Core tip: Orthokeratology uses specially designed rigid contact lenses to temporarily reshape the cornea to ameliorate refractive errors and it has also been suggested to slow the progression of myopia. None of the published studies to date in assessing its efficacy are rated as level I evidence. Orthokeratology carries the risk of microbial keratitis, which is potentially sight threatening and the safety of orthokeratology remains difficult to assess. Practitioners prescribing orthokeratology must receive appropriate training with respect to the local standards, inform patients and/or their parents of the potential risks, and ensure their patients’ compliance in proper handling of the day to day care of their lenses to minimize the infective risks.