Riboflavin-ultraviolet A corneal crosslinking (CXL) is currently a clinically effective intervention for keratoconus based on biomechanical principles. Although the standard CXL protocol has proven to be safe and effective, limitations such as prolonged treatment time remain. To improve crosslinking efficiency and enhance patient visual outcomes, various modified protocols have been developed, including transepithelial CXL, accelerated CXL, and customized CXL. Moreover, the establishment of theoretical models has provided important references for predicting crosslinking effect and optimizing treatment parameters. In this paper, the biomechanical advances in CXL for keratoconus are reviewed, aiming to offer insights for improving clinical management strategies and developing novel therapeutic approaches.