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Purpose The purpose of this study was to evaluate the prevalence of keratoconus among candidates of refractive surgery in Upper Egypt. Setting The study was conducted in Sohag University Hospital and Future Center (a private center) for laser in-situ keratomiluesis and refractive surgery in Sohag Governorate, Egypt. Design This is an observational cross-sectional study. Patients and methods Refractive surgery candidates referred for preoperative evaluation before laser in-situ keratomiluesis, photorefractive keratectomy, and phakic intraocular lens implantation in the period from April 2015 to September 2015 were screened for keratoconus using Sirrus Scheimpflug camera. Results The study included 1202 patients, 623 male and 579 female. Keratoconus was detected in 210 (17.5%) patients. Conclusion Prevalence of keratoconus among refractive surgery candidates in Upper Egypt is relatively high, which may reflect an underlying high prevalence in the general population.