Progressive corneal destruction of varying causes can result in pathologic changes that are incompatible with globe survival. Reconstructive keratoplasty and scleroplasty, in combination with other procedures, can be attempted as an alternative to enucleation, evisceration or spontaneous phthisis bulbi. The results of 50 reconstructive keratoplasties in 36 patients with severe corneal destruction are presented with one- to twenty-two year follow-up. Ninety-nine percent of the eyes were salvaged, 69% have clear grafts, 86% are visually improved and 51% achieved acuity of 20/100 or better.