“…1–3 The most common visual symptoms in these patients are blurred vision, photophobia, red eye, discharge, foreign body sensation, itching, or eye pain. 4,5 These symptoms influence their social interaction and personal relationships, and their daily activities and ability to work. 6–9 The most common sign is an irregular astigmatism that can be related to different diseases or conditions, such as keratoconus (KC) (see Table , Supplemental Digital Content 1 , http://links.lww.com/ICL/A260), pellucid marginal degeneration (PMD), corneal transplant or scar, corneal ectasia after refractive surgery, intracorneal stromal rings segment (ICRS), corneal trauma, severe ocular dryness, exposure keratitis, and diffuse or nodular corneal opacities, among others.…”