Keratoconus is a progressive corneal disease characterized by stromal thinning leading to corneal ectasia. Of all the modalities available to treat this condition, corneal cross-linking (CXL) is the only treatment that can arrest or mitigate the progression of the disease. But in the clinical setting we are often faced with a conundrum: Conventional CXL, performed as per the Dresden protocol, mandates a minimum corneal thickness of 400 microns, given the risk of endothelial damage due to UV radiation in thinner corneas. But because keratoconus is an ectatic disease causing corneal thinning, a large cohort of patients with keratoconus, especially in the moderate to advanced stage, present with a corneal thickness less than 400 microns! As a solution to this vexing dilemma, a number of modifications to the conventional form of CXL have been suggested, thus obviating the need for an invasive procedure such as a lamellar or a penetrating keratoplasty. This video serves to present the Dresden protocol and the ensuing problem in thinner corneas and to elucidate the myriad interesting alternatives currently available to tackle this difficulty.