Aim: To evaluate the sequence of events leading to diagnosis of keratoconus and its impact on quality of life. Methods: This survey-based study was done the Department of Ophthalmology, Nalanda Medical College and Hospital, Patna, Bihar, India for 10 months, after taking the approval of the protocol review committee and institutional ethics committee. The study included patients over the age of 13 years who were diagnosed with subclinical or clinical KCN for the first time at our tertiary eye center. Results: The present study included 200 eyes of 100 patients diagnosed with clinical or subclinical KCN. The mean age of patients at the time of diagnosis was 21.82 ± 5.89 years. Despite a drop in BCVA, 50(50%) patients reported never having visited an ophthalmologist before presenting to our tertiary eye care center. 40 (40%) patients were advised a screening test (corneal topography) to rule out KCN before presenting to our tertiary care center. 16 (40%) of these patients did not get it done. The time interval between the last screening test and KCN diagnosis at the tertiary center was 19 ± 5.9 months. The mean pachymetry at the thinnest point was 63.78 ± 60.8 Microns. Distribution of pachymetry at the thinnest location .The distribution of inter‑asymmetry score was <3 in 45 (27%), 3 in 15 (15%), and 4–5 in 58 (58%) patients. It was found that 68 (68%) had never noticed a difference in vision in the two eyes, whereas 32(32%) were aware of some difference. Conclusion: Keratoconus is a disease of the young and severely affects their quality of life. Improving awareness of the general public, ensuring timely referral by optometrists, and keeping a high index of suspicion for KCN is emphasized.