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Purpose: To evaluate the long-term results of rigid gas permeable (RGP) contact lenses in severe keratoconic eyes. Material and Method: Severe keratoconic eyes with RGP contact lenses were evaluated retrospectively. Results: Long-term follow-up results of RGP contact lenses applied to 59 eyes of 42 patients (25 women, 17 men) with a diagnosis of severe keratoconus were analyzed. Follow-up period was 3 to 12 years (mean: 6.57±3.60). The mean age at first exam was 25.88±9.10 years, the mean corneal curve K1 was 6.49±0.40 mm and K2 was 5.91±0.40 mm. Mean visual acuities with spectacles and contact lenses were 0.26±0.10 lines (0.63±0.20 logMAR) and 0.66±0.20 lines (0.20±0.10 logMAR), respectively. The difference between both visual acuities was statistically significant (p=0.0001). At the last visit, the mean visual acuity with RGP contact lenses was 0.68±0.20 lines (0.19±0.10 logMAR). There was no statistically significant difference in visual acuity between first and last examinations with contact lenses (p=0.32). During the long-term follow-up period, apical scarring developed in 17 eyes. Only the 2 eyes of one patient needed penetrating keratoplasty after 6 years of RGP contact lens use. Discussion: Use of RGP contact lenses should be considered before penetrating keratoplasty in cases of severe keratoconus. [ABSTRACT FROM AUTHOR]