We conducted a retrospective analysis of the management of 118 eyes of 66 new patients presenting with keratoconus at the University of Florida from 1987 through 1992. Eyes were ultimately managed by one of three methods: glasses or no correction; contact lenses; or penetrating keratoplasty. The outcome of each management method was determined by evaluating initial and final vision and keratometry for each group. Twenty-one eyes received glasses or required no correction. Rigid gas permeable lenses, Dura-T style PMMA lenses, and specialty design gas permeable lenses were used to successfully fit 63 eyes. Twenty-eight eyes underwent penetrating keratoplasty (PK), and an additional six eyes were PK candidates. Factors associated with the need for PK included best corrected initial visual acuity of 20/40 or worse, average keratometry > 55 D, and the presence of apical scarring (P < 0.001).