L-carnitine plays a role in physiological reactions throughout the body, including sugar aerobic metabolism, oxidative phosphorylation and, most importantly, fatty acid oxidation. In addition, L-carnitine has antiapoptotic, antioxidative and osmolytic properties, which may be useful in the treatment of ocular pathologies (e.g. retinitis pigmentosa [RP] and keratoconus), in corneal tissue repair and in ophthalmic procedures (e.g. photorefractive keratectomy and laser-assisted subepithelial keratectomy [LASEK]). Preliminary studies have suggested that L-carnitine supplementation may be useful in patients with RP. Although studies are warranted to ascertain the benefit of L-carnitine in the LASEK procedure, potentially it could be used instead of alcohol to facilitate epithelial detachment and as a hypo-osmotic solution in the fluid filler used in therapeutic photoablation. Furthermore, its antiapoptotic properties may improve cellular migration, proliferation and adhesion of keratocytes, epithelial cells and endothelial cells, which may be useful in the corneal repair process. Similarly, L-carnitine in high concentrations may prove useful in cross-linking parasurgical treatment of keratoconus, owing to its osmolytic and non-cytotoxic properties.