# Astigmatism

- Category: chronic
- Review status: reviewed (every claim checked against a document named on this page)
- Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class FD69.00 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Subjective Refraction Technique: Astigmatic Dial - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK589695/
- Verified date: 2026-08

## Verified against

- No dose - referral pathway, no medicine given in primary care
- Astigmatism - disease-level clinical article (astigmatism-clinical.txt)

## Treatment metadata

- No drug therapy in primary care (Recognition & Referral)

## Complete treatment card

```text
ASTIGMATISM
Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class FD69.00 -
         condition scope only, no dose · No dose - referral pathway, no medicine given in primary
         care · Subjective Refraction Technique: Astigmatic Dial - StatPearls - NCBI Bookshelf -
         https://www.ncbi.nlm.nih.gov/books/NBK589695/
Review status: REVIEWED against No dose - referral pathway, no medicine given in primary care,
               Astigmatism - disease-level clinical article (astigmatism-
               clinical.txt)  (2026-08)

IS IT THIS? - reference only, to read alongside your own examination
  SYMPTOMS - what the patient reports (3)
    - Eye-strain type symptoms: headache, eye ache, heaviness and trouble focusing  [eye pain ·
      headache · inattention]
    - Blurred and reduced vision, with objects appearing stretched or elongated  [blurred vision]
    - Tendency to hold reading material very close to the eyes
  SIGNS - what you find (3)
    - Slit-lamp exam looks for lid or corneal problems behind the astigmatism, such as keratoconus
      or a corneal scar  [scarring]
    - Lens exam checks for sclerotic change, subluxation, dislocation or traumatic cataract
    - Dilated fundus exam looks for a tilted optic disc or an obliquely placed macula
  TESTS (5)
    - Visual acuity testing (Snellen or E-chart), recording uncorrected, best-corrected and pinhole
      vision
    - Retinoscopy identifies the axis and magnitude of the astigmatism and its reflex pattern
    - Keratometry or corneal topography shows differing curvature along two axes
    - Pachymetry measures corneal thickness to help plan refractive surgery
    - Astigmatic fan test and Jackson cross cylinder confirm the axis and power of correction needed
  IF NOT THIS - what else fits (1)
    - Other refractive errors: short-sightedness, long-sightedness, or age-related loss of near
      focus
  Source  StatPearls "Astigmatism" - disease-level clinical article
  Status  traced to the source above

1. NO DRUG THERAPY IN PRIMARY CARE (RECOGNITION & REFERRAL)[1st line]
   Adult    A refractive error causing blurred vision from uneven corneal/lens curvature.
            Universally common. There is nothing to prescribe; management is corrective lenses or
            refractive surgery, so the GP's role is recognising it and referring to an optometrist
            or ophthalmologist. - Refer
   Peds     Children follow the same pathway: recognise and refer. No primary-care medicine is
            implied.
   Source   No dose - referral pathway, no medicine given in primary care
   Why      A refractive error causing blurred vision from uneven corneal/lens curvature.
            Universally common. There is nothing to prescribe; management is corrective lenses or
            refractive surgery, so the GP's role is recognising it and referring to an optometrist
            or ophthalmologist.
   Caution  RED FLAG - Rapidly progressive astigmatism in a young patient (suspected keratoconus):
            assess urgently and refer.
            No medicine is prescribed for this in primary care - this entry is for recognition and
            referral. Anything given is decided by the service it is referred to.
            RED FLAG - Untreated astigmatism in childhood can cause permanent, irreversible vision
            loss (amblyopia), which makes prompt referral considerably more urgent in a child than
            in an adult.
            RED FLAG - A sudden change in vision, or eye pain or redness accompanying the visual
            complaint (which suggests a separate diagnosis): assess urgently and refer.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.
```

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