Purpose. To evaluate risk factors associated with keratoconus in a monocentric cross-sectional case-control study. Methods. is observational study occurred from June 2019 to February 2021 in a university hospital (France). e case group consisted of 195 patients with keratoconus in at least one eye who were followed up by a corneal specialist. e control group consisted of 195 patients without any evidence of keratoconus on slit-lamp examination and corneal topography, who were matched 1 : 1 to controls by age and sex. Data were collected by a self-completed paper questionnaire before the consultation, and a multivariate logistic regression was performed. Results. Multivariate analysis revealed signi cant associations of keratoconus with family history (odds ratio [OR] 22.2, p < 0.001), rubbing eyes (OR 10.9, p < 0.001), allergy (any kind) (OR 3.80, p < 0.001), smoking exposure (OR 2.08, p 0.017), and dry eyes (OR 1.77, p 0.045f). e worst eye was associated with the more rubbed eye (p < 0.001) and the more pressed eye during the night according to sleeping position (p < 0.041). Conclusion. is study con rmed the association between keratoconus and eye rubbing, family history, and allergy. It highlighted the role of pressure on the eyes during sleep. Other less known risk factors such as dry eyes and smoking exposure should be explored in future studies.