ASTIGMATISM

INDEX
DEFINITION
ETIOLOGY
CLASSIFICATION
STURM’S
CONOID/INTERVAL
SIGNS AND SYMPTOMS
CLINICAL TESTS
MANAGEMENT
 ASTIGMATISM

 Is refractive error wherein refraction

varies in different meridian
therefore rays of light entering eye
can not converge to a point of focus
but form focal lines
 The shape of eye ball
The shape of eye in astigmatism
ball
Classifications
Based on etiology
Based on relation between principal
meridians
Based on orientation of meridian or
axis
Based on focal points relative to the
retina
 Classification based on etiology
Axis
perpendicular
REGULAR

Curvature of
cornea

IRREGULAR Axis not

perpendicular
Regular astigmatism

DEFINITION:
The principal meridia are perpendicular i.e 90 and 180
degree

Irregular astigmatism
DEFINITION:
The principal meridia cannot be defined
E.g. Keratoconus, Corneal scars
 Regular astigmatism
The refractive power changes regularly from one meridian
to the other

Aetiology
Corneal – curvatural abnormalities

Lenticular
- Curvatural: congenital abnormalities in curvature
- Positional: d/t tilting or oblique placement of the lens
- Index : DM and cataract
Types of Regular astigmatism

• With-the-rule astigmatism
• Against-the-rule astigmatism
• Oblique astigmatism
• Bi-oblique astigmatism
 With the rule astigmatism
• Vertical meridian is steeper than horizontal
meridian

• Eyes see vertical lines more sharply than

horizontal lines

• Requires concave cylinders at 180ͦ+ /- 20

• Or convex cylinders at 90ͦ +/- 20

 Against the rule astigmatism
• Horizontal meridian is steeper than
vertical meridian

• Eyes see horizontal lines more

sharply than vertical lines

• Requires concave cylinders at 90

deg+/-20 deg

• Or convex cylinders at 180 deg+/-20

deg
 Oblique astigmatism

• Two principle meridians lies

somewhere between the axis
defining either with-the-rule or
against-the-rule astigmatism

• Complementary (45 deg in one

meridian,135 deg other meridian)
Bi-oblique astigmatism

• Principle meridia are not at right

angle

• One at 30 degree &other At 100degree

 STURM’S CONOID

• Parallel rays of light are not brought to focus on a point

but form focal lines

• Configuration of rays refracted from an astigmatic

surface– STURM’S CONOID

• Distance between to focal lines– focal interval of

Sturm
(measures the degree of astigmatism)
Focal interval of Sturm :- Distance
between 2 focal lines

• Circle of least diffusion

At the dioptric mean of focal lines
the cross section of sturms conoid
appears as circular patch of light rays –
best overall focus
• Based on focus of the principal meridians

• Simple astigmatism
– Simple hyperopic astigmatism
– Simple myopic astigmatism
• Compound astigmatism
– Compound hyperopic astigmatism
– Compound myopic astigmatism
• Mixed astigmatism
• Simple
Rays are focused on retina in one meridian or
either in front or behind in the other.
 Simple Myopic Astigmatism

 When one of the principal meridians is focused in front of

the retina and the other is focused on the retina (with
accommodation relaxed)
 Simple Hyperopic Astigmatism

 When one of the principal meridians is focused

behind the retina and the other is focused on the
retina (with accommodation relaxed)
• Compound
Rays of light in both meridia are focused either
in front or behind the retina.
 Compound Myopic Astigmatism

 When both principal meridians are focused in

front of the retina (with accommodation relaxed)
Compound Hyperopic Astigmatism
 When both principal meridians are
focused behind the retina (with
accommodation relaxed)
• Mixed
Light rays in one meridian are focused in front and in
the other meridian behind the retina.
 SYMPTOMS
• Includes tiredness of eyes
• Headache(mild frontal ache to violent explosions of
pain)
• Dizziness
• Irritability, fatigue
• Symptoms more common in patients with
Low astigmatism
Hypermetropic astigmatism
• Tilting of head- to reduce image distortion.

