Introduction:
In recent years, keratoconus has become an increasingly prevalent eye disease, characterized by progressive thinning of the central or paracentral cornea. The primary treatment is corneal cross-linking (CXL), which offers a wide range of therapeutic techniques. The main aim of this review is to compile and present the most commonly used CXL treatment methods in a manner that will help clinicians create the most appropriate treatment plan based on each patient’s unique needs.

Review methods:
This review is based on 42 articles meticulously selected through open-access sources, utilizing the PubMed and Google Scholar databases. The search encompassed therapeutic approaches to CXL for both adults and children. The literature review covers publications from 2003 to 2024.

State of knowledge:
CXL is considered a primary therapeutic strategy for the management of keratoconus. Numerous studies suggest that this treatment modality exhibits superior efficacy in patients suffering from this condition.

Conclusions:
This review evaluates various CXL. The transepithelial cross-linking (TE-CXL) approach retains the epithelial layer, which reduces postoperative complications and enables treatment for thinner corneas and advanced keratoconus. Although the aforementioned method is safer, less painful, and promotes faster recovery, its effectiveness may be compromised by inadequate riboflavin penetration. Conversely, epithelium-off (epi-off) CXL, especially the Dresden protocol, remains the gold standard, though it poses risks of complications such as pain. The study emphasizes the need to balance safety and efficacy when choosing CXL methods, while recognizing that all the methods are effective in managing keratoconus progression.