Management of viral keratitis comprises a variety of approaches, ranging from topical antiviral therapy to full-thickness corneal transplantation, depending on the clinical presentation. Typically, medical management is the primary treatment option, while cases with corneal opacification and/or perforation/corneal thinning may necessitate penetrating/lamellar keratoplasty. However, the limited availability of corneal tissues and the poor outcomes in certain clinical scenarios pose challenges for performing corneal transplantation. Several alternative surgical options have been proposed to address this gap between medical management and penetrating keratoplasty including their use in emergency situations such as amniotic membrane transplantation, tissue adhesives combined with bandage contact lenses, SMILE-derived lenticule patch grafts, Tenon’s patch grafts, corneal patch grafts, conjunctival flap procedures, corneal neurotization, and tarsorrhaphy. These procedures utilize biological tissues from the patient, such as Tenon’s capsule, conjunctiva, and corneal lamellar patch, or easily accessible synthetic materials, such as tissue adhesives and bandage contact lenses. While these alternatives benefit small perforations, they generally provide only temporary tectonic support and limited visual gain. In this chapter, we explore the various surgical options available for managing viral keratitis, along with their indications, advantages, and drawbacks.