We report the case of a 30-year-old woman with recent onset of unilateral iris distortion and glaucoma that was noticed following uneventful laser in situ keratomileusis (LASIK). The corneal endothelium in the right eye appeared normal with the slitlamp microscope, and LASIK-related anterior segment ischemia was initially considered in the differential diagnosis. However, in vivo confocal microscopy revealed abnormal endothelial cells, confirming the diagnosis of iridocorneal endothelial syndrome. In patients having refractive corneal procedures, in vivo confocal microscopy is recommended to diagnose preexisting corneal abnormalities that might otherwise remain undetected. © 2008 ASCRS and ESCRS.