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AIM: To evaluate the visual performance of the patients with traumatic corneal astigmatism, after the treatment of topography guided off-flap epipolis laser <i>in situ</i> keratomileusi(off-flap Epi-LASIK).<p>METHODS: This prospective clinical study was comprised of 21 eyes of 21 patients with irregular corneal astigmatism caused by trauma, they were treated by off-flap Epi-LASIK from July 2012 to December 2013. The data included uncorrected visual acuity(UCVA), best spectacle-corrected visual acuity(BSCVA), contrast sensitivity 1, 6mo before and after surgery; the healing area percentage of corneal epithelia, the healing time of corneal epithelia and pain score at 3d after surgery.<p>RESULTS: Postoperative 1mo both UCVA and BSCVA were improved significantly than that before surgery(<i>t</i>=15.703, 4.351, <i>P</i><0.05); Compared with the 1mo after surgery, UCVA at 6mo after surgery raised significantly(<i>t</i>=6.867, <i>P </i><0.05). There was no statistical significance between 6 and 1mo after surgery about BSCVA(<i>t</i>=1.497, <i>P</i>=0.140). After surgery, mean spherical equivalent(SE)was reduced from -2.43±3.02D to -0.23±0.49D(<i>P</i><0.05), and the mean cylinder was reduced from -1.86±2.23D to -0.46±1.03D(<i>P</i><0.05). Postoperative 1mo,4 kinds of spatial frequency and contrast sensitivity had no significant difference compared with the preoperative(<i>P</i>>0.05). Postoperative 6mo except the 3c/d spatial frequency, the remaining 3 spatial frequency contrast sensitivity compared with those before operation were significantly improved(<i>P</i><0.05). The healing area percentage of corneal epithelia was 92.46%±8.24%(80%-100%)at 3d after surgery; The healing time of corneal epithelia was 3.50±1.56d; Pain scores at 3 and 7d after surgery was 1.54±1.32 and 0.04±0.64, respectively.<p>CONCLUSION: Topography-guided off-flap Epi-LASIK is safe and effective in treating the patients with traumatic corneal irregular astigmatism. The operation can improve both the contrast sensitivity and the visual performance.