To investigate whether there are significant changes in corneal topography during accommodation in normal corneas and corneas that are pathologically thinner due to keratoconus.A videokeratoscope was modified to present an accommodation stimulus that was coaxial with the instrument's measurement axis. Six subjects with normal corneas and four subjects with keratoconus were studied. Eighteen videokeratoscope measurements of one eye of each subject were taken at 0 diopter (D) accommodation demand and six for both of 4 D and 9 D accommodation demand. The effects of ocular micromovements on multiple topography maps were minimized using software algorithms. Average maps for the 4 D and 9 D accommodation demands were calculated and subtracted from the average map of the 0-D accommodation demand. A t test was applied at each point location within the topography maps to analyze the statistical significance of change (p < 0.001) within the difference maps.In the initial analysis, we found that a number of the subjects showed significant changes in corneal topography as accommodation changed. However, further analysis showed a significant group mean excyclotorsion of the topography maps of 1.6 +/- 1.1 degrees (p < 0.03) for the 4-D stimulus and 2.0 +/- 1.3 degrees (p < 0.01) for the 9-D stimulus compared with the 0-D stimulus. When we accounted for the excyclotorsion, we did not find clear evidence of statistically significant changes in corneal topography as a result of accommodation, either for the normal corneas or the keratoconic corneas.It appears unlikely that changes occur in central corneal shape during accommodation up to a level of 9 D in normal or keratoconic corneas. A small ocular excyclotorsion typically accompanies accommodation, and this changes the relative orientation of the topography of the cornea. This has significant implications for the interpretation of the optical characteristics of eyes during near viewing conditions.