Detailed knowledge of the image of the point spread function (PSF) is necessary to optimize astronomical coronagraph masks and to understand potential sources of errors in astrometric measurements. The PSF for astronomical telescopes and instruments depends not only on geometric aberrations and scalar wave diffraction but also on those wavefront errors introduced by the physical optics and the polarization properties of reflecting and transmitting surfaces within the optical system. These vector wave aberrations, called polarization aberrations, result from two sources: (1) the mirror coatings necessary to make the highly reflecting mirror surfaces, and (2) the optical prescription with its inevitable non-normal incidence of rays on reflecting surfaces. The purpose of this article is to characterize the importance of polarization aberrations, to describe the analytical tools to calculate the PSF image, and to provide the background to understand how astronomical image data may be affected. To show the order of magnitude of the effects of polarization aberrations on astronomical images, a generic astronomical telescope configuration is analyzed here by modeling a fast Cassegrain telescope followed by a single 90° deviation fold mirror. All mirrors in this example use bare aluminum reflective coatings and the illumination wavelength is 800 nm. Our findings for this example telescope are: (1) The image plane irradiance distribution is the linear superposition of four PSF images: one for each of the two orthogonal polarizations and one for each of two cross-coupled polarization terms. (2) The PSF image is brighter by 9% for one polarization component compared to its orthogonal state. (3) The PSF images for two orthogonal linearly polarization components are shifted with respect to each other, causing the PSF image for unpolarized point sources to become slightly elongated (elliptical) with a centroid separation of about 0.6 mas. This is important for both astrometry and coronagraph applications. (4) Part of the aberration is a polarization-dependent astigmatism, with a magnitude of 22 milliwaves, which enlarges the PSF image. (5) The orthogonally polarized components of unpolarized sources contain different wavefront aberrations, which differ by approximately 32 milliwaves. This implies that a wavefront correction system cannot optimally correct the aberrations for all polarizations simultaneously. (6) The polarization aberrations couple small parts of each polarization component of the light (∼10-4) into the orthogonal polarization where these components cause highly distorted secondary, or “ghost” PSF images. (7) The radius of the spatial extent of the 90% encircled energy of these two ghost PSF image is twice as large as the radius of the Airy diffraction pattern. Coronagraphs for terrestrial exoplanet science are expected to image objects 10-10, or 6 orders of magnitude less than the intensity of the instrument-induced “ghost” PSF image, which will interfere with exoplanet measurements. A polarization aberration expansion which approximates the Jones pupil of the example telescope in six polarization terms is presented in the appendix. Individual terms can be associated with particular polarization defects. The dependence of these terms on angles of incidence, numerical aperture, and the Taylor series representation of the Fresnel equations lead to algebraic relations between these parameters and the scaling of the polarization aberrations. These “design rules” applicable to the example telescope are collected in § . Currently, exoplanet coronagraph masks are designed and optimized for scalar diffraction in optical systems. Radiation from the “ghost” PSF image leaks around currently designed image plane masks. Here, we show a vector-wave or polarization optimization is recommended. These effects follow from a natural description of the optical system in terms of the Jones matrices associated with each ray path of interest. The importance of these effects varies by orders of magnitude between different optical systems, depending on the optical design and coatings selected. Some of these effects can be calibrated while others are more problematic. Polarization aberration mitigation methods and technologies to minimize these effects are discussed. These effects have important implications for high-contrast imaging, coronagraphy, and astrometry with their stringent PSF image symmetry and scattered light requirements.