As the worldwide demand for human donor corneas far exceeds supply, there is a need for a new source of corneas for clinical transplantation. Genetically engineered pigs may prove to be that new source, particularly as current evidence indicates that the anatomical and biomechanical properties of human and pig corneas are similar. Experience with clinical and experimental corneal xenotransplantation has been comprehensively reviewed and is summarized. Studies in small and large animal models have documented that both humoral and cellular immune responses play roles in xenograft rejection. Recent progress in the genetic manipulation of pigs has led to the prospect that clinical corneal xenotransplantation, in the absence of exogenous immunosuppressive therapy, may become successful in the foreseeable future. © 2010 John Wiley & Sons A/S.