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The aim of this study was to monitor corneal pachymetry changes during accelerated collagen cross-linking (CXL) for keratoconus while using isotonic riboflavin with HPMC.All consecutive patients who underwent CXL for progressive keratoconus, using accelerated protocol and isotonic riboflavin with HPMC, from December 2012 to September 2013 were included in the study. The corneal pachymetry measurements were obtained at different time points: after epithelial removal, after riboflavin application for 20 minutes, and after ultraviolet A irradiation for 10 minutes at 9 mW/cm2.A total of 14 eyes of 14 consecutive patients were included in this study. The mean age of the patients was 19 ± 8 years. There were 8 left eyes and 6 right eyes. After epithelial debridement, the thinnest pachymetric readings were between 324 and 452 μm (average, 401.4 ± 40.7 μm). No significant difference (P = 0.80) was found between the deepithelialized corneal thickness and after 20 minutes of isotonic riboflavin with HPMC (pachymetric average, 405.3 ± 37.5 μm). Pachymetric average after ultraviolet A irradiation was 419.29 ± 20.60 μm. There was no statistical significant change in the corneal thickness after the irradiation (P = 0.24).During corneal CXL using isotonic riboflavin and HPMC with accelerated cross-linking protocol, no significant decline in the corneal thickness was demonstrated.