Osteo-odonto-keratoprosthesis (OOKP) is the procedure of choice for end stage ocular surface disease with severe dryness and keratinisation, and in those eyes with structural and functional lid abnormalities. The device retention rates and visual outcomes of the OOKP are far superior than any other keratoprosthesis. However, this device can have complications at every step during surgery and unto many years afterwards. Complications after the Stage 1 include: mucosal thinning and ulceration, mouth related, resorption of the implanted lamina and infections. Complications after the Stage 2 include: mucosal thinning and ulceration, mucosal overgrowth onto the optic, lid malpositions, lamina problems like resorption, tilting, infection, posterior segment complications like retinal detachment and vitreous haemorrhage. Glaucoma is a major cause of visual loss in a successful OOKP eye. Social and psychological complications can arise after visual restoration or the preexisting problems can continue. In addition, operative complications, systemic morbidity and anesthetic related problems do occur. A majority of the complications can be sight threatening if not rectified appropriately in a good time. They may be preventable or reducible with correct patient selection, improvements in preoperative and postoperative patient care and education. A sound surgical technique, reflective learning, harnessing the medical technology and multidisciplinary team approach can effectively reduce and treat the complications of OOKP surgery. Multidisciplinary team approach, having an experienced anesthetist and psychologist on board, and a continuous social support will prevent patient morbidity and optimise good outcomes.