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Keratoconus (KC) has traditionally been defined as a bilateral, non-inflammatory, progressive disease that leads to an increase in corneal curvature and central or paracentral thinning. However, recent studies have evidenced the presence of pro-inflammatory mediators and biomarkers such as interleukin-6 (IL-6), tumor necrosis factor Alpha (TNF-α) and matrix metalloproteinase (MMP) -9 in tears from these patients. The physiological changes that contact lenses produce on the ocular surface have also been studied, such as the overexpression of IL-6, TNF-alpha, ICAM-1 and VCAM-1 in the tears of these patients, these increased levels are higher in advanced cases, the above could exacerbate this condition given the microtrauma that can occur especially when a proper adaptation philosophy is not used. Taking into account the quasi-inflammatory component, the management and treatment with contact lenses will depend on multiple factors.