Recent focus on the optical correction for "contact lens failure" keratoconus patients has been in the use of epikeratoplasty as an alternative to penetrating keratoplasty. In a 2-year retrospective review of keratoconus patients, 33 were referred as "contact lens failures" and as such might be considered candidates for surgical intervention. Of these, 29 patients (average keratometry, 50.4; range, 43-73) were successfully refitted with contact lenses. All patients obtained wearing times of 12 hours and achieved a visual acuity of 20/40 or better, with 85% realizing 20/30 or better. The data suggest that with concerted effort most keratoconus patients may be successfully refitted despite initial contact lens failure.