Whether you can slow or stop astigmatism from worsening depends entirely on what is driving the change in your cornea. Some causes are behavioral and surprisingly controllable, like chronic eye rubbing. Others, like the gradual shift in corneal curvature that comes with aging, are essentially baked into your biology. The practical answer is a mix: a few high-impact habits, timely medical treatment when needed, and knowing which changes warrant a trip to the eye doctor rather than just a new prescription.
Stop Rubbing Your Eyes
If you take one thing away from this article, let it be this: habitual eye rubbing is the single most modifiable risk factor for worsening astigmatism, especially the irregular kind associated with keratoconus. The compressive and shearing forces your knuckles and fingers exert on the cornea can thin the tissue over time, and the damage scales with how hard and how often you rub.1PubMed Central. The correlation between keratoconus and eye rubbing: a review A study of patients with allergic conjunctivitis found a significant positive correlation between rubbing scores and irregular astigmatism in both eyes, reinforcing the idea that this is not a theoretical concern but a measurable, dose-dependent relationship.2Pakistan Journal of Medical & Cardiological Review. Correlation of Ocular rubbing, Tear film stability, and Irregular astigmatism in Allergic Conjunctivitis
The tricky part is that most people who rub their eyes do not realize they are doing it frequently enough to matter. It often happens at night, during allergy flare-ups, or as an unconscious stress habit. If your doctor has flagged early keratoconus or progressive astigmatism, actively monitoring and breaking the rubbing habit is one of the few things you can do that has strong evidence behind it. Some clinics now counsel patients on this as aggressively as they would counsel a smoker about quitting.
Get Allergies Under Control
Allergies and astigmatism are linked through a frustrating feedback loop. Allergic conjunctivitis causes itching, itching drives eye rubbing, and rubbing reshapes the cornea. But the connection may go deeper than just the mechanical force. Research suggests that the chronic inflammation from atopic conditions like allergies, asthma, and eczema can independently affect the corneal microenvironment through inflammatory molecules and oxidative stress, potentially making the cornea more vulnerable to structural change even without rubbing.3PubMed Central. Independent and interactive effects of eye rubbing and atopy on keratoconus
A higher proportion of keratoconus patients have a history of systemic or ocular allergy, with elevated allergen-specific antibodies compared to the general population.4PubMed Central. Relevance of IgE, allergy and eye rubbing in the pathogenesis and management of Keratoconus Research in urban schoolchildren has also shown an association between allergic conjunctivitis and astigmatism, with habitual rubbing from allergy-driven itchiness cited as a likely mechanism.5PubMed Central. Astigmatism Associated with Allergic Conjunctivitis in Urban School Children
The practical upshot: if you have seasonal or perennial allergies, treating them is not just about comfort. Antihistamine eye drops, mast cell stabilizers, and even oral allergy medications reduce the urge to rub. Cold compresses over closed lids can relieve itching without putting pressure on the cornea. If you have eczema around the eyes, managing the skin condition matters for your corneal health too, not just cosmetics.
Treat Dry Eye Before It Muddies the Picture
Dry eye disease has an underappreciated relationship with astigmatism. An unstable tear film creates an irregular optical surface on the front of the cornea, and this irregularity can mimic or exaggerate astigmatism measurements. Research has shown that treating dry eye with agents that stabilize the tear film significantly reduces the variability in both the power and the axis of corneal astigmatism readings between repeated measurements.6Springer. Effects of Rebamipide on Differences in Power and Axis of Corneal Astigmatism Between Two Intra-patient Keratometric Measurements in Dry Eyes
This matters for two reasons. First, if your astigmatism appears to be getting worse based on prescription changes, part of that shift might actually be tear film instability rather than a true structural change in the cornea. Getting dry eye treated can unmask your real baseline. Second, chronic dryness makes your eyes itchy and irritable, which circles back to rubbing. If you spend long hours at a screen, live in a dry climate, or take medications that reduce tear production, preservative-free artificial tears and good lid hygiene are worth the effort not just for comfort but potentially for corneal stability.
Corneal Cross-Linking for Progressive Keratoconus
For people whose astigmatism is worsening because of keratoconus, a progressive thinning and bulging of the cornea, corneal collagen cross-linking is the closest thing to a genuine disease-halting treatment. The procedure uses riboflavin (vitamin B2) drops and ultraviolet light to create new chemical bonds between collagen fibers in the cornea, stiffening the tissue and stopping further bulging. In the largest randomized controlled trial to date, which followed 100 eyes for three years, cross-linking not only stopped progression but slightly reversed corneal steepening, while untreated eyes continued to worsen.7PubMed Central. Corneal Collagen Cross-Linking in the Stabilization of Keratoconus
A prospective study of patients with progressive keratoconus found that at six months after cross-linking, astigmatism decreased from roughly 3.5 diopters to about 2.9 diopters, and both uncorrected and best-corrected visual acuity improved significantly, with no major complications.8JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH. Effect of Corneal Collagen Crosslinking with Riboflavin in Patients of Progressive Keratoconus: A Prospective Cohort Study Cross-linking is not a cure for keratoconus. You will likely still need glasses or contacts. But it is the first treatment that changes the natural course of the disease rather than just compensating for it. The key is timing: it works best when done early in the progression, before the cornea has thinned too severely. If your eye doctor tells you that your keratoconus is progressing, asking about cross-linking promptly is one of the most consequential decisions you can make.
What About Eye Drops for Myopia Control?
Low-dose atropine drops have become a popular treatment for slowing myopia progression in children, and parents sometimes wonder whether they help with astigmatism too. The evidence here is not encouraging. A two-year clinical trial comparing 0.02% atropine, 0.01% atropine, and a control group found that all three groups experienced a small but significant increase in ocular astigmatism over time, with no meaningful difference between the groups receiving atropine and those that did not.9PubMed Central. Effect of 0.02% and 0.01% atropine on astigmatism: a two-year clinical trial
There is even a hint that atropine might slightly increase astigmatism in the treated eye. One study found that atropine-treated eyes showed a statistically significant increase in refractive astigmatism compared to the untreated fellow eye, mainly due to changes in corneal astigmatism.10Invest. Ophthalmol. Vis. Sci. Effects of Atropine 0.01% on Refractive Errors in Myopic Children The effect was small, but it underscores that treatments designed for myopia do not automatically benefit astigmatism. If your child has both conditions, your eye doctor should be monitoring astigmatism separately rather than assuming the myopia treatment covers both.
Orthokeratology and Toric Lenses in Children
Orthokeratology, or ortho-k, involves wearing specially designed rigid contact lenses overnight that temporarily reshape the cornea. The effect wears off during the day, but while it holds, it corrects both myopia and astigmatism without daytime glasses or contacts. For children with substantial astigmatism, toric ortho-k lenses have shown striking short-term results: in one study, manifest astigmatism dropped from about 1.9 diopters to 0.4 diopters after just one month of wear.11PubMed. Toric orthokeratology for highly astigmatic children
Ortho-k also slows eye growth. Children wearing ortho-k lenses showed significantly less increase in axial length (the front-to-back measurement of the eye) compared to children wearing standard glasses over a year.12PubMed Central. Effects of Long-Term Wear and Discontinuation of Orthokeratology Lenses on the Eyeball Parameters in Children with Myopia That matters because axial elongation is a major driver of myopia, and myopia often accompanies astigmatism. However, the corneal reshaping from ortho-k is temporary. When you stop wearing the lenses, the cornea returns to its original shape. So ortho-k manages astigmatism rather than permanently stopping its progression, though slowing overall eye growth in childhood could have lasting benefits.
Scleral Lenses for Advanced Irregular Astigmatism
When astigmatism becomes highly irregular, as it does in moderate-to-advanced keratoconus, ordinary glasses and soft contact lenses cannot adequately correct vision. Scleral lenses offer a different approach. These large-diameter rigid lenses vault over the entire cornea and rest on the white part of the eye, the sclera. The space between the lens and the cornea fills with saline, creating a perfectly smooth optical surface that effectively erases the corneal irregularities underneath.13PubMed Central. Scleral lenses and PROSE: indications, complications, and future challenges
The visual results can be dramatic. In a study of 40 cases of irregular astigmatism, the average visual acuity before scleral lens fitting was roughly 20/200. After fitting, nearly half the patients achieved 20/20 vision, and three-quarters improved their acuity by at least tenfold.14Medicina ClÃnica y Social. Visual rehabilitation with scleral contact lenses in patients with irregular astigmatism A case report of bilateral advanced keratoconus demonstrated that customized scleral lenses restored 20/20 vision in both eyes while maintaining corneal health through appropriate vault and clearance.15PubMed Central. Visual Rehabilitation of Bilateral Keratoconus With Customized Scleral Lenses: A Case Report Scleral lenses do not stop astigmatism from progressing, but they can restore functional vision even in cases where other options fall short, and their fluid reservoir helps protect and hydrate the corneal surface in the process.
Age-Related Astigmatism Shifts
Even in eyes with no disease at all, astigmatism changes over the decades. In younger adults, astigmatism tends to be “with-the-rule,” meaning the cornea is steepest along the vertical axis. As you age, the cornea gradually shifts toward “against-the-rule” astigmatism, where the steepest curve moves horizontally.16Cornea. Effects of Aging on Anterior and Posterior Corneal Astigmatism This shift averages a fraction of a diopter every five years and is considered a normal part of aging.17PubMed. Changes in ocular astigmatism with age: A longitudinal study
The causes are not fully understood, but likely contributors include changes in eyelid tension, shifts in the collagen fibers of the corneal stroma, and alterations in Descemet’s membrane (a thin layer at the back of the cornea).18Cornea. Age-Related Changes in Astigmatism and Potential Causes Various upper and lower eyelid conditions, including lid masses and age-related drooping, have been shown to affect corneal shape, so changes in eyelid weight and position as you age are plausible contributors.19JAMA Ophthalmology. Effect of Upper Eyelid Surgery on Corneal Topography You cannot really prevent this age-related drift. But knowing it exists is useful because it means a gradually changing glasses prescription in middle age does not necessarily signal disease. It also means that if you are planning cataract surgery or a lens implant later in life, your surgeon needs to account for where your astigmatism is heading, not just where it is now.
Screen Time and Young Children
A growing body of research connects early childhood screen exposure to astigmatism risk, though this area of science is still young. One large cohort study found that children exposed to screens during early life had roughly double the risk of developing astigmatism compared to those without early screen exposure. The greatest risk was observed in infants exposed from birth to one year, where the adjusted prevalence ratio was about three times higher than in unexposed children.20MDPI. Screen Exposure during Early Life and the Increased Risk of Astigmatism among Preschool Children: Findings from Longhua Child Cohort Study
The mechanism is not pinned down. It could involve the sustained near-focus demands screens place on developing eyes, the reduced time spent outdoors (which is separately linked to better eye development), or some combination. This is observational data and does not prove screens cause astigmatism in the way that a randomized trial would. But for parents of very young children, the findings add another reason to follow pediatric screen-time guidelines, which already recommend avoiding screen use for children under 18 months outside of video calls.
The Genetic Piece
Astigmatism has a clear hereditary component, and genome-wide studies have identified specific gene variants that influence corneal curvature. Variants in the PDGFRA gene on chromosome 4 were identified as significantly associated with corneal astigmatism across five Asian cohorts.21PLOS Genetics. Genome-Wide Meta-Analysis of Five Asian Cohorts Identifies PDGFRA as a Susceptibility Locus for Corneal Astigmatism More recently, the gene FMNL2 has been linked to corneal astigmatism in children, with each additional risk allele increasing the predisposition to both corneal and refractive astigmatism.22PubMed Central. Gene polymorphisms associated with corneal curvature, astigmatism and its vector components in children The same FMNL2 variant showed a stronger association with corneal astigmatism in older children, suggesting that genetic effects on astigmatism may become more pronounced over time.23Scientific Reports. Genetic associations of corneal astigmatism in Hong Kong Chinese children
You obviously cannot change your genes, and there is no genetic test that will tell you whether your astigmatism will get worse. But family history matters as a practical signal. If a parent or sibling has keratoconus or high astigmatism, that is a reason to get more frequent eye exams and to be especially vigilant about the modifiable factors like rubbing and allergy management. Genetic predisposition loads the gun, but environmental and behavioral factors often pull the trigger.
How Doctors Track Progression
Knowing whether your astigmatism is truly progressing or just fluctuating is not as straightforward as comparing two prescription numbers. Modern corneal tomography can map both the front and back surfaces of the cornea in fine detail, and sophisticated software can detect early ectatic changes before they show up in a standard refraction. Researchers have found that three parameters, corneal thickness at the thinnest point, and the curvature of the front and back corneal surfaces measured from the central optical zone, can be tracked with surprisingly tight precision.24PubMed Central. Assessing progression of keratoconus: novel tomographic determinants Additionally, the back surface of the cornea can reliably distinguish keratoconic eyes from normal ones, which is useful for catching disease before it becomes obvious on standard testing.25PubMed Central. Mean Posterior Corneal Power and Astigmatism in Normal Versus Keratoconic Eyes
Why does this matter for you? If your glasses prescription keeps changing in the same direction, ask your eye doctor whether tomographic imaging is warranted. A simple refraction tells you what correction you need today; tomography tells you whether the underlying cornea is stable or quietly thinning. This distinction is especially important for younger adults, in whom keratoconus progresses fastest and where early cross-linking can prevent years of vision loss.
Laser Surgery for Stable Astigmatism
LASIK and PRK can correct astigmatism surgically by reshaping the cornea with a laser. Both procedures achieve good outcomes for high astigmatism, with LASIK showing a mild edge over PRK in head-to-head comparisons.26PubMed. LASIK versus PRK for high astigmatism The critical word here is “stable.” Laser surgery corrects your current prescription by removing corneal tissue. If the underlying cause of your astigmatism is still active, whether from keratoconus, ongoing corneal thinning, or another progressive condition, the correction can regress or the cornea can continue to distort after surgery. Most surgeons require documentation that your prescription has been stable for at least a year, and sometimes two, before considering you a candidate. And keratoconus is an absolute contraindication for standard LASIK because removing tissue from an already-thin cornea would accelerate the disease.
Connective Tissue Disorders and the Eyes
People with connective tissue conditions like Ehlers-Danlos syndrome are more likely to have visually significant refractive errors, and astigmatism is among the more commonly reported ocular findings alongside myopia.27Frontiers in Medicine. Ehlers-Danlos syndromes and their manifestations in the visual system Keratoconus itself is also associated with connective tissue abnormalities, and environmental factors like UV exposure and contact lens wear have been flagged as contributors to disease progression in susceptible individuals.28Nature Reviews Disease Primers. Keratoconus
If you have a known connective tissue disorder and also have astigmatism, the bar for proactive monitoring should be lower. Regular tomographic screening, early allergy management, and strict avoidance of eye rubbing all become more important when the structural proteins of your cornea may be inherently weaker. For these patients, even moderate UV exposure and extended soft contact lens wear may be worth discussing with a specialist, since the combination of a predisposed cornea and mechanical or environmental stressors can tip the balance toward progression faster than it would in someone without the underlying condition.