linking is right for you.
Book a corneal assessmentEpi-on vs epi-off — and other keratoconus options
The main decision is between epithelium-on and epithelium-off cross-linking. Both aim to stabilise the cornea; they differ in comfort and recovery. Your surgeon will advise which is most appropriate for your cornea.
Cross-linking only stops progression — it does not usually improve the existing shape of the cornea. Where vision is already affected, it is often combined with, or followed by, options such as Intacs corneal rings or specialist scleral contact lenses. In advanced cases a Bowman layer transplant or DALK corneal transplant may be considered.
What happens during Epioxa cross-linking
Epioxa is carried out as a day case under local anaesthetic eye drops. Because the epithelium is not removed, the procedure is far more comfortable than epi-off cross-linking.
- Numbing drops are placed in the eye and it is gently held open with a small clip.
- The reformulated riboflavin solution is applied to the surface and allowed to soak through the intact epithelium into the cornea.
- The cornea is exposed to UV-A light while supplemental oxygen is delivered to the eye, driving the cross-linking reaction.
- The new collagen cross-links stiffen and stabilise the cornea.
- The eye is rinsed and a protective contact lens or drops are given; you rest briefly before going home the same day.
Recovery week-by-week
Recovery from epi-on cross-linking is generally quicker and far more comfortable than epi-off, because there is no surface wound to heal.
Day of treatment
Mild grittiness, watering or light sensitivity is normal. Anti-inflammatory and antibiotic drops begin. Most discomfort is mild compared with epi-off.
Days 1–3
The eye settles quickly. Vision may be a little blurry but there is no painful surface wound to recover from. Avoid rubbing the eye.
Week 1
First review. Many patients are back to normal activities and screen work sooner than with epi-off cross-linking.
Months 1–3
Drops are tapered. Repeat corneal scans confirm the cornea has stabilised. Any glasses or contact lens prescription is reviewed.
Long term
Cross-linking aims to keep keratoconus stable for many years. Periodic topography monitoring confirms no further progression.
Cost & insurance
Our Epioxa pricing is all-inclusive — assessment, corneal scans, the procedure, post-op drops and follow-up reviews are all covered, with no hidden extras.
- Self-pay: from £4,500 per eye for epi-on Epioxa cross-linking, including consultant assessment, topography, the procedure and aftercare.
- Both eyes: where both eyes show progression, treatment is planned for each — your surgeon advises on timing.
- Insurance: recognised by many private insurers when cross-linking is clinically indicated for progressive keratoconus. We handle pre-authorisation.
- Finance: 0% options available to spread the cost.
Compare the full range on our corneal cross-linking cost page.