This study aimed to differentiate between the therapeutic and purely cosmetic aspects of keratopigmentation by examining the results of previous studies. Corneal opacity, corneal leukoma, and iris abnormalities represent the primary reasons for keratopigmentation in therapeutic settings. In therapeutic contexts, the most commonly reported adverse effects included inflammation, foreign body sensation, light sensitivity, reduced intraocular pressure, and neovascularization. The side effects most frequently noted in purely cosmetic applications were photophobia and ectasia. In therapeutic scenarios, patients who experience pre-operative vision impairment often report not only the absence of visual loss post-procedure but also an enhancement in visual acuity, accompanied by alleviation of symptoms such as glare. In purely cosmetic procedures, visual acuity tends to remain stable. Research indicates that dissatisfaction with keratopigmentation results is more prevalent in studies aimed at therapeutic interventions compared to cosmetic enhancements. Furthermore, instances of discoloration and fading are more frequently observed in therapeutic cases than in cosmetic ones, including the need for retouching. The use of keratopigmentation in both therapeutic and cosmetic settings produces positive and acceptable results, especially in cosmetic applications. Nevertheless, complications are more commonly observed in therapeutic situations, which underscores the importance of candidate selection for keratopigmentation procedures.