Refractive surgery is now highly accepted, and has been successfully used for treatment of myopia, hyperopia, and astigmatism in adults. Anisometropia occurs because of uncorrected unequal refractive error between fellow eyes. High degrees of anisometropia cause disparity in image size between the two eyes (aniseikonia). Contact lens is an alternative treatment for anisometropia. It essentially eliminates the issue of aniseikonia for most patients, provide better quality of vision and larger visual field with improved contrast sensitivity, because of young age and coexisting ocular or medical problems, compliance with contact lens use during all waking hours is not possible. In these cases, refractive surgery may provide a better option that should not be discarded. In adults excimer laser refractive surgery has been successful. Refractive surgery in children is controversial; the major areas of concern are unstable refraction due to ongoing growth of the eye, poor cooperation and long-term implications and there are some technical difficulties. The primary goal of LASIK in older children and adolescent is resolution of sufficient myopia and astigmatism to allow spectacle correction of the residual refractive error and return to binocularity.