Purpose: To evaluate the presentation and characteristics of patients with keratoconus at a tertiary eye care center in Mumbai, India.Methods: This single center, non-comparative, retrospective cohort analysis was performed on patients with keratoconus who presented to the Clear Vision Eye Center clinic from April 2007 to March 2009. Data was collected to characterize correlations among visual acuity, corneal biomicroscopic findings, and refractive and topographic findings in keratoconus.Results: Records of 274 patients including 189 male and 85 female subjects with mean age of 20.1±3.5 (range, 13 to 29) years at the time of diagnosis were assessed. There was history of skin allergy in 73 (26.6%), symptomatic ocular allergy in 67 (24.45%) and asthma in 31 (11.31%) patients. The most frequent corneal sign was Fleischer’s ring which was observed in 81% of cases. Corneal topography revealed mean SIMK (simulated keratometry) of 53.3±6.1 (range, 41.2 to 69.0) diopters. Corneal topography analysis with the Cone Location Magnitude Index disclosed the presence of inferior cones in 93% of patients.Conclusion: This group of patients had younger age at presentation and more severe keratoconus as compared to western populations; contact lenses were used only in a minority of patients.