PURPOSE: To analyze indications safety and potential complications of cosmetic therapeutic corneal keratopigmentation to treat disfiguring aspect of opaque corneas. METHODS: Eight eyes of 8 consecutive patients were enrolled in therapeutic corneal keratopigmentation. Surgery was performed using manual technique, and a two-plane corneal dissection was performed. In the deeper pocket, brown pigment was injected to mimic iris color. In the more superficial and smaller pocket, black pigment was used to simulate pupillary opening. RESULTS: Seven out of 8 eyes had significant improvements in cosmesis after surgery. One patient did not have a major improvement due to significant superficial corneal neovascularization. In two eyes, there was pigment fading in the postoperative period, but no additional surgeries were performed. No complications were noted in any of the patients. CONCLUSION: Therapeutic corneal keratopigmentation can lead to a significant change in ocular appearance and may improve self-esteem and overall life quality. Pigment fading and corneal neovascularization can be a potential problem. Careful patient selection and counseling are important to avoid patients seeking unachievable results.