The advent of modern cataract surgery, has led to quick visual recovery owing to a reduced risk of surgically induced astigmatism (SIA) and the possibility of correcting pre-existing astigmatism (PEA). After surgery, most patients expect to see clearly without spectacles and surgeons should be able to achieve this goal. The surgical approach to phacoemulsification should involve choosing between the available techniques to correct PEA and deciding upon the best incision site to achieve the optimal outcome in post-operative astigmatism. Approximately 80% of patients have 1.5 D or less PEA, which can be reduced by an incision at the steep axis or with opposite clear cornea incisions (OCCIs). Around 15% to 20% of cataract patients have more than 1.50 D of astigmatism (corneal, refractive or both) and are possible candidates for incisional surgery astigmatic keratotomy (AK), limbal relaxing incisions (LRIs) or peripheral corneal relaxing incisions (PCRIs), full-arc, depth-dependent astigmatic keratotomy (FDAK) or toric IOL implantation. In patients with corneal ectasic disorders, the insertion of intra-corneal ring segments (ICRS) followed by cataract surgery could be considered. The goal for astigmatism control may be a postoperative cylinder of less than 0.75 D at any axis. With this degree of astigmatism, most patients have the benefit of good uncorrected visual acuity. Some studies suggest a benefit of leaving some amount of residual against-the-rule astigmatism, so that unaided near vision is improved.