Background: Keratoconus is a corneal ectatic disease characterized by progressive, non-inflammatory corneal disorder, which is characterized by thinning, protrusion of central or paracentral portion of the cornea resulting in irregular astigmatism, myopia, corneal scarring and reduction in visual acuity. The onset of the keratoconus usually occurs at puberty with the progression until the third to fourth decade of the life in most of the cases. Objective: To estimate the prevalence of keratoconus in Egyptian people who have corneal astigmatism using pentacam as an imaging device. Patients and Methods: A retrospective study was done at Al-Sayed Galal University Hospital in Ophthalmology outpatient clinics. The retrieved data revealed 80 eyes of 40 patients photographed during the period from June 2019 to December 2019 by using Scheimpflug imaging device (pentacam) as screening device for keratoconus. All such cases underwent a complete ophthalmic examination that includes visual acuity measurement, refraction, slit lamp biomicroscopy, retinoscopy, fundus examination and corneal topography (pentacam). Results: Mean age of our study cases was 26.55 ± 8 years, which included 22 (55%) males and 18 (45%) females. Cases with KC have higher keratometric corneal values (k1, k2, kmax) and thinner pachymetric values than normal astigmatic eyes. Conclusion: The higher the astigmatism was the higher risk to have keratoconus. Cases with astigmatism ≥ 1.5D who present to outpatient clinics, should undergo corneal topography screening for early diagnosis of KC even if visual acuity is not affected. Pentacam may provide more accurate information about anterior and posterior corneal anatomy especially in suspected eyes.