Corneal astigmatism, both naturally occurring and iatrogenically induced, is a commonly encountered problem. Examination of corneal topography with instruments that digitize reflected ring images and calculate corneal geometry suggests that corneal astigmatism often deviates from spherocylindrical optics; the observed topography may be highly asymmetrical about the center of the pupil. Currently used incisional procedures are limited in terms of predictability of surgical outcome. The 193 nm excimer laser can be used to alter anterior corneal curvature and flatten the cornea to correct myopia. For correction of astigmatism, a slit-opening in the laser delivery system can be used to selectively flatten the steep meridian. Early results using this procedure for correction of iatrogenically induced high corneal astigmatism are promising. A nationwide multicenter clinical trial is now underway in the United States to evaluate this technique for the correction of naturally occurring astigmatism and compound myopic astigmatism.