Objective: To report the association between keratoconus and Tourette Syndrome (TS) and to reinforce that eye rubbing may be a causative factor for keratoconus. Design: Observational case series. Participants: Three patients with TS who presented with clinical and topographic findings suggestive of asymmetric or unilateral keratoconus. Methods: Evaluation of patients in a single clinical practice. Results: Patients' histories revealed asymmetric or unilateral rubbing of the affected eye as a result of a TS tic. Other organic causes associated with keratoconus were absent in these patients. Conclusions: A possible association between TS and keratoconus exists with chronic eye rubbing being the suggested mechanism. Eye rubbing seems to be an important causative factor for keratoconus.