Corneal irregularity is a potential complication that appears as a consequence of laser refractive surgery and leads to unacceptable visual symptoms and the loss of best-corrected vision. Corneal refractive surgery changes the aberrometric pattern of the cornea, and the consequence of this is a change in the visual perception and quality of vision. To a certain extent, the neuroprocessing role of the brain is able to compensate for these changes. However, when the corneal optical dysfunction reaches high levels, such as with the loss of best-corrected vision, it frequently becomes a complication that is difficult to solve. In the current chapter, we will review this relevant complication, reviewing the most common sources of irregularity, its diagnosis, and the different surgical methods available for its correction, including customized treatments, aiming to restore an acceptable or a normal level of visual quality.