ISRS (intrastromal ring segments) were originally developed to treat low levels of myopia in healthy eyes, however a new role for these segments, in the treatment of corneal ecstatic disorders, has now been firmly established with numerous published articles to support their use. The indications for the use of ICRS include keratoconus, pellucid marginal degenerations and other causes of corneal ectasia, e.g. refractive surgery induced. The rationale for treatment of conditions, such as keratoconus, is that they regularize the corneal surface essentially providing a scaffold for the cornea. Surgery is performed either under topical anesthesia or general anesthesia, according to patient and surgeon preferences; postoperatively, patients are prescribed an antibiotic and steroid combination drops. Overall complications are rare and as long as they recognized and managed appropriately, there is minimal compromise to the patient’s vision. ICRS are an important part of the surgical repertoire now available to treat keratoconus. Patient no longer need to proceed automatically to a corneal graft procedure which involves a prolonged route to visual rehabilitations.