This was a retrospective non-comparative, interventional case series of 50 eyes in 50 patients with symptomatic PBK who underwent CXL (epithelium-off). Central corneal thickness (CCT), pain score, best corrected visual acuity (BCVA), and corneal transparency were recorded at baseline; at day seven, day 15; and one, three, and six months after the CXL. The mean pain score decreased from 8.1+/-0.6 at presentation to 2.1+/-0.7 on day seven (P=0.0001). Regression was seen in pain scores over six months (5.3+/-1.5). The mean CCT decreased from a preoperatively 724.8+/-78.4 to 694.9+/-77.9um by the end of the first month (P=0.0001) and remained stable at subsequent follow-up. The BCVA improved from log MAR) 2.0+/-0.5 preoperatively to log MAR 1.8+/-0.5 by the end of the first month (P=0.001). The subsequent follow-up showed a progressive deterioration in the BCVA to the preoperative levels at six months. Corneal bullae recurred in 44% (22 eyes) at six months after an initial disappearance. A significant improvement in the BCVA and a lack of recurrence of bullae were significantly associated with a thinner CCT on presentation (<700um). The authors conclude that CXL in symptomatic PBK temporarily improved pain without providing long-term improvement in the BCVA. Case selection is important with more effect seen in patients with a thinner CCT at presentation. Other reports in addition to this support the use of CXL as a useful intervention as a palliative procedure rather than for visual rehabilitation. Those with thicker CCT will have greater irreversible stromal changes and perhaps this is why the authors report a better outcome in those with thinner corneas. It may be an intervention to consider prior to a Gunderson’s flap in a painful blind eye due to bullous keratopathy.