Since the advent of keratorefractive surgery and its rising popularity, irregular astigmatism has become an increasingly important issue for ophthalmologists and optometrists. Despite the success of LASIK and PRK, there are more and more patients experiencing visual quality problems due to the non-physiological modification of the corneal structure. Among these complications, irregular astigmatism is perhaps the most difficult to treat. Every physician who performs keratorefractive surgery understands that in reducing a patient.s refractive error, there is a possibility of creating irreversible effects on visual quality. This text is intended to help prevent and reduce the iatrogenic creation of irregular astigmatism, as well as provide effective treatment when postoperative complications do arise. With the maturation of keratorefractive technology in recent years, effective treatment for iatrogenic irregular astigmatism is quickly developing. It provides everything refractive surgeons, ophthalmologists, and optometrists need to know about this important topic.