Keratoconus is a bilateral, progressive, non-inflammatory corneal degeneration characterized by a conical protrusion of the cornea which leads to marked corneal thinning thereby inducing severe visual impairment due to increasingly irregular astigmatism. Current corneal imaging technology provides an accurate anatomical and topographical analysis of the cornea which is the 'gold standard for the diagnosis of keratoconus and preoperative screening in refractive surgery. Until recently evaluation of corneal biomechanics was feasible only in vitro as the technology required for in vivo analysis was not available. However, in recent years methods have been developed which enable an accurate in vivo analysis of corneal biomechanics thereby enhancing the early detection of keratoconus and improving the safety profile of corneal refractive procedures.