Purpose: to compare safety and efficacy of Transepithelial (epi-on) corneal collagen crosslinking as opposed to standard (epi-off) corneal collagen crosslinking, in the management of keratoconus. Design: Prospective, interventional, non-randomized, non-controlled study. Methods: 40 keratoconus eyes divided in 2 groups: 20 eyes in Group 1 received Standard (epi-off) Crosslinking & 20 eyes in Group 2 received Transepithelial (epi-on) crosslinking. All patients were evaluated regarding best spectacle corrected visual acuity (BSCVA), corneal maximum keratometric value (Kmax), central corneal thickness (CCT), corneal hysteresis (CH) and corneal resistance factor (CRF). These aspects were evaluated preoperatively and postoperatively after 3, 6 and 12 months. Results: Regarding BSCVA, Standard CXL group showed insignificantly increase (improvement) after 1 year, while Transepithelial CXL group showed significantly decrease (worsening). Regarding Kmax, both groups showed flattening, which was statistically significant in Standard CXL group and insignificant in Transepithelial CXL group. Regarding CCT, both groups showed statistically significant thinning. Regarding CH and CRF, there was decrease in values in both groups. Conclusion: Despite temporary corneal haze. Discomfort and early postoperative pain; Standard (epi-off) CXL is an effective method for management of keratoconus and although transepithelial CXL is safe and comfortable, it does not effectively halt the progression of keratoconus compared to Standard CXL.