Aim: To report a case of bilateral post-laser in situ keratomileusis (LASIK) ectasia associated with pigmentary glaucoma (PG), in which intraocular pressure (IOP) assessment had been relentlessly underestimated by Goldmann's applanation tonometry (GAT). Materials and methods: Case report and prospective literature review. Results: The patient presented for second opinion regarding ectasia in the right eye, while ectasia was diagnosed in the left eye. Uncorrected visual acuity was 20/40 oculus dexter (OD) and 20/200 oculus sinister (OS). Distance corrected visual acuity was 20/20 in OD and 20/50 OS; GAT was 18/18 mm Hg. Slitlamp biomicroscopy was relevant for a well-positioned superior hinge cornel flap and Krukenberg's spindle in both eyes, and Fleischer's ring in the left eye. Corneal compensated IOP was 47.8 and 43.8 mm Hg in OD and OS as measured by the ocular response analyzer (ORA; Reichert, Buffalo, New York, USA). The biomechanicalcompenated (IOPb) was 62.9 mm Hg OD and unmeasured OS by Corvis ST (Oculus; Wetzlar, Germany), which also demonstrated attenuated corneal deformation OU. Pentacam confirmed corneal ectasia in both eyes, being considerably worse in OS. One day after initiation of a fixed combination of beta blocker and carbonic anhydrase inhibitor, the patient noted significant improvement of vision with reduction of IOPb to 13 and 13.5 mm Hg in OD and OS respectively. Patient referred improvement in quality of vision and there was marked reduction on corneal scatter, thickness, and curvature. Conclusion: Pigment dispersion syndrome (PDS) and PG may coexist with corneal ectasia. Careful consideration of the corneal impact on IOP assessment is mandatory when evaluation patients after laser vision correction (LVC). The IOP normalization may improve corneal ectasia in patients with coexisting glaucoma or ocular hypertension.