Corneal vascularization is an important clinical event that requires careful management. Vessel penetration can serve to heal a threatening inflammatory process, cause opacification and loss of vision, induce graft rejection, or serve as a warning of corneal distress. The latter condition is particularly common in contact lens wearers. Practitioners should be aware of the subtle signs of early neovascularization, and work toward its remission. Acute vessel penetration is a difficult clinical situation to manage. Quiescent vessels in the cornea must be explained by history and managed with either monitoring or intervention.