Aim: The aim of the study is to report a case of pregnancy-associated progressive keratoconus with atypical horizontally aligned Vogt's striae. Background: Hormonal changes during pregnancy have been proposed as a risk factor for progressive keratoconus. There have been only a few cases of progressive keratoconus diagnosed with progression after pregnancy, without either an existing disease or an attributable cause. Case description: A 36-year-old New Zealand European woman presented with progressive myopic astigmatism following her first pregnancy. Stigmata of keratoconus were present on clinical examination and included horizontally aligned Vogt's striae. Tomography measurements confirmed the diagnosis with characteristic inferior corneal steepening and ectasia bilaterally. The patient was advised to abstain from eye rubbing, commenced topical olopatadine, and underwent corneal collagen cross-linking following delivery to prevent further keratoconus progression. Conclusion: Pregnancy-associated progressive keratoconus in a 36-year-old woman was documented after the pregnancy. Clinical significance: Atypical presentation features that include horizontally aligned Vogt's striae, advanced age at diagnosis, and rapid pregnancy-associated progression in a previously stable patient.