This retrospective cohort study evaluated long-term visual, refractive, topographic and safety outcomes of corneal cross-linking (CXL) in patients younger than 18-years-old with keratoconus. The study included all consecutive paediatric patients who underwent epithelium-off CXL treatment for keratoconus at the study centre, during the period of 2006 to 2010. The decision to perform CXL was based on visual disturbance in patients diagnosed with keratoconus for the first time and not progression of disease. Eye with worst vision was treated and the fellow eye left untreated. Exclusion criteria were advanced keratoconus with corneal irregularity or scarring and minimum corneal thickness less than 400µm. Patients were assessed at one, three and six months, and once a year from one to five years after the procedure. Study included 80 eyes of 40 patients. Mean age of the patients was 15.6±2.1 years. Forty eyes of 40 patients underwent CXL with Dresden protocol. Throughout the entire five year follow-up period, the treated eye showed statistically significant improvements in mean uncorrected distance visual acuity (UCDVA), mean manifest cylinder, mean Kavg and an improvement trend or stability in mean best-corrected distance visual acuity (BCDVA), mean Kmax and corneal aberrations. The authors claim that this is the only study that reports the results of untreated eyes of paediatric patients who underwent CXL in the fellow eye because of keratoconus. In contrast to previous studies, the fellow untreated eye demonstrated stability of keratoconus in both visual and topographic measurements during all five years of follow-up. The authors do not agree with others’ recommendations to treat the fellow eye in children without waiting for progression of keratoconus. In conclusion, this long-term follow-up study suggests that cross-linking is a safe procedure in the paediatric age and there is no urgency in treating paediatric patients with keratoconus without proof of progression.