• Half closure of lids – high astigmatism in

an effort to make a stenopaeic slit

• Rubbing of eyes, hyperaemia of lid margin

Most Astigmatic Corneas have 2 curves, steeper and flatter curves

Light focus on more than one point

in eye

Cause blurring of vision

Distorted
vision
 INVESTIGATION
S
• Visual acuity tests – distance and near vision
• Autorefraction-Used to measure degree of
refractive erroe in the eye
• Keratometry
• Retinoscopy
– Most reliable source of information for cylinder power
and axis
• Monocular subjective refraction
– Astigmatic fan test
– Jackson cross cylinder
– Computerised corneal topography
 Retinoscopy
It is a technique to obtain an objective
measurement of the refractive error of a
patient's eyes. The examiner uses
a retinoscope to shine light into the
patient's eye and observes the reflection
(reflex) off the patient's retina.

Shows different power in different

meridians.
 KERATOMETE
R
Keratometry works on the principle of recording
the image size reflected from a known-sized object.
Given the object size and distance from image to
object, the radius of curvature of the cornea can be
calculated.

• It shows different corneal

curvature in different
meridians
JACKSON’S CROSS CYLINDER
TEST
It is a combination of two cylinders of
equal strength but with opposite sign
placed with their axis at right angles to
each other and mounted in a handle.
COMPUTERISED CORNEAL
TOPOGRAPHY

• Corneal topography system or

videokeratography implies
computerised video assisted
technique

• It provides detailed information

about shape of corneal surface
Astigmatic fan test(Maddox V test)
• The patient is asked to look at
the figure and if any of the line
is more distinct than the other
then astigmatism is present.
• Rotating the V slightly to the
direction of the blacker limb an
intermediate position is reached
when the two limbs of V are
equally distinct. This gives the
direction at right angles
to the exact axis of the
correcting cylinder.
 PLACIDO DISC TEST
-Placido's disc test
reveals distorted
circles
 Treatment Options
 Spectacles
 Cylindrical lenses in spectacles

 Contact lens
 Toric soft contact lenses
 rigid gas permeable contact lenses

 Refractive surgery
 Photorefractive keratectomy (PRK)
 Laser in-situ keratomileusis (LASIK)
 CONTACT LENSES

• Toric soft contact lenses

Soft lenses are more comfortable to wear

,easy to fit, adhere more tightly to cornea .
REFRACTIVE
SURGERIES
 Astigmatic keratotomy-4 to 6 D

 Photoastigmatic refractive keratotomy

 Limbal relaxing incisions-up to 2 D

 LASIK
 ASTIGMATIC KERATOTOMY

• Arcuate keratotomy incisions are

placed in the cornea at 7mm
optical zone) to the steepest
corneal meridia.

• Can correct upto 4-6D of

astigmatism.
Limbal relaxing incisions

• Incision is given at the

limbus

• Correct -1 to -2D of
astigmatism.
 Laser based corneal refractive
procedure
• Photo refractive keratotomy
• uses cylindrical photoablation pattern.)
—can correct upto 3D of astigmatism
• Astigmatic LASIK
• can correct upto 5D
• Wavefront-guided and wavefront-
optimised LASIK
– -10 to -12D of Myopic astigmatism
– +6D of hyperopic astigmatism and
– +5D of mixed astigmatism
 Irregular astigmatism
• Characterized by an irregular change of refractive power
in different meridia

Etiological types
1. Corneal irregular astigmatism – corneal scars
or keratoconus.

2. Lenticular irregular astigmatism

3. Retinal irregular astigmatism – due to distortion of

the macular area
Symptoms:
Defective vision , distortion of objects and polyopia.

Treatment
• Optical – contact lenses
• Surgical – PRK
 QUESTIONS
Ultra Short notes
 1.Define astigmatism
 2.Types of astigmatism
 3.Difference between regular and irregular astigmatism
 4.Type of astigmatism seen in keratoconus
 5.What type of astigmatism seen in conventional ECCE

Short notes
 1.classify astigmatism
 2.sturm’s conoid
 3..investigations of astigmatism
 4.surgical correction of astigmatism
 5.short notes on contact lens
 Medal exam questions

1.How to prevent astigmatism following various types of cataract surgery

2.How to manage the post operative astigmatism following different types of cataract surgery
 THANK YOU