·AIM:To evaluate the role of corneal topography in distinguishing children keratoconus from high myopic astigmatism.METHODS:This study analyzed the corneal index of twenty patients diagnosed with kerotoconus and twenty patiens diagnosed with high myopic astigmatism using TMS-4 corneal topography.RESULTS:Keratoconus group was compared with high myopic astigmatism group,the former was significantly higher than the latter in central corneal refractive power,surface asymmetry index,surface irregularity index,difference in central corneal refractive power of two eyes in same patient,and I-S(P<0.01).And statistically significiant difference was found in SimK’s Astig(P<0.05),espically differences in central corneal refractive power of two eyes and I-S were sensitive to identify.CONCLUSION:It is useful for identifying children kerotoconus and high myopic astigmatism using corneal topography to analyse index,thus we can avoid misdiagnosis of amblyopia and unnecessary training.