<strong>Background:</strong> Asthenopia is a common complaint amongst patients who attend eye care settings. Owing to associated discomfort or distress, asthenopia affects efficient reading and performance of near tasks.<br /><br /><strong>Purpose:</strong> To study the prevalence of asthenopia and any association with refractive errors in a clinical setting.<br /><br /><strong>Methods:</strong> In this cross-sectional practice-based study, the clinic records of 1109 school-aged children (mean age and standard deviation 14.39 ± 3.39 years) were analysed. The sample comprised 427 (38.5%) male and 682 (61.5%) female patients between the ages of 6 and 19 years. Refractive errors were classified into various types, and the association between these refractive types and symptoms in asthenopia were explored.<br /><br /><strong>Results:</strong> The most common symptom of asthenopia was headaches (40.8%), of which temporal headaches were the most frequent type (15.7%). Various symptoms were significantly associated with mainly astigmatism.<br /><br /><strong>Conclusion:</strong> Headaches were the most frequent complaint amongst patients who attended the author’s optometric practice. Astigmatism was the most frequent cause of asthenopia. Female patients were more likely than male patients to complain of asthenopia, whilst high school students were more likely than primary school children to complain of asthenopia. Further studies to relate asthenopia to binocular anomalies will be relevant in enhancing our understanding of the relationship between asthenopia and vision anomalies
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