Astigmatism is a refractive error characterised by a variation in the dioptric power of the eye from one meridian to another.
The most common symptom is diminished visual acuity.
The aetiology is still unknown, but it is probably influenced by both genetic and environmental factors.
Among the common risk factors are a family history of astigmatism; myopia; Native American, East Asian, Hispanic, or Brazilian ethnic origin; eye trauma or surgery; and certain genetic and eyelid pathologies.
In most cases, the diagnosis is clinical and further diagnostic tests are usually not necessary.
Screening in the paediatric population is essential, primarily to decrease the risk of amblyopia.
Astigmatism is a refractive error characterised by a variation in the dioptric power of the eye from one meridian to another. Instead of having a spherical cross-section, the cornea and/or lens is cylindrical, with different focal power depending on the plane in which the light travels (the meridian). The meridians that have the greatest and the least dioptric power are known as the principal meridians. Astigmatism is termed regular when the principal meridians are at 90° to each other; otherwise, it is termed irregular. When astigmatism is present, the optical system is incapable of generating a clear image.
History and exam
Key diagnostic factors
- presence of risk factors
- blurred vision
Other diagnostic factors
- asthenopia (eye strain)
- distorted retinal reflex
- Munson's sign
- positive family history
- presence of myopia
- East Asian, Hispanic, Native American, or indigenous Brazilian ethnicity
- eye trauma or surgery
- genetic syndromes
- eyelid pathology
1st investigations to order
Investigations to consider
- corneal topography
- wavefront analysis technology
- anterior-segment optical coherence tomography (AS-OCT)
borderline astigmatism in patients ≥1 year old (age-dependent dioptre cutoffs)
- Examining patients with learning disabilities
- Preferred Practice Pattern guidelines: pediatric eye evaluations
- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer