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Mohamed Karim Sidky, Dina Hosameldin Hassanein, Sherif A Eissa, Yehia M Salah, Nancy M Lotfy Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, EgyptCorrespondence: Mohamed Karim SidkyDepartment of Ophthalmology, Faculty of Medicine, Cairo University, Al-Saray Street, El Manial, Cairo 11956, EgyptTel +201 222262629Email mksidky@gmail.comPurpose: To report the prevalence of subclinical keratoconus (KC), and KC suspects, in pediatric Egyptian population with astigmatic error ≥ 2 diopters (D), with the use of CSO Sirius tomographer.Methods: A cross-sectional study that included all the children aged 6– 18 years with an astigmatic error of ≥ 2 D who attended the pediatric ophthalmology clinic for routine checkups during the period between March 2017 and December 2017 was done. All subjects underwent comprehensive ophthalmic examination, and corneal imaging using CSO Sirius instrument, a pentacam with Scheimpflug technology.Results: There were 547 subjects enrolled in our study. Mean age was 11.34 ± 3.03 (range 6– 18) years. There were 278 subjects (50.8%) between 6 and 12 years, and 269 subjects (49.2%) between 12 and 18 years. Males represented 48.4% and females represented 51.6% of patients. Among all the subjects, there were 26 (4.8%) KC patients, 24 (4.4%) KC suspects, and 497 (90.9%) were normal.Conclusion: Prevalence of subclinical KC among pediatric age group with astigmatism is relatively high, hence the importance of corneal tomography screening of children with astigmatic error ≥ 2 D.Keywords: pediatric keratoconus, subclinical keratoconus, astigmatism, Scheimpflug, Sirius, Egypt