Keratoconus is a common and progressive ectatic disease characterized by apical thinning and bulging of the cornea leading to severe visual loss. Current treatment approaches for keratoconus include options to treat or halt the progression of the disease and improve the quality of vision. Therefore, multiple methods are currently applied in the clinical practice including penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK), corneal collagen cross-linking (CXL) which is a process of increasing cross-links between collagen structures in the corneal stroma with the help of UV-A and riboflavin, with its modifications such as accelerated CXL and iontophoresis CXL. Due to possible complications of keratoplastic surgical method approaches, early diagnosis of the disease and halting the disease with CXL methods are becoming more and more crucial. This review attempts to summarize the current treatment approaches for keratoconus most especially focusing on CXL treatment options and novel nanotechnology-based drug delivery systems for non-invasive, effective and safe treatment designs.