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Astigmatism

Last reviewed: 8 Apr 2025
Last updated: 21 Sep 2023

Summary

Definition

History and exam

Key diagnostic factors

  • blurred vision
Full details

Other diagnostic factors

  • asthenopia (eye strain)
  • distorted retinal reflex
  • Munson sign
Full details

Risk factors

  • positive family history
  • presence of myopia
  • Native American, African-American, East Asian, Hispanic, or indigenous Brazilian ethnicity
  • eye trauma or surgery
  • genetic syndromes
  • eyelid pathology
Full details

Diagnostic tests

1st tests to order

  • retinoscopy
Full details

Tests to consider

  • keratometry
  • corneal topography
  • wavefront analysis technology
  • anterior-segment optical coherence tomography (AS-OCT)
Full details

Treatment algorithm

ACUTE

borderline astigmatism in patients ages ≥1 year

regular astigmatism

irregular astigmatism

Contributors

Authors

Erez Bakshi, MD

Department of Ophthalmology

Assaf Harofeh Medical Center

Tel Aviv University

Israel

Disclosures

EB declares that he has no competing interests.

David Zadok, MD

Principal Investigator

Department of Ophthalmology

Assaf Harofeh Medical Center

Tel Aviv University

Israel

Disclosures

DZ declares that he has no competing interests.

Peer reviewers

Michael P. Ehrenhaus, MD

Assistant Professor of Ophthalmology

Cornea External Disease and Refractive Surgery Local Director

Long Island College Hospital Eye Center

Brooklyn

NY

Disclosures

MPE declares that he has no competing interests.

Gus Gazzard, MA, MBBChir, MD, FRCOphth

Consultant Ophthalmic Surgeon

King's College Hospital

Honorary Research Fellow

Institute of Ophthalmology

London

UK

Disclosures

GG declares that he has no competing interests.

Richard Davidson, MD

Assistant Professor

Department of Ophthalmology

Rocky Mountain Lions Eye Institute

University of Colorado Denver School of Medicine

Denver

CO

Disclosures

RD serves on the speakers bureaux for Alcan Inc and Allergan Inc. The work for these companies does not conflict with the review or nature of this topic.

Robert Chang, MD

Associate Professor of Ophthalmology

Ophthalmology Research/Clinical Trials

Stanford University

Palo Alto

CA

Disclosures

RC declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Jacobs DS, Afshari NA, Bishop RJ, et al. Refractive errors preferred practice pattern®. Ophthalmology. 2023 Mar;130(3):P1-60.Full text  Abstract

Read SA, Collins MJ, Carney LG. A review of astigmatism and its possible genesis. Clin Exp Optom. 2007 Jan;90(1):5-19. Abstract

Gwiazda J, Grice K, Held R, et al. Astigmatism and the development of myopia in children. Vision Res. 2000;40(8):1019-26. Abstract

Hutchinson AK, Morse CL, Hercinovic A, et al. Pediatric eye evaluations preferred practice pattern. Ophthalmology. 2023 Mar;130(3):P222-70.Full text  Abstract

Jacobs DS, Lee JK, Shen TT, et al. Refractive surgery preferred practice pattern®. Ophthalmology. 2023 Mar;130(3):P61-135.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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