Modified osteo-odonto-keratoprosthesis (MOOKP) forms the treatment of choice for corneal blindness in the end stage of bilateral ocular surface disorders. The hostile ocular environment encountered in severe bilateral chemical or physical injuries and Stevens-Johnson syndrome are very common among the Indian population, and other less common but serious autoimmune disorders also affecting the ocular surface result in dry eyes. In some of these diseases, such as Sjögren syndrome, pemphigoid, graft-versus-host diseases, and trachoma, conventional penetrating keratoplasty and limbal allografting are almost impractical. The resilience offered by the MOOKP procedure in these eyes along with the good image resolution from the rigid optical cylinder is responsible for its long-term success. The indications, contraindications, preoperative assessment, surgical techniques, postoperative follow-up, comparative results, and complications are described in detail. Case illustrations, indicating postoperative improvement in the quality of life, signify the value of the otherwise time-consuming and surgically demanding procedure.