Background: Scleral lenses are one of the best options to manage corneal irregularities and severe ocular surface diseases. As scleral lenses rest on the sclera, scleral topographical data are necessary when fitting these lenses. Aim: The aim of this article was to present a review of the literature on scleral topography and its usefulness in scleral lens fitting. Method: A search was performed by the author with the PubMed database for the literature related to the topic by using a combination of keywords as search criteria. The most specific combination was represented by the junction of keywords (scleral topography and scleral lens fitting). Forty-four articles were related to scleral topography and scleral lens fitting. Results: Fifteen articles were found to be more relevant to the topic and were selected for review. These articles originated from 11 different countries and five continents. Many (60%) of the articles were from European countries. Conclusion: The shape of the anterior surface of the eye beyond the limbus is not rotationally symmetrical, and the asymmetry increases as we move away from the limbus. Scleral topography is important in the fitting of scleral lenses, especially that keratometry measurements cannot be used to predict the base curve of the best fitting scleral lens.