A two and one-half year (April 1985-October 1987) retrospective review of all newly referred keratoconus patients was performed to determine the treatment regimen of previously diagnosed "contact lens failures." The records of 48 patients (average age 32 +/- 9.0 years; 24 males, 24 females) were reviewed. Thirty-nine patients had been diagnosed as "contact lens failures" and referred for surgical intervention. Of these 39 patients, seven eyes were excluded from evaluation (four with prior grafts, two cases of unilateral keratoconus, and one with a dense central scar). Of the remaining 71 eyes, 57 (80%) (average keratometry 50.7 +/- 5.1 D, range 43-73) were successfully refit with contact lenses. All obtained a daily wearing time of 12 hours or more and a visual acuity of 20/40 or better--with 87% realizing 20/30 or better. The data suggest that the vast majority of keratoconus patients previously thought to be contact lens intolerant can be successfully refit and achieve excellent visual acuity and prolonged wearing times.