Keratoconus is a condition that is progressive condition and leads to irregular corneal shape due to thinning of the cornea typically on the inferior cornea.  There is usually a history of eye rubbing since early childhood, but the exact onset and mechanism is not clearly defined; therefore each case is independent and needs to managed accordingly.  The irregularity of the cornea is usually a red flag for most refractive procedures, but again that depends on the severity of keratoconus and age of the patient.  In mild forms PRK can be an option but that again depends on topography scans, corneal thickness and stability of the condition.   Another technique available now is to stabilize the cornea using cross-linking with riboflavin drops, the cross-linked cornea is much more stable and could potentially be stable enough for refractive surgery.   Intacs is another option for keratoconus and will be discussed in the…