Purpose. For irregular corneal shapes, the fitting of a contact lens piggyback system is an established procedure for optical rehabilitation. The aim of this paper is to describe the different possibilities of this method based on current measurement and manufacturing techniques. Material and Methods. Based on the respective indication, the topographical characteristics are analysed. A distinction is made between the condition in keratoconus and after keratoplasty. The general requirements and the procedure of the fitting, as well as the care and handling are described. Results. When fitting a contact lens piggyback system, a variety of different geometries of the soft lens and the add-on RGP lens are available. When choosing the soft lens, a decision can be made between a standardised geometry or one that is individually determined according to the contour of the cornea. In addition to the appropriate choice of geometry, physiological compatibility and the subjective satisfaction of the wearer are decisive for success. Conclusion. A piggyback contact lens system designed to meet the needs of the user offers a good alternative in the fitting of irregular corneal shapes. Keywords Piggyback, contact lens, keratoconus, keratoplasty, cornea