The diagnosis of keratoconjunctival tumors were mainly relied on the examination of the slit lamp microscope and histopathology till now. Making an accurate diagnosis to ocular surface tumor in time was very important for deciding the treatment method and evaluating the prognosis. In recent years, in vivo confocal microscopy (IVCM) has been used in ophthalmic clinical diagnosis as a new evaluation method. It was easy to detect cytological characteristics of ocular surface diseases safely in vivo. More and more researches results have shown that IVCM could provide powerful supports to the diagnosis and management of keratoconjunctival tumors, especially for the pigmented tumors and ocular surface squamous neoplasia. In this paper, the applications of IVCM for diagnosing keratoconjunctival tumors were reviewed. (Chin J Ophthalmol, 2016, 52: 789-793).