Astigmatism

is a type of refractive error

wherein the refraction varies in the
different meridian.

Astigmatism

is a defect in which light

entering the eye is unable to be brought to
a single focus on retina resulting in blurred
vision at all distances.

 It

simply means that there is a

variation
and disturbance in the shape of the
cornea or lens. It is usually due to an
Irregularly shaped cornea*
Scarring of the cornea *
*Abnormities in the crystalline lens

**Some eyes conditions are seen along

with astigmatism as
Nystagmus
Cataract
Ptosis
Retinitis pigmentosa
Albinism
Inflammation
degeneration

Symptoms:Eye strain
discomfort
headache
dry eye
sensitivity to light
Blurred vision

Classification of astigmatism
Pathological

Physiology
regular

Irregular

compound

simple

myopic
myopic

mixed
hypermetropic

With the rule

Hypermetropic

With the rule

With the rule

With the rule

With the rule

Against the rule

Against the rule Against the rule

Against the rule

Against the rule

Type of astigmatism :there are two type of astigmatism:-

Regular astigmatism
2. Irregular astigmatism
1.

Regular astigmatism
The

astigmatism is regular when the

refractive power changes uniformly
from one meridian to another

A etiology :-

Corneal astigmatism
2. Lenticular astigmatism
3. Retinal astigmatism
1.

corneal astigmatism
it is the result of abnormality of
curvature of cornea
It is usually congenital
acquired corneal astigmatism is
often irregular

Causes
Congenital

curvature astigmatism
Keratoconous
Trauma to the cornea or lens
After cataract operation

Lenticular astigmatism
Mainly

due to

*congenital abnormality of lens

*refractive index of lens
*congenital or traumatic subluxation
of the lens

Retinal astigmatism
*Due to oblique placement of macula
* It can be corrected by visual aid

type of regular astigmatism

It is subdivided into four type ;
With-the-rule

astigmatism
Against-the-rule astigmatism
Oblique astigmatism
bi-oblique astigmatism

With-the-rule astigmatism
Refractive power of the vertical
meridian is greatest
.The vertical meridian is steepest than
horizontal meridian.
Eyes see vertical lines more sharply
than horizontal lines.
Requires concave cylinders at 180+ /20
Or convex cylinders at 90+/-20 degrees

: Against-the-rule astigmatism

the refractive power of horizontal

meridian is greatest than vertical
meridian.
Horizontal meridian is steepest than
vertical meridian.
Eyes see horizontal lines more sharply
than vertical lines.
Requires concave cylinders at 90 +/20degrees
Or convex cylinders at 180+/-20 degrees.

:Oblique astigmatism
In which the two principle meridians
lies somewhere between the axis
defining either with-the-rule or
against-the-rule astigmatism.
Complementary (45 in one
meridian,135 in other meridian)

Bi oblique astigmatism
Principle

meridian are not at right

angle
One at 30 , other at 100

optics of regular astigmatism

 Light

entering the eye cannot converge to

a point focus but form focal lines
Configuration of rays refracted from the
astigmatic surface ( sturms conoid) .
Lens with cylinder produces an astigmatic
focus .this astigmatic focus contains
vertical line ,corresponding to the focus of
the horizontal principal meridian .and
horizontal focal line corresponding to the
focus of the vertical principal meridian .

 The

region between these two lines

is known as the conoid of sturm .
At the dioptric mid point between
these two focal line , the astigmatic
focus forms a circular patch known
as circle of least confusion

a. Simple hypermetropia astigmatism

When refracted rays from one
meridian takes focus on the retina
and refracted rays from other
meridian takes focus behind the
retina.

b)Simple myopic astigmatism

When refracted rays from one
meridian takes focus on the retina
and refracted rays from other
meridian takes focus in front of
retina.

c)
Compound
hypermetropic

:astigmatism
In this condition of astigmatism refracted
rays from both meridians take focus
.behind the retina

d) Compound myopic astigmatism:

In this condition of astigmatism
refracted rays from both meridians
take focus in front of retina.
e) Mixed astigmatism: When
refracted rays from one meridian
take focus in front of retina and
refracted rays from other meridian
take focus behind the retina.

 b)

Irregular astigmatism:
Irregular differences in curvature or
refractive index of the optic
components or misalignment of any
optical component may lead to
irregularity.
It is often the result of trauma,
pterygium,
corneal scars,
and complication of refractive surgery.
Another not uncommon condition is
conical cornea (keratoconous)

Diagnostic
Objectively:

With the help of retinoscopy

Autorefractometer
Keratometer
Corneal topography
Subjectively:
By Jacksons cross cylinder
By astigmatic fan
By stenopaeic slit

management

CONSERVATIVE MANAGEMENT:

Prescription eye wear

Spherical soft contact lenses
Spherical RGP contact lenses
Toric soft contact lenses

SURGICAL MANAGEMENT
1.
2.
3.
4.
5.
6.
7.

Conventional LASIK
Astigmatic Keratotomy
Photorefractive Keratectomy
PAI LASIK
LASEK
Orthokeratology
Phakic Intraocular Lens(PIOL)

Physiological astigmatism
Almost

all have minor degree of

astigmatism {physiological }
Diameter of cornea in vertical axis is
11.5mm and in horizontal meridian is
12mm.
This means horizontal meridian is
flatter than vertical.
Because diameter is inversely
proportional to curvature.

 Occur

as lid press on anterior corneal

surface.
Make vertical meridian steeper
Only small astigmatic error
Usually 0.12D
NO TREATMENT REQUIRED,

life is an echo ,all comes back ,the

good ,the bad, the false and the
,true
so give the world the best u have and
.the best will come back to u

For Further Queries Contact :

Ms. Priyanka Singh
Head Optometry Service
Email
optometry@venueyeinstitute.org