Keratoconus – Fidia Farmaceutici S.p.a.



Keratoconus is a progressive, non-inflammatory disorder of the eye characterized by thinning and protrusion of the cornea, that loses its typical spherical shape and takes the form of a truncated cone.(1)


Fidia is committed to offering patients and ophthalmologists technical solutions for iontophoresis-assisted corneal cross-linking (CXL) option, a valid non-surgical alternative for keratoconus.


Keratoconus is considered a hereditary disease, because genetic factors seem to play a major role in its development.(2)

It usually occurs at the time of puberty, in late adolescence for males, in early twenties for females, and it may slowly progress until the third to fourth decade.(7)

Other risk factors are ethnicity (i.e. to be Asian or Arab), medical condition such as Down syndrome, connective tissue disorders, atopy and Leber’s congenital amaurosis.(1) Environmental factors include eye rubbing and sun exposure.(3)


The cone-shaped eye leads to myopia, irregular astigmatism, and vision impairment.(1)

Signs and symptoms of keratoconus may change as the disease progresses.

They include ocular discomfort(1), reduction in visual acuity, image distortion, increased sensitivity to bright light and glare.(7)


Spectacles and contact lenses are one of the main options in early keratoconic cases. Surgical solutions to achieve corneal flattening and improved visual outcomes are ICRS (intrastromal corneal ring segments) implantation or keratoplasty (PK or DALK) for advanced forms of keratoconus.(1)

Corneal cross-linking (CXL) techniques are now a widespread non-surgical option. In CXL, riboflavin (vitamin B2) is administered in conjunction with ultraviolet A, an interaction which leads to biomechanical stiffening of the cornea.(4)

By absorbing UV-A, riboflavin also prevents damage to deeper ocular structures, such as the endothelium, lens and retina.(5)
Iontophoresis-assisted transepithelial CXL (I-CXL) increases the imbibition of riboflavin into the corneal stroma with a non-invasive delivery system via a small electric current.(6)


RICROLIN+® is a hypotonic ophthalmic solution to allow the quick passage of riboflavin into the corneal stroma, either through the healthy epithelium, after de-epithelialization or through a low intensity electrical field applied topically (iontophoresis).(8)

IONTOFOR-CXL is the corneal iontophoresis applicator for the administration of riboflavin into the corneal stroma.(9)

I-ON CXL is the generator for corneal iontophoresis to be connected to Iontofor-CXL.(10)

1. Andreanos K.D. et al.; Ophthalmol Ther 2017; 6: 245-262.
2. Mas Tur V. et al.; Survey of Ophthalmology 2017; 62: 770-783.
3. Ariela Gordon-Shaag et al., The Genetic and Environmental Factors for Keratoconus, BioMed Research International Volume 2015, Article ID 795738.
4. Hidenaga Kobashi et al., Corneal Collagen Cross-Linking for Keratoconus: Systematic Review, BioMed Research International Volume 2017, Article ID 8145651.
5. O’Brart D.P.S.; J Optometry 2014; 7: 113-124.
6. Hong-Zhen Jia et al., Iontophoresis-assisted corneal crosslinking using 0.1% riboflavin for progressive keratoconus, Int J Ophthalmol, Vol. 10, No. 5, May 18, 2017.
7. Asimellis G, Kaufman EJ. Keratoconus. [Updated 2020 Jan 10].
8. Ricrolin+ package insert.
9. IONTOFOR-CXL package insert.
10. I-ON CXL package insert.