To report the case of a patient with high hyperopia and bilateral keratoconus.A high hyperopic patient was evaluated using Orbscan corneal topography and slitlamp biomicroscopy to confirm suspected keratoconus.A male patient (32 years old) with a long history (10 years) of daily hydrogel contact lens wear with severe hyperopia was examined (RE +8.25-5.00 x 070 degrees , visual acuity [VA] 0.7 and LE +8.00-3.00 x 100 degrees , VA 0.9). The patient's Orbscan topography was compatible with bilateral asymmetric keratoconus (asymmetry of central dioptric power, irregular astigmatism, high anterior (110 and 63 microm for RE and LE, respectively) and posterior (200 and 128 microm for RE and LE, respectively) corneal elevation values; and corneal thinnest point (450 and 471 microm for RE and LE, respectively, in the cone). Slitlamp biomicroscopic findings included Vogt striae in RE. High Dk rigid gas-permeable CLs with keratoconus design (Z-B4P, Menicon, Japan) were fitted in both eyes (in RE the back optic zone radius [BOZR] was 7.70 mm, the total diameter was 10.00 mm, and the power was +4.00D, which provides a VA of 1.0; the LE BOZR was 7.65 mm, the total diameter was 10.00 mm, and the power was +4.25D, which provides a VA of 1.0).Although rare, keratoconus may occur in cases of high hyperopia. Management of hyperopic keratoconus with rigid gas-permeable contact lens fitting may be similar to that applied with other cases of keratoconus.