Strongly anisotropic critical systems are considered in a ddimensional film geometry.Such systems involve two (or more) distinct correlation lengths ξ β and ξα that scale as nontrivial powers of each other, i.e. ξα ∼ ξ θ β with anisotropy index θ = 1. Thus two fundamental orientations, perpendicular (⊥) and parallel ( ), for which the surface normal is oriented along an α-and β-direction, respectively, must be distinguished. The confinement of critical fluctuations caused by the film's boundary planes is shown to induce effective forces F C that decay as F C ∝ −(∂/∂L)∆ ⊥, L −ζ ⊥, as the film thickness L becomes large, where the proportionality constants involve nonuniversal amplitudes. The decay exponents ζ ⊥, and the Casimir amplitudes ∆ ⊥, are universal but depend on the type of orientation. To corroborate these findings, n-vector models with an m-axial bulk Lifshitz point are investigated by means of RG methods below the upper critical dimension d * (m) = 4 + m/2 under periodic boundary conditions (PBC) and free BC of an asymptotic form pertaining to the respective ordinary surface transitions. The exponents ζ ⊥, are determined, and explicit results to one-or two-loop order are presented for several Casimir amplitudes ∆ BC ⊥, . The large-n limits of the Casimir amplitudes ∆ BC /n for periodic and Dirichlet BC are shown to be proportional to their critical-point analogues at dimension d−m/2. The limiting values ∆ PBC ,⊥,∞ = limn→∞ ∆ PBC ,⊥ /n are determined exactly for the uniaxial cases (d, m) = (3, 1) under periodic BC. Unlike ∆ PBC ,∞ , the amplitude ∆ PBC ⊥,∞ is positive, so that the corresponding Casimir force is repulsive.